Hepatocellular carcinoma is the most prevalent type of primary liver tumor, and its incidence has been rising in recent years.Portal vein involvement is one of the most concerning complications of HCC, making early diagnosis crucial. This condition is linked to a poor prognosis, as it is strongly associated with intrahepatic metastasis and tumor recurrence. Even with the best supportive care, patients typically have only a few months of overall survival. In this condition, treatment options are limited, and the best therapeutic approach remains highly debated. Surgery with curative intent is often technically difficult, and liver transplantation is generally contraindicated. PVTT is associated with aggressive tumor biology, a substantial tumor load, elevated serum marker levels, impaired liver function, and a poor overall patient condition.Several factors have been recognized as independent risk contributors to PVTT in patients with HCC: presence of liver cirrhosis, elevated serum alkaline phosphatase levels, tumor size exceeding 8 cm, incomplete tumor capsule, invasion of adjacent organs.Currently, PVTT is classified using two systems: the Japanese VP classification and Cheng’s classification. Research suggests that Cheng’s classification is more suitable for evaluating disease progression, guiding treatment decisions, and determining prognosis in PVTT patients. As a result, it is the preferred method for assessing the extent of PVTT.Cheng’s classification categorizes tumor thrombus in the portal vein into four levels based on medical imaging findings:

• Type I – Thrombus affecting segmental or sectoral branches of the portal vein or higher. Nevertheless, an additional initial category exists, Type I0, which denotes a thrombus detectable solely under a microscope.
• Type II – Thrombus involving the right or left portal vein.
• Type III – Thrombus extending to the main portal vein.
• Type IV – Thrombus spreading to the superior mesenteric vein.