Liver Cancer (Hepatocellular Carcinoma)
The most common form of liver cancer, almost always arising in cirrhosis or chronic hepatitis B. Surveillance with ultrasound every 6 months in at-risk patients catches it early — when cure is possible.
Category
Serious
Red flags
2
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Hepatocellular carcinoma (HCC) is cancer arising from liver cells. Unlike most cancers, it usually develops on a background of chronic liver disease — cirrhosis from any cause, or chronic hepatitis B even without cirrhosis. Treatment depends on the stage at diagnosis.
How common is it?
Rising in Saudi Arabia, mainly due to MASLD-related cirrhosis and chronic hepatitis B. The 6th most common cancer globally and the 3rd leading cause of cancer death.
Why does it happen?
Risk factors: cirrhosis (any cause), chronic hepatitis B (even without cirrhosis), heavy alcohol use, MASLD/MASH, aflatoxin exposure (contaminated grains/nuts), family history.
Symptoms
- Often silent until late stages — why surveillance is critical
- New abdominal pain or fullness
- Unintentional weight loss
- Worsening of cirrhosis (new ascites, jaundice)
- Fatigue
Red flags — seek urgent medical care
Sudden severe abdominal pain in a patient with cirrhosis
Possible tumor rupture — emergency.
Rising AFP on surveillance
Triggers detailed imaging to look for HCC.
How is it diagnosed?
Surveillance: liver ultrasound + AFP every 6 months in at-risk patients (cirrhosis, chronic hepatitis B). Suspicious lesion → triple-phase CT or MRI with contrast — radiologic features alone often diagnose HCC without biopsy. Biopsy if imaging is uncertain.
What the latest science says
Multiple new immunotherapy and targeted therapies in the past 5 years (atezolizumab + bevacizumab, tremelimumab + durvalumab, lenvatinib, regorafenib, cabozantinib). Survival in advanced HCC has improved substantially.
Outlook — what to expect
When found small (<3 cm) on surveillance: 5-year survival >70% with curative treatment. When found late: median survival ~6-12 months but improving with new immunotherapy. Surveillance is the single most important factor.
Treatment
Habits & Lifestyle
Prevention is best — and surveillance saves lives.
- Get surveillance ultrasound + AFP every 6 months if you have cirrhosis or chronic hepatitis B.
- Treat underlying liver disease aggressively.
- Stop alcohol completely.
- Vaccinate against hepatitis A and B.
- Avoid moldy nuts and grains (aflatoxin).
Diet
Mediterranean diet plus underlying disease management.
- Mediterranean pattern, no alcohol.
- Coffee 3-4 cups daily — modestly protective.
Medications
Treatment depends on stage — discussed at multidisciplinary tumor board.
- First-line systemic for advanced HCC: atezolizumab + bevacizumab, or tremelimumab + durvalumab.
- Tyrosine kinase inhibitors: lenvatinib, sorafenib (older first-line), regorafenib, cabozantinib (later lines).
- Treat underlying hepatitis to slow tumor recurrence.
Procedures & Surgery
Curative treatments for early-stage disease.
- Surgical resection — for solitary tumors with good liver function.
- Liver transplantation — best curative option for early HCC in cirrhosis (within Milan criteria).
- Local ablation (radiofrequency, microwave) — for small tumors not suitable for surgery.
- TACE (transarterial chemoembolization) — for intermediate stage.
- Y-90 radioembolization — emerging option.
- Surveillance ultrasound + AFP every 6 months.
In the Saudi context
Saudi tertiary centers offer all standard HCC treatments including transplantation, TACE, and Y-90. Tumor boards are standard. MOH covers most treatments; some immunotherapies require pre-authorization.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- What stage is my HCC?
- Am I a candidate for transplantation?
- Should I get systemic immunotherapy?
Medically reviewed by: SGA Hepatology Panel · Last reviewed 24/04/2026