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Health condition · Clinically reviewed

Liver cancer (HCC), hepatocellular carcinoma — surveillance, staging and modern systemic therapy.

Hepatocellular carcinoma usually arises in cirrhotic livers. Six-monthly surveillance in cirrhosis catches it early; modern systemic therapy (atezolizumab + bevacizumab) has transformed advanced-disease outcomes.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced, not summarised

    Every claim is checked against NICE, BASL, EASL or a peer-reviewed source you can see at the end.

  • 03

    Updated for 2026

    Reflects current UK guidance on cirrhosis surveillance, LI-RADS reporting, BCLC staging and modern immunotherapy.

Key facts

Liver cancer (HCC) at a glance.

The essentials, in plain English — what it is, who’s at risk, how it’s found early and how modern treatment is chosen.

  • What it is

    Primary hepatocellular carcinoma — the commonest primary cancer arising from the liver cells themselves.

  • Biggest risk factor

    Cirrhosis of any cause — viral hepatitis (B and C), alcohol-related liver disease and MASLD.

  • How common

    Around 6,200 new cases each year in the UK, with incidence rising alongside MASLD.

  • Surveillance

    Six-monthly ultrasound and AFP in cirrhosis — the single most important way to catch HCC early.

  • Staging

    BCLC (Barcelona Clinic Liver Cancer) staging drives treatment — from resection to systemic therapy.

  • First-line advanced

    Atezolizumab + bevacizumab is the standard first-line systemic therapy for advanced HCC.

Why this guide matters

Surveillance changes outcomes.

HCC is one of the few cancers where a simple, six-monthly scan really does change what happens next — and modern immunotherapy has transformed advanced-disease care.

  • Cirrhosis is the biggest risk factor

    Viral hepatitis, alcohol and MASLD all drive cirrhosis — and cirrhosis drives HCC.

  • Six-monthly surveillance catches it early

    Ultrasound and AFP every six months in cirrhosis picks up curable tumours before symptoms appear.

  • BCLC staging drives treatment

    The Barcelona Clinic Liver Cancer stage combines tumour and liver function to guide the right modern therapy.

How the diagnosis is made

From surveillance scan to a clear plan.

The LI-RADS and BCLC-driven pathway UK hepatology and HPB teams now follow, in order — so you know what to expect and why.

  1. 01

    Assessing

    Symptom + liver disease history

    A careful history — cirrhosis, viral hepatitis, alcohol, MASLD — sets the pre-test probability from the start.

  2. 02

    Assessing

    Serum AFP in context

    Alpha-fetoprotein is interpreted alongside imaging and cirrhosis status — never a screening test on its own.

  3. 03

    Assessing

    Ultrasound + AFP surveillance

    People with cirrhosis are offered a liver ultrasound with AFP every six months to catch HCC early.

  4. 04

    Confirming

    Multiphase CT / MRI (LI-RADS)

    A dedicated four-phase CT or MRI, reported using LI-RADS, characterises any suspicious liver nodule.

  5. 05

    Confirming

    Biopsy if imaging inconclusive

    A targeted biopsy is done when imaging cannot confirm HCC — many lesions are diagnosed on imaging alone.

  6. 06

    Planning

    Child-Pugh + BCLC staging

    Liver function (Child-Pugh) and tumour burden are combined into the BCLC stage that drives treatment.

  7. 07

    Planning

    HPB / liver MDT

    A specialist hepato-pancreato-biliary multi-disciplinary team recommends the best treatment path for you.

Typical timeline: 4–8 weeks from suspicious surveillance scan to a treatment plan.

Symptoms

What liver cancer actually shows up as.

Early HCC is usually silent — that’s why surveillance matters. When symptoms do appear, they often reflect the underlying cirrhosis as much as the tumour.

  • Asymptomatic

    Most early HCC is picked up on surveillance imaging in someone with cirrhosis — with no symptoms at all.

  • Right upper quadrant pain

    A dull ache or heaviness under the right ribs can be the first sign of a growing liver lesion.

  • Jaundice

    Yellow skin or eyes may reflect worsening liver function or tumour blocking the bile ducts.

  • Weight loss

    Unexplained weight loss, poor appetite and fatigue are common as HCC progresses.

  • Ascites

    New or worsening abdominal swelling from fluid often signals decompensation of the underlying cirrhosis.

  • Hepatic encephalopathy

    Confusion, drowsiness or personality change can develop when the liver can no longer clear toxins.

  • Variceal bleed

    Vomiting blood or passing black stools in liver disease is a medical emergency — always call 999.

  • Red flag

    Variceal bleed, new encephalopathy or hepatorenal syndrome — call 999 or attend A&E immediately.

Treatment

How liver cancer is treated in the UK.

Treatment is chosen by BCLC stage and liver function — from curative resection or ablation, to locoregional TACE and SIRT, to modern immunotherapy combinations.

  • Surgical resection

    Removal of the tumour — best for solitary lesions in a well-preserved, non-cirrhotic or Child-Pugh A liver.

  • Radiofrequency / microwave ablation

    Image-guided thermal destruction of small tumours — a good option for early-stage HCC not fit for surgery.

  • Transarterial chemoembolisation (TACE)

    Chemotherapy delivered through the tumour’s blood supply, then blocked — the mainstay for intermediate BCLC B disease.

