LIVER CANCER TREATMENT:
WORLD-LEADING EXPERTISE IN CHINA & INDIA
From surgical resection and HAIC-FOLFOX for PVTT to living donor transplantation and Y-90 β access Asia's deepest hepatobiliary expertise at 80β90% lower cost than Western countries through CancerFax.
analyticsAt a Glance
- check_circleHCC treatment options include resection, transplant, TACE, TARE, ablation, and systemic therapy
- check_circleSorafenib, lenvatinib, atezolizumab plus bevacizumab are standard systemic options
- check_circleChina has extensive HCC expertise and interventional oncology programmes β including HIFU and TACE
- check_circleCAR-T trials targeting GPC3 and AFP are active in China for HCC patients
Liver Cancer Biology: HCC, Cholangiocarcinoma, and Underlying Liver Disease
Liver cancer is almost always diagnosed in the context of pre-existing liver disease. Every treatment decision must balance tumour control with preservation of the functional liver reserve β the unique challenge that makes specialist hepatobiliary expertise essential.
βHCC with PVTT classified as BCLC Stage C in Western guidelines is aggressively treated at Chinese centres with HAIC, surgery, and combined modalities β achieving survival outcomes that contradict the Western prognosis.β
Hepatocellular Carcinoma (HCC) β 75β85%
Originates in hepatocytes. Almost always occurs on a background of cirrhosis from HBV, HCV, alcohol, NASH, or MAFLD. China has ~46% of global HCC burden (85β90M HBV carriers). HBV-related HCC tends to occur with less advanced cirrhosis and better liver function than HCV or alcohol-related disease.
Intrahepatic Cholangiocarcinoma (iCCA) β 10β15%
Bile duct cell origin; large non-vascular tumour. No cirrhosis association. Distinct molecular alterations: FGFR2 fusions (10β15%), IDH1 mutations (10β20%), BRAF V600E, HER2 overexpression. NGS mandatory before second-line. Targeted agents: pemigatinib, futibatinib, ivosidenib.
The Dual Challenge: Tumour + Liver Function
Cirrhosis impairs the liver's regenerative capacity β normally allowing 60β70% resection. A Child-Pugh B patient may lack reserve to survive a resection that would be standard in a Child-Pugh A patient. FLR (future liver remnant) adequacy and Child-Pugh score jointly determine surgical candidacy.
HBV: Critical β Antiviral Therapy Mandatory
Every HBV-related HCC patient must be on antiviral therapy (tenofovir or entecavir) BEFORE commencing any HCC treatment. HBV reactivation triggered by surgery, TACE, ablation, or systemic therapy can cause fulminant hepatitis and liver failure. Standard at all Chinese and Indian specialist centres β confirm before treatment begins.
BCLC Staging System: Tumour Characteristics, Liver Function, and Recommended Treatment
The Barcelona Clinic Liver Cancer (BCLC) system is the most widely used HCC staging framework globally. Chinese and Indian hepatobiliary centres routinely go beyond BCLC guidelines β particularly for Stage C (PVTT) where multimodal aggressive treatment achieves far better outcomes than systemic therapy alone.
| BCLC Stage | Tumour Characteristics | Liver Function | Recommended Treatment | 5-Year Survival |
|---|---|---|---|---|
| 0 β Very Early | Single tumour <2cm | Child-Pugh A, PS 0 | Resection or ablation | >70% |
| A β Early | Single tumour or 3 nodules β€3cm | Child-Pugh AβB, PS 0 | Resection, ablation, or transplant | 50β70% |
| B β Intermediate | Multinodular, no vascular invasion or extrahepatic spread | Child-Pugh AβB, PS 0 | TACE (cTACE or DEB-TACE) | 20β40% |
| C β Advanced (PVTT or extrahepatic) | Vascular invasion (PVTT) or extrahepatic spread | Child-Pugh AβB, PS 1β2 | Systemic therapy (atezo-bev / STRIDE) β OR β HAIC + surgery at Chinese/Indian centres | 8β20% (systemic); up to 35β40% at specialist centres with multimodal treatment |
| D β Terminal | Any tumour | Child-Pugh C, PS 3β4 | Best supportive care | <3% |
Liver Cancer Treatment Modalities: From Curative to Disease Control
Liver cancer treatment spans a spectrum from curative surgical and ablative options for early-stage disease to locoregional therapies for intermediate stage and systemic immunotherapy for advanced HCC. The optimal choice depends on BCLC stage, Child-Pugh score, FLR, tumour location, and centre expertise.
