Medical Oncologist
CION Cancer Clinics
Hepatocellular carcinoma (HCC): what it is and how it develops | CION Cancer Clinics
Hepatocellular carcinoma, or HCC, is cancer that starts in the liver's own main cells. It is the commonest primary liver cancer, and it usually grows in a liver already scarred by hepatitis B, hepatitis C, alcohol or fatty liver. This page explains how it develops, what the words on your report mean, how treatment is chosen and why the health of the rest of the liver matters as much as the tumour. At CION Cancer Clinics in Hyderabad, our oncologists explain liver cancer in plain words and plan care around you and your family.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- What is hepatocellular carcinoma?
- What damages the liver enough for HCC to start?
- How does a damaged liver turn into HCC?
- What do the words on an HCC report mean?
- What do families often believe about HCC that is not true?
- How is HCC treated, and who does this page not apply to?
- What this page cannot tell you
- Common questions about hepatocellular carcinoma
The short answer
What is hepatocellular carcinoma?
Hepatocellular carcinoma, or HCC, is cancer that starts in the hepatocytes, the main working cells of the liver. It is the commonest kind of primary liver cancer, meaning cancer that begins in the liver itself. In most people it grows in a liver that has already been damaged for many years.
Primary, not spread from somewhere else
HCC is different from cancer that has travelled to the liver from the bowel, breast, stomach or pancreas. That is called secondary liver cancer and is treated by the plan for the organ it came from. If you are not sure which one is in the report, read the two very different things called liver cancer first.
Two things decide everything
With most cancers, the doctor mainly looks at the tumour. With HCC, the team looks at two things at once: the tumour, and how well the rest of the liver is still working. A small tumour in a liver that is coping well opens many more options than the same tumour in a liver that is failing.
A small HCC found early on a routine scan is often treatable with curative intent. Being found early is the single biggest advantage.Where it comes from
What damages the liver enough for HCC to start?
These are risk factors, not faults. Many people with them never get HCC, and nobody chose them.
Hepatitis B
The leading cause in India. It is often passed from mother to baby or within families in childhood, long before anyone knew. It can lead to HCC even before cirrhosis develops. Antiviral tablets keep it controlled and lower the risk, though they do not remove it.
Hepatitis C
A virus that slowly scars the liver. It is now curable with a short course of modern tablets. Anyone who already had cirrhosis before treatment still needs regular scans afterwards.
Alcohol and fatty liver
Long-term heavy drinking and fatty liver linked to diabetes and weight can both lead to cirrhosis. Fatty liver is now a fast-growing cause, including in people who have never had a drink.
Less common causes
- Aflatoxin, a mould on badly stored grain and groundnuts
- Haemochromatosis, an inherited iron overload
- Autoimmune hepatitis and some rare inherited conditions
Some HCC grows in a liver with no cirrhosis at all. See HCC without cirrhosis.
Not sure whether this applies to you?
Ask an oncologistHow it develops
How does a damaged liver turn into HCC?
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Years of inflammation
A virus, alcohol or fat keeps irritating the liver. Cells die and are replaced again and again. Most people feel nothing at this stage.
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Scarring builds up
Healing leaves scar tissue, called fibrosis. When the scarring spreads through the whole liver and breaks it into lumps, it is called cirrhosis.
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Nodules appear
The lumpy liver forms small nodules of regrowing cells. Most are harmless. Each round of regrowth gives a cell another chance to copy its instructions wrongly.
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One nodule turns cancerous
A nodule can change, grow its own blood supply and become HCC. On a contrast scan this new blood supply is often what gives it away.
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Which is why scans are offered
Because the high-risk group is known, people with cirrhosis or hepatitis B can have a liver ultrasound at regular intervals. See who needs liver cancer screening.
On your report
What do the words on an HCC report mean?
- Arterial enhancement and washout
- The tumour lights up brightly early in a contrast scan, then fades faster than the liver around it. In a cirrhotic liver this pattern is typical of HCC.
- LI-RADS
- A scoring system radiologists use for liver spots in high-risk people. Higher categories mean HCC is more likely.
- AFP
- Alpha-fetoprotein, a blood marker. It is often raised in HCC but can be normal, and it can rise for other reasons.
- Child-Pugh
- A score of how well the liver is working, graded A, B or C. A means the liver is coping best.
- BCLC
- The staging system most teams use for HCC. It combines the tumour, liver function and how fit you are.
- Portal vein involvement
- Tumour growing into the main vein bringing blood to the liver. It changes which treatments are possible.
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Commonly believed
What do families often believe about HCC that is not true?
"Liver cancer only happens to people who drink."
In India, hepatitis B is a leading cause, and fatty liver is a growing one. Many people with HCC have never had alcohol. Where alcohol was part of the story, it is a risk factor to tell the doctor about honestly, and not a reason for blame.
"Every liver tumour needs a biopsy first."
In a liver with cirrhosis, HCC can often be diagnosed from a specialised contrast scan alone, because its pattern is so typical. A biopsy is still arranged when the scan is not clear or the liver is not cirrhotic.
"The patient should stop eating protein to rest the liver."
