Cancer types · Common solid tumours
Liver & Biliary Cancers
This group includes hepatocellular carcinoma (HCC), which arises in liver cells, and biliary tract cancers: cholangiocarcinoma and gallbladder cancer. They differ substantially in their biology and in the role of molecular testing.
For HCC, the underlying liver condition, such as hepatitis B or C, fatty liver disease or alcohol-related disease, is central. Biliary tract cancers more often carry targetable alterations. Gallbladder cancer is reported more often in parts of northern and north-eastern India than in many other regions.
Clinical and molecular questions that often arise
- Which cancer type is it, and is the diagnosis confirmed by imaging, pathology or both?
- For HCC, how well is the liver functioning, and what is the underlying cause?
- For biliary cancers, has molecular profiling looked for FGFR2 fusions, IDH1 mutations, HER2 and other alterations?
- Are there trials relevant to the specific subtype and molecular findings?
Information that may be part of an individual assessment
- Liver imaging with contrast; HCC may sometimes be diagnosed by imaging criteria in cirrhosis.
- Biopsy and histopathology where needed.
- Liver function assessment and viral hepatitis status.
- Molecular profiling, particularly for biliary tract cancers.
Which investigations are appropriate is decided by the treating team for each person.
Molecular profiling and biomarker interpretation
Depending on the setting, molecular and biomarker questions in liver & biliary cancers may involve:
- FGFR2 fusions (intrahepatic cholangiocarcinoma)
- IDH1 mutations
- HER2 amplification (gallbladder and extrahepatic bile duct)
- BRAF V600E
- MSI-high status and NTRK fusions (rare)
- AFP in HCC, interpreted in context
Biomarkers, panels and available tests vary by subtype, disease setting, assay and guideline version. A detected alteration is not automatically actionable.
How KPCIRC pathways may apply
POAS
POAS may be particularly relevant for biliary tract cancers, where reports more often include alterations with targeted-therapy evidence, together with access questions in India.
Molecular Tumour Board
MTB discussion may help where liver function, tumour biology and treatment options all need to be considered together.
Second opinion and progression review
A second opinion may help clarify diagnosis, staging or eligibility for local therapies. Progression review can organise imaging and treatment history.
Hereditary risk and screening
Hereditary predisposition is not common in these cancers, although some inherited variants have been reported in biliary tract cancers. A risk assessment can help where family history raises questions.
How to access the relevant pathway
Patients and families
- Talk to your treating oncologist about whether an additional review may help.
- Request a consultation and tell us which question you want answered.
- Share records only when asked, through the secure route.
Referring doctors
- Define the clinical question and the pathway: POAS, MTB, second opinion or progression review.
- Start a case enquiry without patient identifiers.
- Scope, fees and timing are confirmed before any review proceeds.
Questions and limitations
Why is liver function so important?
In HCC the liver is both the site of cancer and the organ that processes many treatments. Liver function shapes which options can be discussed.
Should biliary cancers have molecular testing?
Molecular profiling is often discussed in advanced biliary tract cancer because targetable alterations are found more often. The treating team decides what is appropriate.
Does this page apply to my situation?
This page is educational. It explains common questions but cannot account for individual circumstances. Your treating clinician is best placed to interpret your reports and plan your care.
Educational content reviewed against the KPCIRC service scope. It is not a diagnosis, a treatment recommendation or a statement that a specialist or service is available for this cancer type.