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Early hepatocellular carcinoma means a single tumour, or up to three small ones, in a liver that still works, without spread or vein invasion. It is treated to cure: cutting out the tumour, destroying it with heat through a needle, or replacing the liver by transplant, chosen by tumour size, liver function and portal pressure.
The Barcelona Clinic Liver Cancer system, first published in 1999 and updated in 2022, defines very early disease (BCLC 0) as a single tumour under 2 cm and early disease (BCLC A) as a single tumour of any size or up to three tumours each under 3 cm, with preserved liver function and performance status and no vascular invasion or spread. Most such tumours are found by six-monthly ultrasound surveillance of people with cirrhosis or chronic hepatitis B, and diagnosis rests on contrast imaging with the LI-RADS criteria rather than biopsy in a cirrhotic liver.
Resection is the first choice for a single tumour when liver function is preserved and portal hypertension absent, and is increasingly done laparoscopically or by robot; thermal ablation with radiofrequency or microwave is the alternative for tumours up to 3 cm, with survival equivalent to resection in randomised trials of small tumours and fewer complications, and stereotactic radiotherapy where ablation is impossible. Liver transplantation, for patients within the Milan criteria of a single tumour up to 5 cm or up to three tumours each up to 3 cm, treats both the cancer and the cirrhosis and gives the best long-term results, with bridging ablation or chemoembolisation while waiting and downstaging protocols for those just beyond the criteria.
Recurrence after resection or ablation is the main problem, reaching about 70 percent at five years because the cirrhotic liver keeps producing new tumours. No adjuvant therapy has been established: sorafenib failed in STORM, and IMbrave050, in which atezolizumab and bevacizumab improved recurrence-free survival at the first analysis, lost that benefit with longer follow-up. Antiviral therapy for hepatitis B or C, alcohol abstinence and continued surveillance are the measures that do reduce recurrence and second tumours.
The stage at which liver cancer can be cured, reached by a minority of patients worldwide but by most of those found by surveillance in cirrhosis; the BCLC system expects five-year survival above 70 percent with resection, ablation or transplantation.
Hepatocellular carcinoma grows in a cirrhotic liver and spreads first inside it and into the portal vein, so staging depends on liver function and vascular invasion as much as on size.
Same organ: Hepatocellular carcinoma, Intermediate hepatocellular carcinoma (BCLC B), Advanced hepatocellular carcinoma (BCLC C), Hepatoblastoma
Nothing recorded yet.
Background: Alpha-fetoprotein (AFP). Also on OnCo: Symptoms and red flags · Early detection roadmap.
Hepatectomy, increasingly laparoscopic or robotic; ablation as an alternative for tumours up to 3 cm.
Liver transplantation, with bridging ablation or chemoembolisation on the waiting list and downstaging for patients just outside the criteria.
Stereotactic body radiotherapy or radioembolisation.
No proven adjuvant therapy (STORM and IMbrave050 negative in the end); antiviral therapy, alcohol abstinence and continued imaging surveillance.
Six-monthly ultrasound with alpha-fetoprotein in cirrhosis and chronic hepatitis B.
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Adjuvant immunotherapy is not standard after curative treatment of hepatocellular carcinoma; surveillance, antiviral therapy and risk factor control remain the approach.
The BCLC stages used on this site's hepatocellular carcinoma pages and their default treatments follow this update.
No adjuvant systemic therapy is recommended after curative treatment of hepatocellular carcinoma, a conclusion reinforced by the later failure of IMbrave050.
The Milan criteria remain the global standard for transplant eligibility in hepatocellular carcinoma, with downstaging protocols extending access to patients just outside them.
Query for this cancer: (TITLE:"Early hepatocellular carcinoma" OR ABSTRACT:"Early hepatocellular carcinoma" OR TITLE:"BCLC 0 and A" OR ABSTRACT:"BCLC 0 and A" OR TITLE:"Very early HCC BCLC 0" OR ABSTRACT:"Very early HCC BCLC 0" OR TITLE:"Early-stage HCC BCLC A" OR ABSTRACT:"Early-stage HCC BCLC A" OR TITLE:"Resectable hepatocellular carcinoma" OR ABSTRACT:"Resectable hepatocellular carcinoma" OR TITLE:"HCC within Milan criteria" OR ABSTRACT:"HCC within Milan criteria") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Early hepatocellular carcinoma (BCLC 0 and A), not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
The shared side effects of drugs that block blood vessel growth (bevacizumab, ramucirumab and VEGFR kinase inhibitors): high blood pressure, protein leaking into the urine, nosebleeds and more serious bleeding, slow wound healing, and rarely holes in the bowel.
Death of brain tissue months to years after radiosurgery or high-dose brain radiotherapy, which can look exactly like tumour growing back on a scan.
Blood clots in the leg veins or lungs. Cancer makes blood clot more easily and some treatments (IMiDs, anti-VEGF drugs, hormone therapy, central lines, surgery) add risk; clots are the second commonest cause of death in cancer patients after the cancer itself.
See all on the product pages:AtezolizumabBevacizumab·Printable cards in the navigator
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