Cancer Types
Common cancer types: symptoms, diagnostic methods and current treatment options.
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Liver Cancer (Hepatocellular Carcinoma): Symptoms, Diagnosis and Treatment
Sources reviewed by: Assoc. Prof. Dr. Ali OğulLast updated: October 2026
Liver cancer (HCC) symptoms, diagnosis, BCLC staging, local treatments, immunotherapy and targeted drugs. Medical oncology assessment in Mersin.
Key information
| Definition | A malignant tumour arising from liver cells (hepatocellular carcinoma, HCC) |
|---|---|
| Main risks | Chronic hepatitis B and C, cirrhosis, alcohol, fatty liver disease |
| Common symptoms | Upper right abdominal pain, weight loss, jaundice, fluid in the abdomen |
| Diagnosis | Contrast-enhanced CT or MRI, AFP, biopsy when needed |
| Treatment | Surgery, transplantation, local treatments, immunotherapy, targeted drugs |
What is liver cancer?
Liver cancer usually refers to hepatocellular carcinoma (HCC), which arises from liver cells. Tumours that spread to the liver from other organs (liver metastases) are a different disease, and their treatment is planned according to the original cancer. In most patients HCC develops on a background of cirrhosis caused by chronic hepatitis B or C, alcohol or fatty liver disease; treatment decisions therefore take into account both the tumour and the remaining function of the liver [1][2].
Risk factors
The main risk factors are chronic hepatitis B and C infection, cirrhosis, long-term alcohol use, metabolic dysfunction-associated steatotic liver disease (MASLD), diabetes, obesity and aflatoxin exposure. Hepatitis B vaccination and treatment of hepatitis reduce the risk [2][3].
What are the symptoms?
In the early stage it often causes no symptoms. As it progresses, pain or fullness in the upper right abdomen, loss of appetite, weight loss, fatigue, jaundice, fluid in the abdomen (ascites) and worsening signs of cirrhosis may occur. People with cirrhosis or chronic hepatitis B carriage are advised to have an ultrasound twice a year (with AFP when needed) [1][2].
Most of these complaints can also be caused by other conditions; complaints that persist or get worse need to be assessed by a doctor.
How is it diagnosed?
Multiphase contrast-enhanced CT or dynamic MRI is the main diagnostic method; in a cirrhotic liver, typical imaging findings (LI-RADS) may be sufficient for diagnosis. If imaging is not typical or there is no cirrhosis, a biopsy is performed. AFP level, liver function tests, the Child-Pugh score and the patient’s general condition (ECOG) are needed for treatment planning [1][2].
Staging
The Barcelona Clinic Liver Cancer (BCLC) system is the most widely used in practice. It assesses tumour burden, liver function and general condition together, defines very early (0), early (A), intermediate (B), advanced (C) and terminal (D) stages, and sets out the recommended treatment approach for each stage [1][4].
Treatment options
- Surgery and transplantation: Liver resection in suitable early-stage patients, or liver transplantation in patients who meet criteria such as the Milan criteria, are options with curative intent.
- Local ablative treatments: Radiofrequency or microwave ablation for small tumours; transarterial chemoembolisation (TACE) or radioembolisation (TARE) in the intermediate stage; stereotactic body radiotherapy (SBRT) in selected patients.
- Systemic treatment: In advanced disease, guidelines recommend first-line immunotherapy combinations such as atezolizumab + bevacizumab or durvalumab + tremelimumab. In patients not suitable for immunotherapy, tyrosine kinase inhibitors such as sorafenib or lenvatinib may be used; later-line options include regorafenib, cabozantinib or ramucirumab (AFP ≥400 ng/mL) [1][4][5].
- Hepatitis treatment and support: Antiviral prophylaxis during treatment is important for hepatitis B carriers. Screening for varices (endoscopy) is recommended before bevacizumab.
Treatment is planned individually, taking into account the stage, tumour characteristics, general condition and the patient’s preferences. Not every option listed here is suitable for every patient.
Recent developments
In recent years immunotherapy combinations have become the standard first-line treatment for advanced HCC. Studies combining TACE with immunotherapy and/or anti-angiogenic drugs in the intermediate stage are ongoing; routine use of these approaches should be assessed in line with guideline updates [4][5].