Hepatic Resection β Best Long-Term Cure
Surgical removal of the tumour-bearing liver segment. 5-year survival 40β70% after R0 resection at high-volume centres. Chinese centres (EHBH, Zhongshan, West China) perform 10,000+ hepatic resections/year β world-leading in PVTT resection, laparoscopic/robotic hepatectomy, and large tumour surgery. Child-Pugh A required; FLR >40% for cirrhotic livers.
Thermal Ablation (RFA / MWA / Cryo) β Curative for Small HCC
RFA and MWA achieve outcomes equivalent to surgery for tumours <3cm in Child-Pugh AβB patients. MWA preferred near vascular structures (less heat-sink effect); cryoablation for tumours near bile ducts or liver surface. Combination TACE + ablation outperforms either alone for 3β5cm tumours in randomised trials.
TACE β Intermediate-Stage Standard
Most common locoregional treatment for multinodular HCC. Delivers high-dose chemotherapy intra-arterially exploiting HCC's exclusive hepatic artery supply, combined with embolisation causing ischaemic necrosis. Conventional TACE (lipiodol + doxorubicin), DEB-TACE (drug-eluting beads), or super-selective TACE with CBCT guidance at Chinese specialist centres.
HAIC-FOLFOX β China's Contribution for Advanced HCC
High-dose intra-arterial FOLFOX chemotherapy via indwelling hepatic artery catheter. Response rates 20β30% in PVTT patients vs <15% with sorafenib. HAIC-FO trial: superior PFS and OS vs sorafenib in advanced HCC with PVTT. Combination with PD-1 inhibitors (sintilimab, camrelizumab) emerging. Primarily available in China.
SIRT / Y-90 Radioembolisation
Y-90 microspheres (SIR-Spheres or TheraSphere) delivered intra-arterially β radiation-dominant mechanism, not embolisation. Safe in PVTT (avoids liver failure risk of TACE). Radiation lobectomy: induces contralateral lobe hypertrophy, enabling future resection. Effective bridge-to-transplant. Available at specialist centres in China (USD 18β30K) and India (USD 15β25K).
Liver Transplantation for HCC: China vs India vs USA
Transplantation simultaneously cures the cancer and eliminates the cirrhotic liver from which new HCCs arise β achieving 70β75% 5-year survival within Milan Criteria. India's living donor programme (90% of transplants) eliminates deceased-donor waiting time; China accepts beyond-Milan patients under Hangzhou Criteria.
| Parameter | China | India | USA / Europe |
|---|---|---|---|
| Annual transplant volume | ~5,000β6,000 | ~1,500β2,000 | USA: ~9,000 / EU: varies |
| Primary donor type | Deceased donor (growing since 2015 voluntary system) | Living donor (~90% of transplants) | Deceased donor dominant |
| Cost (USD, approx.) | 40,000β70,000 | 25,000β45,000 | 300,000β500,000+ |
| Waiting time (deceased donor) | 6β24 months (varies by centre and blood type) | Variable; LDLT avoids wait entirely | 6 monthsβ5 years (USA varies by region) |
| Beyond-Milan criteria acceptance | Yes β Hangzhou Criteria (includes AFP and histological grade) at specialist centres | Yes β at high-volume centres with careful selection | Limited β UNOS downstaging protocol only |
| International patient access | Yes β CancerFax facilitated; LDLT option at EHBH, Zhongshan, West China | Yes β CancerFax facilitated; Medanta, Apollo, Global Hospitals | Very limited; cost-prohibitive |
TACE Types: Standard cTACE vs DEB-TACE vs Super-Selective vs HAIC
Four TACE modalities are available at Chinese and Indian specialist centres, each with distinct advantages for different clinical scenarios. HAIC-FOLFOX is uniquely available in China as a China-pioneered approach for advanced HCC.
TACE Strengths
- Conventional TACE (cTACE): Broadest evidence baseDoxorubicin/cisplatin + lipiodol emulsion + Gelfoam/PVA. Most used worldwide; lowest cost; 3 decades of optimisation in China.
