Liver Cancer (Hepatocellular Carcinoma)

Risk factors: cirrhosis (any cause), chronic hepatitis B (even without cirrhosis), heavy alcohol use, MASLD/MASH, aflatoxin exposure (contaminated grains/nuts), family history.

Rising in Saudi Arabia, mainly due to MASLD-related cirrhosis and chronic hepatitis B. The 6th most common cancer globally and the 3rd leading cause of cancer death.

Saudi tertiary centers offer all standard HCC treatments including transplantation, TACE, and Y-90. Tumor boards are standard. MOH covers most treatments; some immunotherapies require pre-authorization.

Surveillance: liver ultrasound + AFP every 6 months in at-risk patients (cirrhosis, chronic hepatitis B). Suspicious lesion → triple-phase CT or MRI with contrast — radiologic features alone often diagnose HCC without biopsy. Biopsy if imaging is uncertain.

Prevention is best — and surveillance saves lives.

• Get surveillance ultrasound + AFP every 6 months if you have cirrhosis or chronic hepatitis B.

• Treat underlying liver disease aggressively.

• Stop alcohol completely.

• Vaccinate against hepatitis A and B.

• Avoid moldy nuts and grains (aflatoxin).

Mediterranean diet plus underlying disease management.

• Mediterranean pattern, no alcohol.

• Coffee 3-4 cups daily — modestly protective.

Treatment depends on stage — discussed at multidisciplinary tumor board.

• First-line systemic for advanced HCC: atezolizumab + bevacizumab, or tremelimumab + durvalumab.

• Tyrosine kinase inhibitors: lenvatinib, sorafenib (older first-line), regorafenib, cabozantinib (later lines).

• Treat underlying hepatitis to slow tumor recurrence.

Curative treatments for early-stage disease.

• Surgical resection — for solitary tumors with good liver function.

• Liver transplantation — best curative option for early HCC in cirrhosis (within Milan criteria).

• Local ablation (radiofrequency, microwave) — for small tumors not suitable for surgery.

• TACE (transarterial chemoembolization) — for intermediate stage.

• Y-90 radioembolization — emerging option.

• Surveillance ultrasound + AFP every 6 months.

Multiple new immunotherapy and targeted therapies in the past 5 years (atezolizumab + bevacizumab, tremelimumab + durvalumab, lenvatinib, regorafenib, cabozantinib). Survival in advanced HCC has improved substantially.

When found small (<3 cm) on surveillance: 5-year survival >70% with curative treatment. When found late: median survival ~6-12 months but improving with new immunotherapy. Surveillance is the single most important factor.

• What stage is my HCC?

• Am I a candidate for transplantation?

• Should I get systemic immunotherapy?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the SGA Hepatology Panel. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.