Which therapy is typically used for stage B hepatocellular carcinoma (intermediate stage)?

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In intermediate-stage hepatocellular carcinoma, the goal is to control multiple liver tumors while preserving liver function, using a liver-directed, regional therapy. Transarterial chemoembolization fits this purpose because it delivers chemotherapy directly to the tumor via the hepatic artery and then blocks the arterial blood flow to the tumor. This combination both exposes the tumor to high local chemotherapy and induces ischemia, leading to tumor necrosis. It’s particularly suitable when there are several nodules but the liver remains functionally capable and there’s no vascular invasion or extrahepatic spread, making surgical removal less feasible.

Resection is typically reserved for patients with a single lesion and good liver reserve, where removing the tumor can be curative. Systemic therapy is more appropriate for advanced disease or when TACE isn’t possible, and palliative care is focused on comfort in incurable, end-stage scenarios.