- DEB-TACE: Controlled drug release, lower systemic toxicityDoxorubicin-loaded DC Bead microspheres. PRECISION V trial: improved tolerability vs cTACE; equivalent tumour response. Preferred in Child-Pugh B or hepatic artery sensitivity.
- Super-selective TACE + CBCT guidance: Highest precisionSubsegmental catheterisation targeting the exact tumour-feeding vessel. Cone-beam CT provides real-time 3D vascularity confirmation. Maximises tumour dose while preserving normal parenchyma.
- TACE + Ablation: Best for 3β5cm tumoursSequential TACE to induce ischaemia and eliminate heat-sink, then RFA/MWA to ablate residual viable tumour. Randomised trials show superiority over either modality alone.
HAIC-FOLFOX Strengths (China)
- HAIC-FOLFOX: Active against PVTTIntra-arterial oxaliplatin + 5-FU + leucovorin via indwelling catheter. Response rate 20β30% in PVTT vs <15% with sorafenib. HAIC-FO trial: superior PFS and OS vs sorafenib.
- Directly treats portal vein thrombusDrug delivered at high concentration to the tumour and thrombus simultaneously β bypassing the systemic toxicity barrier that limits IV chemotherapy dose.
- Combining with PD-1 inhibitors: Emerging standardHAIC + sintilimab or camrelizumab combinations show promising preliminary results at Chinese HCC centres. Active clinical trials ongoing.
- Primarily available in ChinaHAIC-FOLFOX has no counterpart in Western HCC guidelines. It is the strongest argument for international advanced HCC/PVTT patients seeking treatment in China.
Systemic Therapy for Advanced HCC: First-Line and Second-Line Options
The first-line systemic therapy landscape for HCC transformed between 2020β2023 from sorafenib monotherapy to immunotherapy combinations. China has domestically developed PD-1 inhibitors and anti-VEGF agents at significantly lower cost than imported biologics.
| Regimen | Key Trial | Median OS | ORR | China/India Availability |
|---|---|---|---|---|
| Atezolizumab + bevacizumab (atezo-bev) β 1st Line | IMbrave150 | 19.2 months | 27% | Both β FDA, EMA, NMPA approved; standard of care |
| Tremelimumab + durvalumab (STRIDE) β 1st Line | HIMALAYA | 16.4 months | 20% | China: available; India: major centres |
| Sintilimab + bevacizumab biosimilar β 1st Line | ORIENT-32 | Superior to sorafenib | 21% | China only β NMPA approved; USD 1,200β2,500/cycle; cost-preferred |
| Camrelizumab + rivoceranib β 1st Line | CARES-310 | 22.1 months (longest mOS in 1st-line HCC trial) | 25% | China β both drugs domestically developed; NMPA approved |
| Lenvatinib β 1st Line (TKI option) | REFLECT | 13.6 months (non-inferior to sorafenib) | 18β24% | Both β FDA, EMA, NMPA approved |
| Regorafenib β 2nd Line (post-sorafenib) | RESORCE | 10.6 vs 7.8m (placebo) | 11% | Both β available |
| Ramucirumab β 2nd Line (AFP β₯400 ng/mL) | REACH-2 | 8.5 vs 7.3m (placebo) | 5% | Both β biomarker-selected (AFP β₯400) |
| Cabozantinib β 2nd/3rd Line | CELESTIAL | 10.2 vs 8.0m (placebo) | 4% | Both β specialist centres |
| Pembrolizumab β 2nd Line (PD-1 naΓ―ve) | KEYNOTE-224 | Durable responses; ORR 17% | 17% | Both β relevant if 1st line was TKI monotherapy |
PVTT Management and Downstaging: China's Multimodal Approach
Western guidelines classify HCC with portal vein tumour thrombus (PVTT) as BCLC Stage C β systemic therapy only. Chinese hepatobiliary centres treat PVTT aggressively with multimodal therapy, achieving median survival of 14β20 months vs 6β10 months with sorafenib alone.
- 1
Assess PVTT Type and Child-Pugh Status
Not all PVTT is equal. First-order branch involvement (Vp3) with Child-Pugh A and intact performance status is the most favourable scenario for aggressive treatment. Main portal trunk PVTT (Vp4) requires more complex planning. Imaging with triphasic CT or MRI and liver volumetry is essential before any treatment decision.
