The short answer
NCI lists how well the liver works, including the Child-Pugh score, among the factors in liver cancer treatment. Some tumors can be 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, when the scan shows arterial uptake followed by washout.
NCI says spots under 1 cm found on screening in high-risk people do not need further diagnostic evaluation; close follow-up at 3-month intervals with the same scan is advised.
The Milan criteria are one tumor smaller than 5 cm, or two to three tumors each smaller than 3 cm, and NCI recommends transplant when surgery is ruled out by multiple small tumors or impaired liver function.
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This page is for people with liver cancer (hepatocellular carcinoma) and those helping them. It explains how the choices are made and what to ask your care team.
The plan follows the liver, not just the tumor
In liver cancer the liver itself matters as much as the tumor. NCI names 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 as the factors behind treatment choice.
NCI points to the Child-Pugh score as a measure of liver function. Ask what yours is, since it is likely to come up as you weigh options.
Does this need a biopsy?
Sometimes not, for people who already have cirrhosis (heavy scarring of the liver) or another risk factor for liver cancer, with a spot larger than 1 cm. NCI says triple-phase contrast CT or MRI can be used to diagnose liver cancer in that setting.
The scan is taken in phases after contrast goes in. NCI describes the pattern as arterial uptake followed by washout, meaning the spot lights up early and then fades on later images. If the first scan is not conclusive, NCI notes that a second imaging test of a different type raises detection, from 33% to 41% for one test to 76% for both together.
NCI says a biopsy can be considered when a lesion larger than 1 cm is still unclear after two imaging tests. 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 further diagnostic evaluation. It advises close follow-up at 3-month intervals, using the same scan that found them.
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.
NCI recommends transplant when surgery is ruled out by multiple small tumors (up to 3, each up to 3 cm) or by impaired liver function (Child-Pugh class B or C).
Ask whether you meet the criteria, and whether a transplant center should assess you now rather than later.
Cutting, burning or blocking
Partial hepatectomy removes the part of the liver holding the tumor. Ablation removes or destroys tissue, for example with heat, freezing or alcohol injection. Chemoembolization blocks the artery feeding the tumor while an anticancer drug is given.
NCI reports a meta-analysis finding that chemoembolization improves survival more than supportive treatment alone.
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 or hepatitis while cancer treatment goes on.
Ask how the two plans will be kept in line if they 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 center 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):
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. NCI names liver function and the Child-Pugh score among the factors that affect prognosis and treatment. Ask what yours is before you weigh surgery, ablation or chemoembolization.
When is a transplant considered?
NCI recommends it when surgery is ruled out by multiple small tumors or impaired liver function (Child-Pugh class B or C). Ask whether you meet the Milan criteria and whether a transplant center should assess you.
Who manages my liver disease during cancer treatment?
Ask who is managing your cirrhosis or hepatitis while cancer treatment goes on, and ask how the two plans will be kept in line.
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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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, and this 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 then compared with the sources listed on it, looking for statements those sources do not back up. That check is not a sentence-by-sentence record and can miss errors. 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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