The short answer
Liver cancer is the unusual case where the organ is often as sick as the tumor, so the Child-Pugh score shapes every choice. Many tumors are diagnosed on triple-phase scanning without a biopsy, and transplant is judged by the Milan criteria.
Treatment choice depends on the size and number of tumors, whether blood vessels are involved, whether it has spread, how well you are, and how well the liver works.
For someone at risk with a liver spot over 1 cm, triple-phase contrast CT or MRI can make the diagnosis, because the tumor lights up in the arterial phase.
Spots under 1 cm found on screening in high-risk people do not need immediate workup; close repeat imaging, commonly around every three months, is a usual strategy.
The Milan criteria are one tumor smaller than 5 cm, or two to three tumors each smaller than 3 cm, and transplant treats the tumor and the cirrhosis at once.
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The full explanation.
The plan follows the liver, not just the tumor
Liver cancer is the unusual case where the organ is often as sick as the tumor. NCI says treatment choice depends on the size and number of tumors, whether blood vessels are involved, whether it has spread, how well you are, and how well the liver works.
Liver function is graded with the Child-Pugh score. Ask what yours is. It will come up in every decision that follows.
Does this need a biopsy?
Often not, but only for a particular group: people who already have cirrhosis, chronic liver disease or another risk factor for liver cancer, with a spot larger than 1 cm. NCI says triple-phase contrast CT or MRI can make the diagnosis in that setting. Outside it, imaging alone does not settle the question.
The scan is taken in phases after contrast goes in. Lighting up in the arterial phase is only half of the pattern radiologists look for: the lesion also has to fade below the surrounding liver on the later venous images, which is called washout. Arterial enhancement on its own does not make the diagnosis. If the first scan is not conclusive, NCI notes that a second imaging test of a different type raises detection substantially. Many centres report these scans through the structured LI-RADS categories, so ask which category yours was given.
NCI says a biopsy can be considered when the pattern is not clear. Ask which situation you are in.
Small spots found on screening
NCI says spots under 1 cm found on screening in high-risk people do not need immediate workup. Most turn out to be scarring rather than cancer.
A common approach is close follow-up at roughly three-month intervals, using the same scan that found them, though intervals in the range of three to six months are also used and your hepatologist sets yours. Ask what your interval is, and what would end the watching.
Transplant and the Milan criteria
NCI states the criteria plainly. One tumor smaller than 5 cm, or two to three tumors each smaller than 3 cm.
Transplant is considered when surgery is ruled out by multiple small tumors, or by a liver too damaged to withstand an operation. It is the only treatment that deals with the tumor and the cirrhosis at once.
Ask whether you meet the criteria, and whether a transplant centre should assess you now rather than later.
Cutting, burning or blocking
Surgery removes the part of the liver holding the tumor. Ablation destroys it in place. Chemoembolization blocks the artery feeding it while delivering drug.
NCI reports a systematic review finding that chemoembolization improves survival in liver cancer that cannot be removed.
Ask which of these fits your tumor and your liver, and what recovery looks like for each.
Who looks after the liver disease
Ask who manages your cirrhosis and your hepatitis while cancer treatment goes on. In many places that is a liver specialist working with the cancer team.
Ask what happens if the two plans conflict.
Questions for the liver cancer clinic
- What is my Child-Pugh score?
- Can this be diagnosed on imaging, or do I need a biopsy?
- How many tumors are there, and how big?
- Do I meet the Milan criteria for transplant?
- Should I be referred to a transplant centre now?
- Is surgery, ablation or chemoembolization the better fit?
- Who is looking after my liver disease during all this?
Related pages
Cancer Staging and Biomarker Testing explain the terms used in a liver cancer treatment discussion. Clinical Trial vs Standard Treatment, Palliative Care, and Questions to Ask Your Doctor help you prepare for the liver cancer appointment itself.
Where this comes from
These questions were drawn from current patient guidance for liver cancer (hepatocellular carcinoma):
Words to know
Tap any term to see what it means.
Common questions
Do I need a biopsy to confirm liver cancer?
Often not, if you already have cirrhosis or another liver-cancer risk factor and the spot is over 1 cm. The scan has to show both arterial enhancement and venous washout. NCI says a biopsy can be considered when the pattern is not clear.
Why does my Child-Pugh score keep coming up?
It grades how well the liver is working, and it enters every decision that follows. Ask what yours is before you weigh surgery, ablation or chemoembolization.
When is a transplant considered?
When surgery is ruled out by multiple small tumors, or by a liver too damaged to withstand an operation. Ask whether you meet the Milan criteria and whether a transplant centre should assess you now.
Who manages my liver disease during cancer treatment?
In many places a liver specialist works alongside the cancer team on your cirrhosis and hepatitis. Ask who that is, and ask what happens if the two plans conflict.
Questions to ask your doctor
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Sources last checked: 2026-07-30 what this meansLast updated: 2026-08-19Next planned review: 2027-07-30
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How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and checked line by line against the sources listed on it. That confirms the sources support what the page says. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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