What is hepatocellular carcinoma?

HCC is the most common primary liver cancer (approximately 90% of liver cancers) — arising from hepatocytes (liver cells). It is the 6th most common cancer globally and the 3rd leading cancer killer, predominantly affecting people with chronic liver disease: cirrhosis (from any cause), chronic hepatitis B, or chronic hepatitis C. HCC has an extremely poor prognosis overall — most cases are diagnosed at advanced stage when curative treatment is impossible — making prevention and surveillance critical.

Chronic hepatitis B (HBV): the most common global cause — responsible for approximately 56% of HCC cases (especially in Africa and East Asia where HBV is endemic; HBV causes HCC even without cirrhosis). Chronic hepatitis C (HCV): approximately 20% of HCC — typically causes HCC through cirrhosis. MASLD/NASH: now the fastest-growing cause in HICs — driven by the obesity epidemic. Alcohol: cirrhosis from alcohol causes HCC. Aflatoxin B1 (in HBV-infected individuals): the mould toxin synergistically with HBV dramatically increases HCC risk in Africa and parts of Asia. Hereditary haemochromatosis, primary biliary cholangitis and other cirrhosis causes.

How is HCC prevented?

HBV vaccination: the most impactful HCC prevention intervention globally — the "anti-cancer vaccine." Universal infant HBV vaccination has already dramatically reduced HCC incidence in vaccinated birth cohorts in Taiwan and other countries. HCV treatment: all-oral direct-acting antivirals (DAAs) cure HCV in 8-12 weeks — substantially reducing HCC risk in treated patients (though HCC risk persists for years post-cure in those with advanced fibrosis). Aflatoxin exposure reduction: improved grain storage, post-harvest practices and dietary diversity. MASLD management: weight loss, metabolic control. Alcohol reduction.

How is HCC staged and who can be cured?

The BCLC (Barcelona Clinic Liver Cancer) staging system guides HCC treatment. Early-stage HCC (BCLC 0/A): a single HCC ≤5cm or up to 3 nodules ≤3cm in a patient with preserved liver function (Child-Pugh A/B). Curative options: surgical resection (best for single tumours without portal hypertension), radiofrequency/microwave ablation (≤3cm), or liver transplantation (Milan criteria — single ≤5cm or ≤3 nodules ≤3cm — curative even with the underlying cirrhosis). Five-year survival with curative treatment: approximately 60-80%.

What is HCC surveillance and who needs it?

Six-monthly liver ultrasound ± serum AFP is recommended for HCC surveillance in all patients with cirrhosis (regardless of cause) and in specific high-risk non-cirrhotic groups: chronic HBV patients with active viral replication; HBV patients aged >40 (men) or >50 (women) in Asia; African patients with chronic HBV regardless of age. Surveillance enables early detection when curative treatment is possible — the majority of cirrhotic patients presenting with symptoms already have advanced HCC. Surveillance adherence is unfortunately low globally.

What treatments exist for advanced HCC?

First-line (BCLC Stage C — advanced): atezolizumab + bevacizumab (IMbrave150 — preferred when tolerability permits); or durvalumab + tremelimumab (HIMALAYA); or sorafenib/lenvatinib (alternative if immunotherapy contraindicated). Second-line: regorafenib (after sorafenib), cabozantinib, ramucirumab (AFP >400). TACE (transarterial chemoembolisation) for BCLC Stage B (intermediate): intra-arterial embolisation — the standard for unresectable, non-metastatic multinodular HCC.

How does HCC differ in Africa vs Asia?

In Sub-Saharan Africa: HCC predominantly affects younger patients (mean age 30-40) with chronic HBV (acquired vertically at birth); aflatoxin co-exposure amplifies HCC risk dramatically; most patients present with advanced disease; liver function is often better preserved than in HCV-cirrhotic patients in the West; overall survival is extremely poor due to late presentation and limited treatment access. In East Asia: HBV-driven predominates (though declining with vaccination); patients often present earlier (surveillance programmes exist); curative treatment more accessible. In HICs: HCV-cirrhosis and MASLD-cirrhosis are rising relative to HBV; older age at presentation.

How does GMJ News cover HCC?

GMJ News covers GLOBOCAN HCC data, HBV vaccination as cancer prevention, HCV DAA cure and HCC risk reduction, aflatoxin exposure, IMbrave150 and new immunotherapy approvals, TACE evidence, BCLC staging and HCC surveillance. HCC is a rising cancer burden in Georgia — with HBV as a leading cause — directly relevant to PHIG's cancer and hepatitis programmes.

