Hepatocellular carcinoma
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Liver cancer is a cancer found anywhere in the liver. It can start in the liver. That is called primary liver cancer. It can also spread there from another organ, which is called secondary.
Cirrhosis, which damages the liver, is one of the main risk factors for liver cancer.
NHS inform (NHS Scotland) — Liver cancer, risk factors section
The exact wording of the source
Liver cancer, risk factors section · status: current, verified 2026-09-01
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A condition called cirrhosis, which damages the liver, is one of the main risk factors.
Surgery and some other treatments also depend on how well the healthy parts of the liver are working.
NHS inform (NHS Scotland) — Liver cancer, treatment section, sentence following the list of what treatment depends on
The exact wording of the source
Liver cancer, treatment section, sentence following the list of what treatment depends on · status: current, verified 2026-09-01
Open
Surgery and some other treatments also depend on how well the healthy parts of the liver are working.
The selection of treatment modality depends as much on the underlying liver function and degree of portal hypertension as on the oncological stage of the tumour, as well as performance status.
British Society of Gastroenterology — Treatment of hepatocellular carcinoma, introduction, p15
The exact wording of the source
Treatment of hepatocellular carcinoma, introduction, p15 · status: current, verified 2026-09-01
Open
The selection of treatment modality depends as much on the underlying liver function and degree of portal hypertension as on the oncological stage of the tumour, as well as the patient’s performance status.
In decompensated cirrhosis, treatment options apart from liver transplantation are severely restricted. In compensated liver disease, multiple treatment options are potentially available.
British Society of Gastroenterology — Treatment of hepatocellular carcinoma, introduction, p15
The exact wording of the source
Treatment of hepatocellular carcinoma, introduction, p15 · status: current, verified 2026-09-01
Open
In patients with decompensated cirrhosis, treatment options apart from liver transplantation are severely restricted. In patients with compensated liver disease, multiple treatment options are potentially available.
TNM staging is inadequate here because liver function is not considered, and liver function is a key factor in defining both prognosis and treatment.
British Society of Gastroenterology — Staging of hepatocellular carcinoma, paragraph on the TNM system, p15
The exact wording of the source
Staging of hepatocellular carcinoma, paragraph on the TNM system, p15 · status: current, verified 2026-09-01
Open
This is because liver function is not considered, which as outlined is a key factor in defining both prognosis and treatment.
Assessment for resection in a cirrhotic liver is a multiparametric evaluation considering liver function linked to severity of portal hypertension, extent of hepatectomy, volume of the future liver remnant, comorbidity profile and performance status.
British Society of Gastroenterology — Recommendations: surgical resection, second bullet, p16 (also executive summary, p2)
The exact wording of the source
Recommendations: surgical resection, second bullet, p16 (also executive summary, p2) · status: current, verified 2026-09-01
Open
The assessment for resection of HCC in a cirrhotic liver is a multiparametric evaluation considering liver function linked to severity of portal hypertension, extent of hepatectomy, volume of future liver remnant, as well as the patient’s comorbidity profile and performance status
NICE has defined Child-Pugh A and performance status 0 to 1 as eligibility criteria for NHS-funded systemic therapy.
British Society of Gastroenterology — Recommendations: systemic therapy, general considerations
The exact wording of the source
Recommendations: systemic therapy, general considerations · status: current, verified 2026-09-01
Open
For these reasons, NICE has defined CP-A and PS 0–1 as eligibility criteria for NHS-funded systemic therapy.
Related
- Cirrhosis — can arise as a complication of
- Alcohol-related liver disease — related through cirrhosis
- Ascites — related through cirrhosis
- Hepatic encephalopathy — related through cirrhosis
- AAV vectors — related through cirrhosis
- HCC surveillance — related through cirrhosis
What we have not established
Relationships involving Hepatocellular carcinoma that we have not evidenced are listed, never drawn — a line would read as a weak relationship, which is a different and false claim.
- Hepatocellular carcinoma → BCLC staging — not established
- Hepatocellular carcinoma → Hepatic functional reserve — not established
Evidence search date: 2026-09-01
Content reviewed and approved
What we have not established here
Known gaps on this concept:
NOT A TREATMENT PAGE, and it says so. Transarterial chemoembolisation is entirely absent from the ledger, which leaves a gap between ablation and systemic therapy; ablation is held with no eligible population; and the NICE drug appraisals are held without their commercial-arrangement conditions. Publishing any of those would name a therapy without its eligible population, which the Phase 15 acceptance criteria forbid.
NO STAGING SYSTEM. The page states that TNM omits liver function and does not state what replaces it. BCLC is used operationally by NHSBT POL195 and named by the BSG guideline, and no sourced definition of it is held. It must not be reconstructed.
NO TRANSPLANT LISTING CRITERIA. NHSBT's UK HCC listing criteria were acquired and verified in Phase 15 and are deliberately not rendered: criteria published without their consequences read as promises, and the down-staging route depends on a Duvoux score this platform must not reconstruct. They are backlog for a transplantation concept, not for this one.
NO PROGNOSIS OF ANY KIND, by design. CLM-HCC-0012 - that underlying liver dysfunction may limit life expectancy more than the cancer - is a population statement from a clinical guideline and is deliberately NOT rendered at plain resolution.
No specialist or research resolution.
Surveillance is held in the ledger (NICE NG50, and EASL) and is rendered on the cirrhosis and surveillance concepts rather than here.
What has changed here
2026-09-01 — Concept created at plain and clinical resolutions, scoped to how liver function gates treatment.
Phase 15. The Winning-Element Matrix had asserted since Phase 13 that the routine view of a cancer shows the cancer and hides the organ. This phase was required either to evidence that from a UK source or to withdraw it. The BSG 2024 guideline and NHS inform evidence it at clinical and plain depth respectively.