- 2
HAIC-FOLFOX: Intra-Arterial Chemotherapy
High-dose oxaliplatin + 5-FU + leucovorin delivered via indwelling hepatic artery catheter directly to the tumour and thrombus. Response rates 20β30% vs <15% with sorafenib (HAIC-FO trial). Can be combined with PD-1 inhibitors (sintilimab, camrelizumab) and anti-VEGF agents for enhanced response.
- 3
TACE or SIRT to Primary Tumour
Concurrent or sequential TACE targeting the primary hepatic tumour alongside HAIC for the thrombus. SIRT/Y-90 is safer than TACE in PVTT (radiation mechanism avoids ischaemia risk from embolisation of remaining hepatic artery supply when portal vein is blocked).
- 4
Restage at 4β8 Weeks: Assess Downstaging
Criteria for downstaging success: >50% tumour necrosis, falling AFP trend, absence of new lesions, and thrombus regression. Patients meeting downstaging criteria proceed to surgical planning. Future liver remnant calculation (FLR >40% for cirrhotic livers) guides resectability.
- 5
Conversion Surgery: Resection Β± Thrombectomy
Surgical resection of the downstaged primary tumour with thrombectomy of the residual PVTT. Chinese series (Zhongshan, West China, First Affiliated Sun Yat-sen) report conversion rates of 10β25% in unresectable HCC, with 3-year survival 40β55% post-resection. Portal vein embolisation (PVE) used pre-operatively if FLR remains insufficient.
Key Clinical Trial Evidence: Survival Outcomes
Two landmark first-line trials have established immunotherapy combinations as the new standard, replacing sorafenib. China's domestically developed camrelizumab + rivoceranib combination achieved the longest median OS in a first-line HCC trial to date.
IMbrave150 β Atezo-Bev vs Sorafenib (Advanced HCC, 1st Line)
Advanced HCC, Child-Pugh A, ECOG PS 0β1. N=501.
- Median OS β Atezolizumab + Bevacizumab19.2 months
- Median OS β Sorafenib13.2 months
CARES-310 β Camrelizumab + Rivoceranib vs Sorafenib (1st Line)
Both drugs China-developed. N=543. Longest median OS in any HCC 1st-line trial.
- Median OS β Camrelizumab + Rivoceranib22.1 months
- Median OS β Sorafenib15.2 months
HAIC-FO β HAIC-FOLFOX vs Sorafenib (Advanced HCC with PVTT)
Advanced HCC with portal vein tumour thrombus. Chinese randomised trial.
- Median OS β HAIC-FOLFOX13.9 months
- Median OS β Sorafenib8.2 months
Liver Cancer Treatment Costs: China vs India vs USA
Treatment costs in China and India are 70β90% lower than in the USA across all modalities. India's living donor transplant programme is particularly cost-effective; China's domestically developed immunotherapy agents (sintilimab, camrelizumab) represent the most affordable immunotherapy options globally for HCC.
| Treatment | China (USD) | India (USD) | USA (USD) |
|---|---|---|---|
| Hepatic resection (major) | 12,000β25,000 | 8,000β18,000 | 80,000β150,000 |
| Liver transplant (LDLT) | 45,000β70,000 | 25,000β45,000 | 300,000β500,000+ |
| TACE (per session) | 3,000β7,000 | 2,500β5,000 | 15,000β35,000 |
| SIRT / Y-90 (per treatment) | 18,000β30,000 | 15,000β25,000 | 40,000β80,000 |
| Thermal ablation (RFA/MWA) | 3,000β6,000 | 2,500β5,000 | 15,000β30,000 |
| Atezolizumab + bevacizumab (per cycle) | 3,500β6,000 | 3,000β5,500 | 20,000β30,000 |
| Sintilimab + bev biosimilar (per cycle) | 1,200β2,500 (China only) | N/A | N/A |
| Sorafenib / lenvatinib (per month) | 600β1,500 | 400β1,200 | 8,000β12,000 |
| Proton / heavy ion therapy (course) | 25,000β45,000 | 20,000β35,000 | 80,000β120,000 |
| Comprehensive NGS panel | 800β1,500 | 500β1,200 | 3,000β6,000 |
China vs India: Which Country for Which Patient?
CancerFax routes patients based on clinical need, not geography. China and India each have distinct strengths β understanding the difference enables the right match for each patient's specific situation.
