Liver Cancer (HCC) — Mumbai
Hepatocellular Carcinoma (HCC): Diagnosis, Staging & Treatment
Dr. Chetan Kalal — DM Hepatologist, Gleneagles Hospital Mumbai. Multidisciplinary HCC management: surveillance, staging, ablation, TACE, transplant. APASL guideline-aligned care.
What Is Hepatocellular Carcinoma?
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, accounting for 75–85% of all liver malignancies. In India, it almost always arises in a cirrhotic liver — most commonly from chronic hepatitis B, hepatitis C, alcohol-related cirrhosis, or MASLD. Because cirrhosis is the fertile ground, HCC surveillance every 6 months with ultrasound ± AFP is standard of care for all cirrhotic patients.
When caught early — a single lesion under 2 cm — 5-year survival after resection or transplant exceeds 70%. Caught late, the options narrow sharply. This is why surveillance matters, and why HCC management requires a hepatologist who coordinates the full picture: tumour board, staging, and the transplant window.
HCC Staging & Treatment Options
Surveillance & Early Detection
6-monthly ultrasound abdomen + serum AFP for all cirrhotic patients and chronic hepatitis B with high-risk features. LI-RADS 3–5 characterisation on CECT/MRI.
Staging — BCLC System
Barcelona Clinic Liver Cancer (BCLC) staging guides treatment: Very Early (0), Early (A), Intermediate (B), Advanced (C), Terminal (D). APASL modifications for Asian patients.
Liver Transplant (Curative)
Milan criteria (single ≤5cm or ≤3 nodules each ≤3cm, no vascular invasion) — best long-term outcomes. UCSF criteria for extended selection. Living donor transplant (LDLT) reduces waiting time.
Ablation (RFA / MWA)
Radiofrequency or microwave ablation for BCLC 0/A lesions ≤3cm in patients not fit for surgery. Comparable outcomes to resection for small HCC in cirrhotic liver.
TACE / SIRT
Transarterial chemoembolisation (TACE) for intermediate stage BCLC-B. Selective internal radiation therapy (SIRT / Y-90 radioembolisation) for vascular tumours. Downstaging to transplant criteria.
Systemic Therapy
Advanced/metastatic HCC (BCLC-C): Atezolizumab + bevacizumab (IMbrave150) first-line; sorafenib or lenvatinib alternatives. Second-line: regorafenib, ramucirumab. Immunotherapy eligibility assessment.
Multidisciplinary Tumour Board
Every HCC case reviewed at weekly MDT: hepatologist, transplant surgeon, interventional radiologist, oncologist, and pathologist. Treatment decisions made collectively, not in silos.
Bridging & Downstaging
Locoregional therapy while awaiting transplant listing (bridging) or to bring tumour within transplant criteria (downstaging). Portal vein tumour thrombus (PVTT) management.
Who Is at Risk for Liver Cancer?
Annual incidence of HCC in cirrhosis: 1–8%. Surveillance is mandatory regardless of cause.
HCC can develop even without cirrhosis in HBV. High-risk groups: Asian men >40, African patients >20, family history of HCC.
Surveillance must continue even after successful DAA treatment if cirrhosis was already present — SVR reduces but does not eliminate HCC risk.
Fastest-growing HCC risk group globally. Obesity, type 2 diabetes, and metabolic syndrome amplify risk. Surveillance warranted from F3 fibrosis onwards.
Ongoing alcohol use significantly increases HCC risk. Abstinence reduces risk but does not eliminate it in established cirrhosis.
Metabolic and autoimmune liver diseases with cirrhosis carry the same HCC risk — surveillance protocols are identical.
The Hepatologist’s Role in HCC Care
HCC is not just a surgical or oncological problem — the underlying cirrhosis determines what treatments are feasible and safe. A patient with Child-Pugh C cirrhosis cannot safely undergo resection. A patient with MELD 18 and a 3.5 cm HCC should be transplanted, not ablated. These nuanced decisions require a hepatologist who understands both the tumour and the liver it sits in.
Dr. Kalal coordinates HCC care at Gleneagles Mumbai — from surveillance through staging to the transplant decision, with the full interventional and oncology team.
Detected a Liver Lesion? Get a Specialist Review.
Whether it is an incidental finding on ultrasound, a rising AFP, or a known diagnosis of HCC requiring a second opinion on treatment — a hepatologist-led review ensures you are on the right pathway.
HCC / Liver Cancer Specialist — Mumbai & Across India
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