People with cirrhosis and HCC usually need more protein, not less, to keep their muscles and strength. Cutting dal, eggs or milk can weaken them. Ask the team or a dietitian before changing the diet.
"A herbal liver tonic will help clean it out."
A cirrhotic liver is easily harmed by herbal products and supplements. Tell your oncologist everything you take, including tonics and powders, so they can check it is safe.
The treatment picture
How is HCC treated, and who does this page not apply to?
Treatment depends on the size and number of tumours, whether the blood vessels are involved, how well the liver works and how fit you are. The tumour board weighs all of these together.
The main options
Early HCC may be removed by surgery, destroyed with ablation, or treated with a liver transplant in selected people. Tumours that cannot be removed may be treated through the liver's blood supply with TACE or TARE, or with focused radiation. These procedures are coordinated through accredited partner hospitals. Advanced HCC is treated with medicines, including immunotherapy and targeted tablets, which CION gives at its centres. The overview of liver cancer treatment options explains each one.
Who this does not apply to
This page is about adults with HCC. It does not cover cancer that has spread to the liver from elsewhere, bile duct cancer inside the liver (cholangiocarcinoma), or hepatoblastoma, the liver cancer of young children. Fibrolamellar carcinoma, a rare form in young people with healthy livers, behaves differently too.
Being straight with you
What this page cannot tell you
It cannot tell you whether a spot on your scan is HCC. That depends on the full contrast scan, the state of your liver and sometimes a biopsy, read by a radiologist and an oncologist together.
It cannot tell you what to expect
Outlook in HCC varies enormously from one person to the next, because the liver's health matters as much as the tumour. Statistics from other countries describe large groups and say little about one person. Your oncologist can talk through your own situation honestly.
Who can answer it
A medical oncologist working with a hepatologist, a liver surgeon and an interventional radiologist. At CION, the tumour board reviews your scans and blood results, and the team explains which stage you are at and what it means. If you have hepatitis B or C, keep seeing the doctor who manages it as well.
Bring every scan report and CD, and any blood results from the last few months, to the first appointment.Questions we are asked
Common questions about hepatocellular carcinoma
Is HCC the same as liver cancer?
HCC is the commonest type of primary liver cancer, so when doctors say "liver cancer" they often mean HCC. But "cancer in the liver" can also mean cancer that spread from another organ, or bile duct cancer inside the liver. Ask which one your report describes, because the treatment is different.
Is HCC curable?
When it is found small and the liver is working well, HCC can often be treated with curative intent, using surgery, ablation or, for some people, transplant. When it is found later, the aim is usually to control it and keep you well for as long as possible. Your team will explain which applies.
What are the symptoms of HCC?
Early HCC usually causes no symptoms, which is why regular scans matter for people at risk. Later signs can include pain under the right ribs, weight loss, a swollen belly, yellow eyes or a cirrhosis that suddenly gets worse. These have other causes too, so they need checking by a doctor.
Can HCC happen without cirrhosis?
Yes. Hepatitis B can cause HCC before cirrhosis develops, and fatty liver can too. Fibrolamellar carcinoma, a rare type, occurs in young people with healthy livers. Most HCC still grows in a cirrhotic liver, which is why scans are focused on people with cirrhosis or hepatitis B.
Is HCC hereditary?
HCC itself is rarely inherited. What runs in families in India is usually hepatitis B, passed from mother to baby or between children in a household. That is why family members of someone with hepatitis B are encouraged to get tested and, if not infected, vaccinated.
Does a normal AFP mean there is no HCC?
No. AFP can be normal in people who do have HCC, especially when the tumour is small. It can also rise for other reasons, such as active hepatitis. That is why it is used alongside an ultrasound or a contrast scan, never on its own.
Which medicines are used for advanced HCC?
Immunotherapy combinations, such as atezolizumab with bevacizumab, and targeted tablets such as lenvatinib or sorafenib are used. Which one suits depends on liver function, other illnesses and bleeding risk. These are not right for everyone, including people whose liver is failing. Your oncologist will explain the choice.
Where can we get HCC treated in Hyderabad?
CION's medical oncologists see people with HCC at its centres, review scans at the tumour board, give immunotherapy and targeted therapy, and coordinate surgery, ablation, TACE and transplant assessment through accredited partner hospitals. Call the helpline to book a consultation or second opinion.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- MedlinePlus — Liver cancer - hepatocellular carcinoma
- National Cancer Institute — Liver Cancer Causes, Risk Factors, and Prevention
- American Cancer Society — What Is Liver Cancer?
- EASL — EASL Clinical Practice Guidelines: management of hepatocellular carcinoma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Why HCC almost always starts in a damaged liverThe link between cirrhosis and cancer, step by stepHCC without cirrhosisWhen the liver looked normal before the tumourLiver cancer staging explainedHow BCLC and liver function set the optionsLiver cancer treatment options explainedEvery option, and who each one suits
Talk to us
Has a scan or report mentioned HCC?
A CION medical oncologist can go through the scans and blood results with you and explain what they mean and what the options are. One helpline serves every CION centre.