What is hepatocellular carcinoma (HCC)?

Written by: Mr Satyajit Bhattacharya
Published: | Updated: 01/08/2023
Edited by: Bronwen Griffiths

Primary liver cancer is cancer that starts in the liver. Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. Mr Satyajit Bhattacharya, a leading surgeon and liver cancer expert, explains what HCC is and how it is diagnosed and treated.

What is HCC?

The liver is made up of different types of cells, including liver cells (hepatocytes) and the cells that form bile ducts and blood vessels, and many more. Every type of cell in the liver has the potential to give rise to cancerous growths. Hepatocellular carcinoma (HCC) is cancer of the liver cells (hepatocytes). More than one tumour nodule can present within the liver, which is thought to be because one tumour spreads within the liver via the blood vessels. Once the tumour cells get into the blood stream, HCC can spread to the rest of the body. Tumour cells can also travel via the lymph vessels to the lymph glands underneath the liver.

What causes HCC?

HCC is most common in people with cirrhosis of the liver, however, it can also develop in people with healthy livers. Cirrhosis from various causes increases the risk of developing HCC, however, those with Hepatitis B and C are most at risk. Hence, HCC is most common in parts of the world where Hepatitis B and C are prevalent, including sub-Saharan Africa.

What symptoms does HCC cause?

HCC can be symptomless initially, with symptoms appearing in more advanced stages. The following can result:

In some cases a lump or the enlarged liver can be felt in the right hand side of the abdomen. In advanced stages, ascites can form (collections of fluid in the abdomen).


How is HCC diagnosed?


A diagnosis can be made with an ultrasound scan, which is confirmed with a CT scan. If there is any confusion about a diagnosis, an MRI scan, liver angiography and bone scan may be performed too. Blood can also be checked for Alpha Foeto Protein (AFP) levels as raised levels can indicate HCC, however, sometimes normal AFP levels can be found in patients with HCC, so it is not a reliable diagnosis method and will only be carried out in situations where it is necessary. Patients with cirrhosis or chronic Hepatitis B and C are surveyed regularly with ultrasound scans which often pick up early stage HCC.

What is the treatment for HCC?


Treatment for HCC depends on:

  1. Tumour stage (number of nodules present, their size and location and whether they have spread to other organs, bones or lymph nodes)
  2. Condition of the liver (whether it is healthy or if it has cirrhosis)
  3. Age and fitness of the patient

In an otherwise healthy patient, the tumour can safely be surgically removed. If the tumour is large and cannot be removed safely, chemoembolization (TACE) can be considered which involves injecting anti-cancer drugs or radioactive substances into the artery that feeds the cancerous part of the liver. If the tumour is small, but the patient is either unfit or unwilling to go through surgery, then radiofrequency ablation (RFA) can be considered. This involves placing a needle into the tumour and destroying it with energy generated at the tip of the needle.

In otherwise healthy patients with a slightly disease liver, if the tumour is small then liver transplantation should be considered.

If the patient is not fit for surgery, and their liver is badly diseased or the tumour is large and has spread beyond the liver, then the focus of treatment should be controlling the symptoms. Chemotherapy (in the form of intravenous injections or tablets taken by mouth) is not hugely effective in HCC, nor is external beam radiation. Any new treatments offered to such patients should be within the context of a proper clinical trial.


If you would like to find out more, make an appointment with a specialist.

By Mr Satyajit Bhattacharya

Mr Satyajit Bhattacharya is a highly-respected and award-winning consultant surgeon based in London who specialises in gallbladder surgery, pancreas surgery and pancreatitis, alongside liver surgery, liver cancer and pancreatic cancer.  He privately practises at The London Clinic while his NHS base is Barts Health NHS Trust where he is clinical lead for the multi-disciplinary team for liver and pancreas cancer in north-east London.

Mr Bhattacharya originally trained in Mumbai, qualifying as a doctor from the Grant Medical College. He went onto train in specialist surgery of the liver, pancreas and bile ducts at the Royal Free and University College Hospitals, London, and was a visiting fellow at the University of Minnesota with a grant received from the King's Fund.      

Also currently working at a number of prestigious hospitals including the Royal London and St Bartholomew's Hospital and the King Edward VII Hospital, Mr Bhattacharya has raised large sums of money for pancreatic research. This has helped to run several research projects at Barts Health NHS Trust.

He has published over 50 scientific papers, authored numerous book chapters, and is a member of prestigious boards and societies in his field. These include the International Hepato-Pancreato Billiary Association (IHPBA) and the British Association for the Study of the Liver (BASL). He is a also a member of the Intercollegiate Examinations Faculty of the Royal College of Surgeons (RCS), where he active in postgraduate teaching.  

Other achievements that Mr Bhattacharya is noted for was being named one of Britain's best consultants by Tatler magazine in 2013. Furthermore, he was the Serjeant Surgeon (Surgeon to the Queen) in the Royal Household and has now been conferred from LVO (Lieutenant of the Victorian Order) to CVO (Commander of the Victorian Order) on the King's 2023 Birthday Honours List. 

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