  • Selective internal radiotherapy (SIRT / TARE)

    Radioactive yttrium-90 beads delivered directly into the tumour via its arterial supply.

  • Atezolizumab + bevacizumab

    First-line systemic therapy for advanced HCC — immunotherapy plus anti-angiogenic, transforming outcomes.

  • Tremelimumab + durvalumab

    Dual immunotherapy (STRIDE regimen) — an alternative first-line option in advanced disease.

  • Sorafenib / lenvatinib

    Oral tyrosine kinase inhibitors — used where immunotherapy is unsuitable or in specific clinical scenarios.

  • Liver transplantation

    Curative for early HCC in cirrhosis meeting Milan or extended UCSF criteria — treats both cancer and liver disease.

What this guide is based on

The sources behind every number on this page.

UK and European hepatology and oncology guidance, specialist society standards and patient-organisation resources, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your hepatology or HPB team knows your history and can tell you which parts apply to you.

  • National Institute for Health and Care Excellence (NICE). Hepatocellular carcinoma recommendations and technology appraisals.

  • British Association for the Study of the Liver (BASL). Position statements on HCC surveillance and management.

  • European Association for the Study of the Liver (EASL). Clinical practice guidelines on the management of hepatocellular carcinoma.

  • British Liver Trust. Patient information on liver cancer, cirrhosis and surveillance.

Red flags

When liver cancer becomes an emergency.

Cirrhosis and HCC together can decompensate quickly. These are the situations where you should not wait — act today.

  • Variceal bleed

    Vomiting fresh blood or passing black tarry stools in liver disease — call 999 immediately.

  • Hepatic encephalopathy

    New confusion, drowsiness or altered behaviour needs same-day assessment — do not drive.

  • Ascites decompensation

    Rapidly worsening abdominal swelling, breathlessness or fever suggests spontaneous bacterial peritonitis — urgent care.

  • Hepatorenal syndrome

    Reduced urine output with rising creatinine in advanced liver disease is a medical emergency.

  • Post-TACE liver failure

    Deepening jaundice, fever or confusion after chemoembolisation needs urgent hepatology review.

  • Post-transplant rejection / infection

    Fever, graft tenderness or deranged bloods after a liver transplant — contact your transplant team same day.

  • Immunotherapy hepatitis

    New rise in liver enzymes on atezolizumab or durvalumab may reflect immune-related hepatitis — stop and review.

  • Portal vein thrombosis with tumour

    Sudden abdominal pain and worsening liver function may reflect tumour extending into the portal vein.

  • Palliative-stage crisis

    Uncontrolled pain, bleeding or breathlessness in advanced HCC — contact your palliative care team urgently.

Living with it

A long-term journey, with structured support.

Four things that make the biggest difference day to day — surveillance, treating the underlying liver disease, side-effect awareness and specialist follow-up.

A quiet reminder

Never miss a surveillance scan.

Six-monthly ultrasound and AFP in cirrhosis is the single most powerful thing you can do to catch HCC while it’s still curable.

  1. 01 Monitoring

    Surveillance is what saves lives

    If you have cirrhosis, a six-monthly ultrasound and AFP is the single most important thing you can do.

  2. 02 Liver health

    Treat the underlying disease

    Antivirals for hepatitis B and C, alcohol support and MASLD management all reduce future HCC risk.

  3. 03 Side effects

    Know your immunotherapy warning signs

    Immune-related side effects can hit any organ — new rashes, diarrhoea or fatigue deserve prompt review.

  4. 04 Reviews

    Structured HPB follow-up

    Regular imaging, AFP and liver function checks keep both the cancer and the cirrhosis on track.

Frequently asked

Everything we get asked about liver cancer.

Quick answers on surveillance, AFP, BCLC staging, immunotherapy and when to worry.

  • What is hepatocellular carcinoma (HCC)?

    HCC is the commonest primary liver cancer — a cancer arising from the hepatocytes, the main working cells of the liver. It almost always develops on a background of chronic liver disease, especially cirrhosis.

  • Who should have liver cancer surveillance?

    Anyone with cirrhosis of any cause is offered six-monthly liver ultrasound with AFP. Some people with chronic hepatitis B without cirrhosis are also offered surveillance based on age and other risk factors.

  • Is AFP a reliable screening test on its own?

    No. Alpha-fetoprotein can be normal in HCC and raised in other liver conditions. It is used alongside ultrasound and cross-sectional imaging, not as a standalone screen.

  • What is BCLC staging?

    The Barcelona Clinic Liver Cancer (BCLC) system combines tumour burden, liver function (Child-Pugh) and performance status into stages 0, A, B, C and D. It is the standard framework that guides HCC treatment decisions.

  • What is atezolizumab plus bevacizumab?

    It is the current first-line systemic therapy for advanced HCC in the UK — an immune-checkpoint inhibitor combined with an anti-angiogenic antibody. It has significantly improved survival compared with older sorafenib-based treatment.

  • When should I worry about symptoms?

    Vomiting blood, black tarry stools, new confusion, rapidly worsening abdominal swelling or reduced urine output in liver disease all need urgent assessment. Call 999 for a suspected variceal bleed or acute encephalopathy.

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