Liver Cancer

Primary liver cancer — most commonly hepatocellular carcinoma (HCC) — almost always arises on a background of chronic liver disease: hepatitis B, hepatitis C, alcohol, or non-alcoholic fatty liver disease that has progressed to cirrhosis. Liver cancer is rising in India as these underlying conditions rise. The key to survival is catching it small, on surveillance.

Symptoms (often late)

• Right-upper abdominal pain or mass.
• Unexplained weight loss, loss of appetite.
• Jaundice, dark urine.
• Swelling of the abdomen (ascites), legs.
• Fatigue.
• Early HCC is usually silent — which is why surveillance in at-risk people matters.

Who should have surveillance

• Anyone with cirrhosis — of any cause.
• Chronic hepatitis B — especially with family history of liver cancer, male over 40, female over 50, African or Asian high-risk groups.
• Every 6 months — ultrasound + AFP (alpha-fetoprotein) blood test.
• Treating the underlying disease is as important — hepatitis B antivirals, hepatitis C cure, alcohol cessation, weight loss for fatty liver.

Diagnosis

In cirrhosis, a characteristic pattern on 4-phase contrast CT or MRI can establish HCC without biopsy. AFP helps support. Biopsy is done when imaging is indeterminate.

Treatment

• Surgical resection — for early HCC with good liver function.
• Liver transplantation — for select HCC within specific criteria; curative; available at several Indian centres.
• Ablation (radiofrequency or microwave) — for small tumours.
• Transarterial chemoembolisation (TACE) / radioembolisation — intermediate disease.
• Systemic therapy — targeted drugs (tyrosine-kinase inhibitors) and immune checkpoint inhibitors for advanced disease.
• Palliative care — symptom control, pain, ascites, nutrition — important from early on.

Prevention — achievable

• Hepatitis B vaccine — part of UIP for infants; adults should catch up.
• Treat chronic hepatitis B; cure chronic hepatitis C — transformative; available through Indian government programmes at low cost.
• Stop alcohol — especially with any other liver condition.
• Treat fatty liver — weight loss, diabetes control.
• Avoid aflatoxin-contaminated food (visibly mouldy groundnuts, maize) — stored in damp conditions.