China: For Complex Surgical and Advanced HCC
EHBH Shanghai: world's busiest liver surgical unit (4,000+ resections/year). Largest PVTT surgery series globally. HAIC-FOLFOX only available here. Conversion surgery expertise. Zhongshan Hospital: full HCC programme β surgery, interventional radiology, systemic oncology integrated. Shanghai Proton and Heavy Ion Center: proton and carbon ion therapy for HCC.
India: For Transplant, Cost-Sensitivity, and Regional Proximity
Medanta (Gurugram): Asia's busiest liver surgery and transplant programme. Living donor transplant (90% of cases) eliminates deceased-donor waiting time. Cost: USD 25,000β45,000 vs USD 45,000β70,000 in China. Geographically accessible from Bangladesh, Nepal, Sri Lanka, Pakistan, East Africa, Gulf. English-speaking clinical environment.
Both Countries Offer
TACE (cTACE and DEB-TACE), thermal ablation (RFA, MWA, cryoablation), atezolizumab + bevacizumab first-line systemic therapy, second-line TKI and immunotherapy options, laparoscopic hepatectomy for minor resections, surgical second opinion on resectability.
CancerFax Navigation Principle
China for: PVTT surgery, HAIC, conversion surgery, complex hepatic resection, heavy ion therapy, Chinese-developed IO agents. India for: living donor liver transplant, cost-sensitive programmes, South Asian patients, English-speaking environment. Written second opinion on resectability within 5β7 business days.
Frequently Asked Questions
Staging and Treatment Eligibility
I have been told my HCC is unresectable. Should I accept this conclusion?
Not necessarily β especially if this assessment was made at a general hospital or at a centre without a specialist hepatobiliary surgery programme. The definition of resectability in HCC has expanded significantly at high-volume Chinese and Indian hepatobiliary centres. Tumours that were considered unresectable a decade ago β large solitary HCCs greater than 10cm, multinodular disease within one lobe, HCC with limited portal vein thrombus in first-order branches β are now routinely resected at centres like EHBH Shanghai, Zhongshan Hospital, and West China Hospital, with survival outcomes substantially better than systemic therapy alone. Before accepting unresectability, CancerFax recommends requesting a written second opinion from a high-volume Chinese or Indian hepatobiliary centre, which can typically be completed within 5β7 business days with submission of imaging and pathology.
What is Child-Pugh score and why does it determine my treatment options?
The Child-Pugh score is a clinical scoring system that assesses the severity of liver disease and the functional reserve of the liver. It scores five parameters β serum bilirubin, serum albumin, prothrombin time (INR), presence and severity of ascites, and presence and grade of hepatic encephalopathy β on a scale of 1 to 3 each, giving a total score of 5 to 15. Child-Pugh A (5β6 points) indicates well-compensated cirrhosis with adequate reserve for major hepatectomy, aggressive TACE, and most systemic therapies. Child-Pugh B (7β9 points) indicates moderate impairment β major resection is generally contraindicated, limited TACE or ablation may be appropriate. Child-Pugh C (10β15 points) indicates decompensated liver disease β liver transplantation may be the only curative option, and most systemic therapies are contraindicated. Your Child-Pugh score, alongside BCLC stage, is the primary determinant of which treatments are safe for you.
TACE, HAIC, and Advanced HCC
I have HCC with portal vein tumour thrombus (PVTT). Western guidelines say only sorafenib. Is there more?
Yes β substantially more, and Western guidelines in this case do not reflect the full range of available treatment. PVTT is present in 30β40% of HCC patients in Asia, and Chinese hepatobiliary centres have developed and validated treatment approaches that significantly outperform systemic therapy alone. HAIC-FOLFOX β intra-arterial FOLFOX chemotherapy delivered directly to the tumour and thrombus β achieves response rates of 20β30% in PVTT patients, compared to less than 15% with sorafenib, and the HAIC-FO randomised trial showed superior PFS and OS vs sorafenib. In selected patients with Child-Pugh A status and PVTT limited to first-order portal branches, surgical thrombectomy combined with liver resection achieves median survival of 14β20 months vs 6β10 months with systemic therapy alone. SIRT/Y-90 is also a safer locoregional option than TACE in PVTT. If you have been told that sorafenib or lenvatinib is your only option, CancerFax strongly recommends a second opinion from a high-volume Chinese hepatobiliary centre before committing to systemic therapy as the primary approach.
What is the difference between TACE and HAIC, and which is better for my situation?