Home › Topics › Hepatocellular Carcinoma (Liver Cancer)

Hepatocellular Carcinoma (Liver Cancer)

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Hepatocellular carcinoma (HCC) — the most common primary liver cancer — caused approximately 906,000 new cases and 830,000 deaths in 2020, making it the 6th most common cancer and 3rd leading cancer killer globally, with hepatitis B and C responsible for approximately 80% of HCC cases worldwide (IARC GLOBOCAN 2020). HCC development almost exclusively occurs on a background of cirrhosis or chronic hepatitis — emphasising that HBV vaccination, HCV treatment and MASLD management are the most powerful HCC prevention strategies. The 2020 IMbrave150 trial established atezolizumab + bevacizumab as the new first-line standard for advanced HCC — replacing sorafenib after 12 years as the only approved systemic therapy.

Key messages

906K cases — 3rd leading cancer killer

HCC caused 906,000 new cases and 830,000 deaths in 2020 — the 3rd leading cause of cancer death globally, driven by chronic hepatitis B and C infection in approximately 80% of cases (IARC GLOBOCAN 2020).

Prevention is the primary strategy

HBV vaccination (preventing 90-95% of chronic HBV), HCV treatment (curing chronic HCV with DAAs within 8-12 weeks), and MASLD management prevent the cirrhosis that underlies most HCC. Africa and Asia carry the highest HBV-related HCC burden.

Atezolizumab + bevacizumab — new first-line

IMbrave150 trial (2020): atezolizumab + bevacizumab significantly extended overall survival vs sorafenib (mOS 19.2 vs 13.4 months) — becoming the new first-line standard for advanced HCC after 12 years of sorafenib dominance.

Surveillance saves lives in cirrhosis

Six-monthly liver ultrasound ± AFP in patients with cirrhosis or chronic HBV detects early HCC — enabling curative treatment. Without surveillance, most HCC presents at advanced stage when cure is impossible.

Curative options for early disease

Early-stage HCC (BCLC 0/A): surgical resection or radiofrequency ablation (RFA) achieves cure in approximately 60-80% at 5 years; liver transplantation (Milan criteria) is curative for eligible patients.

Aflatoxin — the dietary carcinogen

Aflatoxin B1 — a mycotoxin produced by Aspergillus mould on mouldy grain, peanuts and maize — is a Group 1 carcinogen and major HCC risk factor in Sub-Saharan Africa and parts of Asia, particularly in HBV-infected individuals (synergistic carcinogenesis).

Key statistics

906K

new HCC cases/year (2020)

IARC GLOBOCAN

830K

HCC deaths/year (2020)

IARC GLOBOCAN

~80%

of HCC attributable to HBV and HCV

WHO/IARC

19.2mth

mOS with atezolizumab + bevacizumab (IMbrave150)

NEJM 2020

leading cause of cancer death globally

GLOBOCAN 2020

60-80%

5-year survival with early curative treatment

ESMO/AASLD

HCC incidence age-standardised rate per 100,000 — GLOBOCAN 2020

Source: IARC GLOBOCAN 2020. East/Southeast Asia and Sub-Saharan Africa carry the highest HCC burden.

Glossary of key terms

BCLC staging
ESMO/AASLDBarcelona Clinic Liver Cancer (BCLC) staging system — the standard staging for HCC guiding treatment decisions: Stage 0 (very early — single <2cm); Stage A (early — single or 3 nodules ≤3cm, Child-Pugh A); Stage B (intermediate — multinodular, no vascular invasion); Stage C (advanced — portal invasion, extrahepatic spread); Stage D (terminal).

Child-Pugh score
AASLD/EASLAssessment of liver functional reserve — combining bilirubin, albumin, INR, ascites and encephalopathy. Child-Pugh A (5-6 points): preserved function — eligible for most treatments. Child-Pugh B (7-9): moderate dysfunction. Child-Pugh C (10-15): severe — palliative care only.

Transarterial chemoembolisation (TACE)
ESMO/EASLAn intra-arterial procedure delivering chemotherapy (doxorubicin/cisplatin) directly to liver tumours via the hepatic artery, followed by embolisation — exploiting the fact that HCC is arterially fed. Standard treatment for BCLC Stage B (intermediate) HCC. Prolongs survival vs BSC.

Sorafenib (Nexavar)
FDA 2008/ESMOA multi-kinase inhibitor (targeting RAF, VEGFR, PDGFR) — the first approved systemic therapy for advanced HCC (2008, SHARP trial). Extended mOS by approximately 3 months vs placebo. Remained first-line for 12 years until IMbrave150 established atezolizumab + bevacizumab as superior.

Atezolizumab + bevacizumab
FDA 2020/ESMOAnti-PD-L1 (atezolizumab) + anti-VEGF (bevacizumab) combination — the new first-line standard for advanced HCC after IMbrave150 trial demonstrated superior OS (19.2 vs 13.4 months) and PFS vs sorafenib. Now several other IO/VEGF combinations approved in first/second line.

AFP (alpha-fetoprotein)
WHO/AASLDA serum biomarker produced by hepatocytes and some HCC cells — elevated in approximately 60-70% of HCC. Used with liver ultrasound for HCC surveillance in cirrhotic patients. AFP >400 ng/mL is highly suggestive of HCC. AFP elevation also occurs in pregnancy and non-malignant liver disease.