China is a large country with hepatitis B. Almost one out of every 10 people is a hepatitis B carrier. Chronic hepatitis B, liver cirrhosis and liver cancer are like a “trilogy of death”, threatening hepatitis B patients all the time. With the improvement of disease prevention and defense level and the improvement of people’s concept, the transmission of hepatitis B has been declining, but there is still a large base of patients facing the challenge of hepatitis B. In this article, the author focuses on the diagnosis and treatment of primary hepatocellular carcinoma based on his own experience in medical practice. This article is divided into two parts: first, the diagnosis of primary liver cancer; second, the treatment of primary liver cancer. First, we will talk about the diagnosis of primary liver cancer. When it comes to diagnosis, there must be certain bases, which include clinical manifestations, physical examination, laboratory examination, imaging examination and pathological examination. (a) Clinical manifestations of primary liver cancer: from early stage to late stage, the manifestations are diverse and difficult to be summarized, mainly the following manifestations: early stage, there may be no obvious symptoms, and some patients only show weakness and poor appetite, which is difficult to attract sufficient attention; further progress, there may be abdominal pain, abdominal distension and wasting, if the tumor is located in the left outer lobe of liver, it is often mistaken for stomach disease, and if it is located in the right lobe, some patients also mistake it for cholecystitis. When the disease becomes more serious, jaundice, fever, ascites, swelling of lower limbs and other symptoms may appear, and even abdominal masses may be felt by themselves and mental symptoms may appear. It is worth noting that some patients visit the hospital for sudden onset of severe abdominal pain, mostly due to bleeding caused by tumor rupture, which requires emergency embolization treatment. (2) Physical examination: how is the mental condition, whether the reaction is normal; whether there is chronic disease face, whether there is yellow stain on the skin and sclera, whether there is rash, whether there is spider mole, whether there is liver palm, whether there is superficial varicose vein. Whether there is pressure pain and rebound pain on abdominal palpation; how is the texture of the liver and whether a mass can be palpated; whether the spleen is palpable and whether it is enlarged; whether the mobile turbid sound is positive; whether there is pressure pain in the gallbladder fossa area. Whether there is edema in the lower limbs. (iii) Laboratory tests: The most important tumor indicator is methemoglobin. If there is a history of chronic hepatitis and elevated fetoprotein within a short period of time, the possibility of hepatocellular carcinoma should be highly suspected. However, there are some patients who do not have elevated fetoprotein. It is recommended that patients with chronic hepatitis B, especially cirrhosis, should have regular medical checkups to detect problems and solve them. (iv) Imaging tests: there are more selective ones, including: CT, PET-CT, MRI, ultrasound and so on. Among the many examination methods, I think MRI has obvious advantages in detecting liver cancer. However, it does not exclude the possibility of missing the diagnosis. For nodules less than 0.5mm, the possibility of missing the diagnosis is higher with any examination. It should be emphasized that for primary liver cancer, the advantage of PET-CT is not obvious, because the metabolism of FDG (PET-CT imaging agent) is not increased by the tumor, so it may not be shown. (E) Pathological examination: There are many pathological classifications of primary hepatocellular carcinoma, including hepatocellular type, bile duct cell type, mixed type, and fibrous lamellar type. Among them, the hepatocellular type has better interventional efficacy, while the cholangiocellular type is inferior. I would like to share my personal thoughts on the treatment of primary liver cancer. (1) Treatment options: At present, the treatment options are still mainly surgical procedures, and others include hepatic artery embolization chemotherapy, radiofrequency ablation, alcohol ablation, microwave ablation, cryoablation, radioactive particle implantation, biological therapy and targeted therapy. Among the many treatment methods, minimally invasive interventional therapy is increasingly recognized by patients and doctors. The treatment methods carried out in our department include hepatic artery embolization chemotherapy, radiofrequency ablation, alcohol ablation, radioactive particle implantation and targeted drug therapy. (2) How to choose: The choice of many options needs to be standardized and individualized, by integrating the indicators and the general condition of the patient. In short, for small single lesions, surgery and radiofrequency ablation can be chosen; for large single lesions without vascular invasion, hepatic artery embolization chemotherapy, surgery or surgery after TACE can be chosen; for single lesions with existing cancer thrombus, hepatic artery embolization chemotherapy or oral targeted therapy with Doxorubicin is recommended; for multiple lesions in the liver, hepatic artery embolization chemotherapy is recommended; for those with distant metastases, oral Doxorubicin is recommended. For those with distant metastases, oral targeted therapy with Doxorubicin is recommended, supplemented by hepatic artery embolization chemotherapy. (c) A little personal experience: for patients with severe cirrhosis, even if imaging shows a single lesion, hepatic artery embolization chemotherapy is recommended first, followed by surgery or radiofrequency ablation. Because this type of patients are mostly cirrhotic regenerative nodules with malignant onset, it is possible that other invisible lesions in the liver may be further confirmed by iodine CT. (D) Daily attention: adequate rest, rich nutrition, especially appropriate intake of high-quality protein (lean meat, fish, sea cucumber, egg whites), cut off smoking and alcohol! (5) A bit of advice: don’t take drugs indiscriminately, especially drugs containing hormones, which may make you feel better in the short term and improve your appetite, but will make the tumor grow explosively. A little immature personal opinion, please correct me.