Support and follow-up during treatment
During treatment, not only the anti-cancer drugs but also the patient’s general condition is monitored. Nausea, fatigue, loss of appetite, pain, infection risk and changes in mood are asked about at every visit; when needed, preventive medication, nutritional support, physiotherapy and psychosocial support are planned. In situations such as fever, shortness of breath, uncontrollable diarrhoea or vomiting, or new severe pain, it is advisable to contact the treatment team without waiting for the scheduled visit. Herbal products and supplements can interact with some cancer drugs, so the treatment team should be consulted before using them.
After treatment, follow-up is usually done with imaging and AFP every 3–6 months. The underlying liver disease (hepatitis, cirrhosis) should continue to be followed together with gastroenterology/hepatology.
Frequently asked questions
No. Liver cancer (HCC) arises from liver cells; a liver metastasis is a cancer from another organ that has spread to the liver, and its treatment depends on the original cancer.
People with cirrhosis or chronic hepatitis B carriage are advised to have an ultrasound twice a year (with AFP when needed), so that tumours can be detected at an earlier stage.
No. The decision takes into account liver function (Child-Pugh), bleeding risk, any history of autoimmune disease and general condition; other drugs may be chosen for patients who are not suitable.
Transplantation is considered for selected patients whose tumour number and size meet certain criteria (e.g. the Milan criteria) and who have no other contraindication; the decision is made together with transplant centres.
Call +90 530 250 54 85 or write to the same number via WhatsApp. The outpatient clinic is open Monday to Friday, 08:00–16:00.
At the medical oncology outpatient clinic of Mersin University Faculty of Medicine Oncology Hospital, Çiftlikköy Campus, 33110 Yenişehir/Mersin, Türkiye. The assessment is done in person.
When needed, yes. The multidisciplinary tumour board meets every Friday from 09:00 to 13:00, and the sequence of surgery, radiotherapy and drug treatment is planned jointly.
Yes. A second opinion is a common way to clarify a treatment plan. Bring your pathology, imaging and discharge reports to the clinic for the assessment.
Pathology report, imaging reports and, if possible, the image CDs, discharge summary, recent blood tests and a list of the medicines you take. Translated copies are helpful if your documents are not in Turkish or English.
Medical oncology consultation for liver cancer in Mersin
If you have been diagnosed with liver cancer, or your diagnostic work-up is ongoing, you can apply for a medical oncology consultation with Assoc. Prof. Dr. Ali Oğul at Mersin University Faculty of Medicine Oncology Hospital (Çiftlikköy Campus, 33110 Yenişehir/Mersin, Türkiye). Medical oncology covers the planning of drug treatments such as chemotherapy, targeted therapy, immunotherapy and hormone therapy, the monitoring of side effects and follow-up after treatment. The hospital has a day treatment unit where drug treatments are given.
Treatment decisions are made by a team. When needed, patient files are discussed at the multidisciplinary tumour board, which meets every Friday from 09:00 to 13:00 with specialists from the relevant departments.
For appointments, call +90 530 250 54 85 or send a WhatsApp message to the same number with your name, diagnosis and reason for the request; you can also send your reports. The outpatient clinic is open Monday to Friday, 08:00–16:00. No diagnosis or treatment recommendation is given via WhatsApp; the assessment takes place in person at the clinic. Consultations are held in Turkish.
Appointment
Evaluation and second opinion
If you have been diagnosed with liver cancer or would like a second opinion on your current treatment plan, you can contact Assoc. Prof. Dr. Ali Oğul with your pathology report and imaging results.
This content is for information only; please consult your physician for diagnosis and treatment.
References
- EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. Accessed: October 2026. https://easl.eu/publication/easl-clinical-practice-guidelines-management-of-hepatocellular-carcinoma/
- ESMO Clinical Practice Guidelines – Hepatocellular carcinoma. Accessed: October 2026. https://www.esmo.org/guidelines/esmo-clinical-practice-guidelines-gastrointestinal-cancers
- NCI – Liver Cancer (PDQ). Accessed: October 2026. https://www.cancer.gov/types/liver
- NCCN Guidelines – Hepatocellular Carcinoma. Accessed: October 2026. https://www.nccn.org/guidelines/category_1
- ASCO Guideline – Systemic Therapy for Advanced HCC. Accessed: October 2026. https://www.asco.org/practice-patients/guidelines
Links open external sources. The references were accessible as of October 2026.