Most hepatocellular carcinoma guidance assumes transplant programmes, routine MRI and every systemic agent on the shelf. The International Hepato-Pancreato-Biliary Association has produced a consensus guideline aimed at hospitals without them, through a global working group and online webinars.
Diagnosis can start with ultrasound, confirmed by cross-sectional imaging, with alpha-fetoprotein and liver synthetic function at baseline; biopsy is not required. Resection is the preferred treatment for a single tumour, or up to three lesions of 3 cm or less, where liver function is preserved. Radiofrequency and microwave ablation are treated as equivalent when resection is not available, and ethanol injection is acceptable for small lesions if thermal ablation is not. Transarterial chemoembolisation or bland embolisation suits intermediate-stage disease. First-line systemic therapy is atezolizumab with bevacizumab, with sorafenib or lenvatinib as alternatives.
The value is in permission: it sets out what good care looks like with fewer tools, rather than defaulting to supportive care when the ideal pathway is out of reach. This is consensus, not new trial evidence.
For Indian general and HPB surgeons, much of this matches what district and many tertiary centres can deliver, and it gives a defensible framework when the full Western pathway is not available.
- Start HCC work-up with ultrasound, then confirm with CT or MRI where available
- Check alpha-fetoprotein and liver synthetic function at diagnosis
- Biopsy is not mandatory when imaging is typical
- Offer resection for a single HCC or up to three lesions of 3 cm or less with preserved liver function
- Use ethanol injection for small lesions only when thermal ablation is unavailable
Why it matters
It replaces the assumption that limited resources mean palliation only.
Don't overread it
This is consensus guidance built by discussion, not new trial evidence.
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