Hepatocellular carcinoma treatment is determined by more than tumor size or number. The German liver-cancer team must assess tumor stage together with liver function, portal hypertension, performance status, vascular invasion, extrahepatic spread and whether a curative local treatment or transplant pathway is realistic. German university liver-cancer centers publish multidisciplinary options including resection, thermal ablation, transarterial treatment, radiation, systemic therapy and selected transplant-related strategies. International patients should therefore request a liver-cancer tumor-board review rather than one procedure in isolation.
Confirm that the tumor is HCC and assess the underlying liver
HCC often develops in a chronically diseased liver, so the same tumor burden can lead to different treatment choices depending on liver reserve and portal hypertension. The German review should include current liver imaging, laboratory results and the background liver diagnosis rather than treating HCC as an ordinary solid tumor in an otherwise normal organ.
Tumor stage and liver function must be considered together
Freiburg's current HCC pathway and Heidelberg's Liver Cancer Center use multidisciplinary review to select among local, surgical, transarterial, radiation and systemic options. Important factors include tumor number and size, vascular invasion, extrahepatic disease, liver function and general condition. A procedure that is technically possible may still be the wrong oncologic or liver-preserving choice.
Resection can be curative in carefully selected patients
Freiburg lists surgical treatment including minimally invasive approaches within its HCC program. Resection requires enough future liver reserve and appropriate tumor anatomy. The liver team should explicitly assess whether surgery, ablation or another pathway offers the best balance of cancer control and preservation of liver function.
Thermal ablation is a local option for selected tumors
Freiburg documents radiofrequency and microwave ablation, while Heidelberg's interventional radiology program publishes RFA among minimally invasive liver-tumor treatments. Tumor size, number, location near vessels or bile ducts and liver function influence whether ablation is suitable and whether another local or surgical approach is preferred.
TACE and TARE/SIRT are transarterial treatments, not interchangeable defaults
Freiburg's current pathway includes TACE and TARE/SIRT for stage-appropriate HCC and specifies tumor-board selection. Charité also documents TACE for hypervascular HCC. Choice of a transarterial treatment depends on stage, vascular anatomy, liver reserve, prior treatment and the wider plan, including whether the goal is disease control, downstaging or bridging.
Radiation can be part of selected liver-cancer pathways
Freiburg lists stereotactic body radiation therapy (SBRT), while Heidelberg coordinates radiation oncology within its Liver Cancer Center. Radiation planning must account for target geometry and normal-liver tolerance and should be discussed alongside other local options rather than promoted as universally superior.
Transplant evaluation is a separate specialist pathway
For selected HCC in the setting of chronic liver disease, liver transplantation can address both the cancer and the diseased liver. Eligibility depends on tumor burden, biology, liver disease, comorbidities and transplant criteria. International patients should not assume that being technically operable or having a small tumor automatically means transplant is available or appropriate.
Advanced HCC can require ongoing systemic treatment
Freiburg documents intravenous immunotherapy and oral tyrosine-kinase inhibitor treatment in its HCC program. Modern systemic treatment changes over time and can depend on liver function, bleeding risk, prior local treatment and disease pattern, so the hospital should provide a current specialist recommendation rather than a static drug list.
Records to send before travelling
A useful liver-cancer review should allow the team to assess both cancer stage and hepatic reserve.
- Multiphasic contrast CT or MRI of the liver in DICOM format
- Radiology reports describing lesion number, size and vascular invasion
- Chest and other staging imaging when already performed
- AFP and current liver laboratory results
- Bilirubin, albumin, INR and platelet count
- Underlying liver disease, hepatitis status and previous decompensation history
- Prior ablation, TACE/TARE/SIRT, surgery, radiation or systemic-treatment details
- Pathology if biopsy or previous surgery has provided tissue
- Current medication and major cardiovascular/renal conditions
- A clear question about resection, ablation, transarterial treatment, transplantation or systemic therapy
Response assessment and liver follow-up continue after treatment
Freiburg's HCC quality pathway explicitly includes standardized response assessment after ablation or transarterial treatment. Before returning home, clarify the imaging timetable, liver-function monitoring, management of cirrhosis or viral hepatitis and when the German tumor board wants the case reviewed again.
Sources and review
This guide was last source-reviewed on 2026-08-30.
- Hepatocellular carcinoma – treatment spectrum and tumor board — University Medical Center Freiburg ↗
- HCC Clinical Pathway 2025/2026 — University Medical Center Freiburg ↗
- Liver Cancer Center Heidelberg — Heidelberg University Hospital ↗
- Interventional Radiology – RFA, TACE and SIRT — Heidelberg University Hospital ↗
- TACE for hepatocellular carcinoma — Charité – Universitätsmedizin Berlin ↗