Understanding Liver Cancer

Liver cancer is among the most challenging malignancies in hepato-pancreato-biliary (HPB) oncology. It develops when cells within the liver — most commonly hepatocytes — grow uncontrollably and form a tumour. The most frequent primary liver cancer is hepatocellular carcinoma (HCC), which accounts for nearly 80–85% of all cases worldwide. Other primary liver cancers include intrahepatic cholangiocarcinoma (arising from bile duct cells inside the liver), fibrolamellar HCC, angiosarcoma and hepatoblastoma in children. The liver is also one of the most common sites for metastatic cancer, particularly from colorectal, neuroendocrine, breast and pancreatic primaries.

Because the liver performs over 500 vital functions — from detoxification and protein synthesis to bile production and glucose regulation — surgical treatment requires meticulous planning to preserve healthy liver tissue while achieving complete tumour clearance. Modern liver surgery, guided by advanced imaging, intraoperative ultrasound and enhanced recovery protocols, allows major hepatectomy with low morbidity when performed by experienced HPB surgeons.

Liver Anatomy & Why It Matters

The liver is divided into eight functional segments (Couinaud classification), each with its own inflow (portal vein and hepatic artery) and outflow (hepatic vein). This segmental anatomy allows surgeons to remove diseased portions while preserving uninvolved segments. In patients with cirrhosis or compromised liver function, preserving adequate functional liver remnant (FLR) is critical to prevent post-hepatectomy liver failure. Techniques such as portal vein embolization and ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) can be used to grow the remnant before major resection.

Stages of Liver Cancer (BCLC Staging)

Unlike most cancers, HCC is staged using the Barcelona Clinic Liver Cancer (BCLC) system, which combines tumour burden, liver function (Child-Pugh score) and patient performance status to guide treatment.

Symptoms of Liver Cancer

Liver cancer is often silent in its early stages, which is why surveillance in high-risk patients is so important. As the tumour grows, patients may experience upper abdominal pain or fullness (especially in the right upper quadrant), unexplained weight loss, loss of appetite, early satiety, persistent fatigue, nausea, yellowing of skin and eyes (jaundice), itching, dark urine, pale stools, swelling of the abdomen due to ascites, and swelling of the legs. Some patients first present with complications of underlying cirrhosis — variceal bleeding, encephalopathy or sudden decompensation — where imaging then reveals an underlying tumour.

Risk Factors

The majority of HCC cases arise in patients with chronic liver disease. Key risk factors include chronic hepatitis B and hepatitis C infection, alcohol-related cirrhosis, non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) — now rapidly rising as a cause of HCC globally — aflatoxin exposure, hereditary haemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency, type 2 diabetes and obesity, and smoking. Cholangiocarcinoma has additional risk factors including primary sclerosing cholangitis, choledochal cysts, hepatolithiasis and liver fluke infections.

Diagnosis & Staging

Diagnosis of liver cancer combines imaging, blood tests and, when needed, targeted biopsy. A triphasic contrast CT or multiphase MRI of the liver is the cornerstone investigation — HCC typically shows arterial phase hyperenhancement with washout in the portal venous or delayed phase, a pattern that can confirm the diagnosis without biopsy in many cases. Serum alpha-fetoprotein (AFP) is a useful tumour marker; CA 19-9 and CEA help evaluate cholangiocarcinoma and metastatic disease. PET-CT may be used to assess extrahepatic spread. Liver function is evaluated with Child-Pugh score, MELD score and indocyanine green (ICG) clearance. Volumetric CT is used to calculate the future liver remnant before major resection.

Treatment Options

Treatment is tailored to tumour stage, liver function, patient fitness and the extent of underlying liver disease. Decisions are made in a multidisciplinary tumour board including HPB surgeons, hepatologists, medical and radiation oncologists, interventional radiologists and transplant specialists.

Recovery & Follow-up

Following liver resection, most patients stay in hospital for 5–8 days, with earlier discharge after laparoscopic surgery. Enhanced recovery protocols include early mobilisation, controlled pain management, optimised nutrition and careful monitoring of liver function. The liver has remarkable regenerative capacity — even after major resection, the remnant can regrow to near-normal volume within weeks. Long-term follow-up includes imaging every 3–6 months, AFP monitoring, surveillance for recurrence in the remnant liver and ongoing management of underlying liver disease.

Why Choose Dr. Abhishek Aggarwal

Dr. Abhishek Aggarwal is a dedicated GI & HPB oncosurgeon with extensive experience in complex liver surgery, including major and minimally invasive hepatectomy, liver resections for HCC and metastatic disease, and multidisciplinary management of cholangiocarcinoma. His practice is grounded in global, evidence-based standards and delivered with a deeply patient-centred approach.