Treatment Options by Stage

The Barcelona Clinic Liver Cancer (BCLC) staging system is a widely recognized staging system to help determine the appropriate treatments for patients with any stage of HCC.

How to Refer Hepatocellular Cancer (HCC) Patients to Provincial Liver Tumour Rounds (VGH/BCC)

To refer a patient for review at Provincial Liver Tumour Rounds, please see the referral process and complete the referral form.

Very Early Stage

Patients must have ECOG Performance Status 0 and Child-Pugh A liver function
Tumours must be less than 2 cm and confined to one lobe of the liver, with absence of vascular invasion and extra-hepatic disease, and complete removal of the tumour with a margin of greater than 1 cm is anticipated
Recommended treatment is ablation or resection if ablation is not possible (see above)
There is no role adjuvant chemotherapy or radiotherapy

Early Stage

Patients must have ECOG Performance Status 0 and Child-Pugh A liver function
Tumours must be confined to one lobe of the liver or up to three nodules all less than 3 cm, with absence of vascular invasion and extra-hepatic disease, and complete removal of the tumour with a margin of greater than 1 cm is anticipated
A solitary tumour of any size may be considered for resection provided the liver function is satisfactory and there is an adequate future liver remnant
Recommended treatment is surgical with resection or in certain circumstances liver transplantation. Alternatively, local treatment with radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI) can be used for patients with tumours less than 3 cm that are not surgical/transplant candidates or refuse surgery

Intermediate Stage

Patients must have ECOG Performance Status 0, Child-Pugh A liver function or selected patients with Child-Pugh B liver function and have adequate renal (liver?) function
Tumours are multinodular with absence of extra-hepatic disease, with patency of the main portal vein
Recommended treatment is locoregional with trans-arterial chemo-embolization (TACE) or trans-arterial radio-embolization (TARE - see UGIYTT)
Stereotactic Ablative Radiotherapy (SABR) is also an option
No role for adjuvant chemotherapy, although clinical trials are underway

Advanced Stage

Patients being considered for systemic treatment must have ECOG Performance Status 0, 1 or 2 and Child-Pugh A liver function
These patients with HCC are ineligible for, or have progressed after, surgical or locoregional therapy
Palliative systemic therapy may be given to help improve symptoms and quality of life, and extend survival in appropriately selected patients
Currently approved systemic agents for HCC include: sorafenib (see UGISORAF) and doxorubicin (see GIA)
Consider treatment on a clinical trial, if available
Palliative radiotherapy for pain control
Symptom management, best supportive care, and involvement of palliative care services as indicated by patient’s clinical status

Terminal Stage

Patients with ECOG Performance Status greater than 2 and/or Child-Pugh C liver function
Palliative chemotherapy may adversely affect outcome
Palliative radiotherapy for pain control
Symptom management, best supportive care, and involvement of palliative care services highly recommended