TACE (transarterial chemoembolisation) delivers chemotherapy intra-arterially combined with an embolising agent that blocks the tumour's blood supply, causing both chemotherapy exposure and ischaemic necrosis. It is the standard treatment for intermediate-stage (BCLC B) multinodular HCC without vascular invasion. HAIC (hepatic arterial infusion chemotherapy) delivers chemotherapy via an indwelling catheter in the hepatic artery continuously, without embolisation. HAIC-FOLFOX specifically uses oxaliplatin, 5-FU, and leucovorin intra-arterially at doses that could not be safely given systemically. HAIC is most useful in advanced HCC with PVTT (where TACE-related liver failure risk is elevated from embolising the hepatic artery when portal vein blood supply is compromised), in patients who have failed TACE, and as a downstaging strategy in patients with large or multinodular unresectable HCC. HAIC-FOLFOX is only available at Chinese centres. The choice between TACE and HAIC depends on BCLC stage, presence of PVTT, prior treatment history, and centre capability, and should be made at a multidisciplinary hepatobiliary tumour board.
Liver Transplantation and Access
My HCC is outside the Milan Criteria. Can I still get a liver transplant?
Potentially yes, through two pathways. First, downstaging β locoregional therapy with TACE, ablation, SIRT, or HAIC may reduce your tumour burden to within the Milan Criteria (single tumour <5cm or up to 3 tumours all <3cm). If you remain within criteria for a minimum observation period of 3β6 months, most transplant centres will proceed with evaluation. Second, some centres accept patients outside the Milan Criteria based on expanded criteria. Chinese transplant centres use the Hangzhou Criteria, which incorporates AFP level and histological grade in addition to tumour size, and have published series showing outcomes comparable to within-Milan patients in carefully selected beyond-Milan candidates. Indian transplant centres at Medanta and Apollo also consider beyond-Milan patients with downstaging. CancerFax can facilitate a formal transplant eligibility assessment at a named Chinese or Indian transplant centre based on your current imaging and pathology.
Why is India a better option than China for liver transplantation for South Asian patients?
India offers several advantages for South Asian patients specifically. Cost is the primary factor: liver transplantation in India costs USD 25,000β45,000 versus USD 45,000β70,000 in China and USD 300,000β500,000+ in Western countries. Geographic accessibility is significant β patients from Bangladesh, Nepal, Sri Lanka, Pakistan, and East Africa face substantially lower travel costs and less logistical complexity reaching Indian centres than Chinese centres. The living donor programme is India's most important structural advantage: with approximately 90% of transplants using a living donor (typically a family member), the waiting time problem of deceased-donor programmes is entirely eliminated. Language and cultural familiarity is also a factor β English is the working clinical language at major Indian transplant centres, reducing communication barriers. CancerFax facilitates the evaluation at both Chinese and Indian transplant centres and recommends the most appropriate option based on each patient's specific clinical situation, logistics, and budget.
How CancerFax Helps
CancerFax is a specialist cancer access and patient-navigation platform. We help patients and families understand their options, organise medical records, coordinate hospital communication, and support cross-border treatment planning where appropriate.
We help collect and organise reports, scans, pathology, biomarker results, and treatment history for structured case review.
We communicate with hospitals or trial teams to assess whether a case may be suitable for further screening.
We support appointment coordination, document submission, translation, and direct communication with international departments.
For international patients, we help with practical coordination β travel planning, hospital admission guidance, and local support.
If this option is not suitable, we help explore other relevant treatments, clinical trials, or advanced care pathways.
From inquiry through to follow-up, our coordinators provide a single point of contact for the family.
CancerFax does not guarantee treatment access, eligibility, or clinical outcome. Our role is to help patients access accurate information, structured review, and appropriate specialist pathways.
Ready to Access Expert Liver Cancer Treatment in China or India?
Upload your imaging (DICOM), pathology report, AFP levels, and prior treatment history. CancerFax will assess your case, determine whether surgery, transplantation, TACE, HAIC, or systemic therapy review is the priority, and connect you with the right specialist β with a written second opinion available within 5β7 business days.
This content is for informational purposes only and does not constitute medical advice. Liver cancer treatment is highly individualised and depends on BCLC stage, Child-Pugh score, tumour characteristics, and prior treatment history. All decisions must be made in consultation with a qualified hepatobiliary oncology specialist.