Hepatocellular carcinoma (HCC), also referred to as liver cell carcinoma, is a malignant tumor arising from hepatocytes. It is the most common primary malignant neoplasm of the liver worldwide and accounts for approximately 75-85% of all primary liver cancers. Globally, HCC is among the leading causes of cancer-related mortality. In Germany, approximately 9,000-10,000 people are newly diagnosed with HCC
each year. In more than 80-90% of cases, HCC develops in the setting of pre-existing liver cirrhosis or chronic hepatitis.
The peak incidence occurs between 60 and 70 years of age; men are affected approximately three times more frequently than women.
Fibrolamellar HCC is a rare subtype that typically occurs in young adults without underlying liver disease. It has a distinct biological profile, often reaches a considerable size before symptoms develop, and is associated with a more favorable prognosis than conventional HCC.
Hepatocellular carcinoma is frequently asymptomatic at an early stage, particularly when detected within a surveillance program for patients with cirrhosis. Clinical symptoms usually develop only when tumor burden increases or the disease becomes more advanced.
HCC is one of the few solid tumors for which, under defined circumstances, a diagnosis based on imaging alone can be guideline-concordant without biopsy, provided that the characteristic contrast-enhancement pattern - arterial-phase enhancement with portal venous washout - is present in a cirrhotic liver.
HCC is classified according to the Barcelona Clinic Liver Cancer (BCLC) system - the internationally established staging system that integrates tumor characteristics, liver function, and the patient's general condition:
Treatment selection in HCC is complex and depends not only on the tumor itself but, crucially, also on the underlying liver function. The decision as to which treatment is most appropriate for an individual patient is made within an interdisciplinary tumor board involving hepatology, visceral surgery, interventional radiology, oncology, and radiosurgery.
Heat is generated by electromagnetic microwaves. Advantages over RFA include:
Tumor destruction through extreme cold. It may be advantageous for perivascular tumors and for tumors close to sensitive structures such as the bile ducts. Cryoablation is used considerably less frequently than RFA or MWA.
Catheterization of the hepatic artery with selective visualization of the tumor-feeding arteries, followed by administration of a chemotherapeutic agent, for example doxorubicin, and subsequent embolization of the tumor vessels.
TARE = Transarterial Radioembolization.
SIRT = Selective Internal Radiation Therapy.
The two terms are generally used synonymously.
Systemic therapies are used primarily in:
Following progression on first-line therapy:
Stereotactic radiosurgery (SBRT/SABR) has become established as an effective and safe treatment option for hepatocellular carcinoma. With CyberKnife, very high radiation doses can be delivered to the tumor with millimeter-level precision while maximizing protection of the healthy liver, gallbladder, stomach, and bowel.
The straightforward CyberKnife treatment improves patient comfort and quality of life. Because the procedure is non-invasive, there are no surgery- or anesthesia-related risks such as those associated with an operative intervention. Many patients can resume their usual daily activities immediately after treatment.
At the ERCM, we have been successfully treating patients for more than 20 years. Current studies report local control rates of 80-95% at 2 years for SBRT in HCC, comparable with thermal ablation in appropriately selected patients. Treatment is generally delivered in 3-6 sessions, each lasting approximately 20 minutes.
HCC is a primary liver tumor - it arises from the liver cells themselves. Liver metastases, by contrast, are secondary tumor deposits from other malignancies, such as colorectal, breast, or lung cancer, that have spread to the liver. The two conditions differ fundamentally in terms of diagnosis, treatment, and prognosis. HCC almost always occurs in association with pre-existing liver disease.
Liver cirrhosis is characterized by years of chronic inflammation, cell death, and regeneration. During this process, genetic alterations may accumulate and ultimately result in malignant transformation. In addition, the fibrotic remodeling of the liver creates a microenvironment that promotes tumor development. For this reason, patients with liver cirrhosis undergo regular surveillance.
Bridging refers to therapeutic measures used to control HCC while a patient is awaiting a donor organ and to prevent the tumor from progressing beyond accepted transplantation criteria, such as the Milan criteria. In addition to TACE (transarterial chemoembolization) and thermal ablation, radiosurgery with CyberKnife® is an established bridging option with high local control rates and good tolerability.
Radiosurgery for HCC is performed on an outpatient basis and generally does not require prolonged physical restrictions. Following treatment, regular imaging follow-up with MRI or CT and serial AFP measurements are required, as the treated tumor tissue undergoes reorganization over a period of months. A transient increase in lesion size on imaging (pseudoprogression) may occur and must not be mistaken for tumor growth. All follow-up intervals are individually coordinated with the treating physician.
Hepatocellular carcinoma (HCC) cannot be reliably diagnosed or excluded on the basis of blood tests alone. The most important tumor marker is alpha-fetoprotein (AFP), which may be elevated in HCC but is not elevated in every case. In addition, liver parameters such as AST, ALT, gamma-GT, alkaline phosphatase, and bilirubin may be abnormal, but they are not specific for malignancy. In advanced disease, laboratory evidence of impaired hepatic synthetic function may also be present. The
definitive diagnosis is based primarily on imaging (ultrasound, CT, MRI) and, where indicated, biopsy.
As treatment options have become increasingly complex, the decision in favor of a particular therapy should always take your individual life circumstances into account. It is important to us that you, your family members, and those close to you who support and accompany you fully understand and are able to assess all aspects of your disease and the available treatment options. Together with our medical partners, we accompany you throughout this process and ensure with our team that you feel well cared for at the ERCM from the very beginning.
For treatment enquiries, please use the contact form. You can also reach us by telephone during our opening hours or through our social media channels. Your enquiry will be reviewed individually and processed promptly.