Clin Mol Hepatol.  2019 Sep;25(3):264-269. 10.3350/cmh.2019.1001.

Hepatocellular carcinoma surveillance in the 21st century: Saving lives or causing harm?

Affiliations
  • 1Mayo Clinic and Minnesota Gastroenterology, Minneapolis, MN, USA.
  • 2Texas Liver Institute, University of Texas Health San Antonio, San Antonio, TX, USA.
  • 3Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA. amit.singal@utsouthwestern.edu

Abstract

Hepatocellular carcinoma (HCC) is the third most common cause of cancer related death worldwide. Prognosis and treatment options largely depend on tumor stage at diagnosis, with curative treatments only available if detected at an early stage. However, two thirds of patients with HCC are diagnosed at a late stage and not eligible for cure. Therefore several liver professional societies recommend HCC surveillance using abdominal ultrasound with or without alpha fetoprotein in at-risk populations, including patients with cirrhosis and subsets of those with chronic hepatitis B. Available data suggest HCC surveillance can significantly improve early tumor detection, curative treatment eligibility, and overall survival. However, the potential benefits of HCC surveillance must be considered in light a shifting HCC demographic from a viral-mediated cancer to an increasing proportion of patients having non-alcoholic steatohepatitis, which has been shown to limit ultrasound sensitivity and may mitigate observed benefits. Further, benefits of HCC surveillance must be weighed against potential physical, financial and psychological harms. Continued data for both benefits and harms of HCC surveillance in contemporary populations are necessary. In the interim, providers should continue to strive for high quality HCC surveillance in at-risk patients.

Keyword

Hepatocellular carcinoma; Liver cancer; Screening; Surveillance; Ultrasound

MeSH Terms

alpha-Fetoproteins
Carcinoma, Hepatocellular*
Diagnosis
Fatty Liver
Fibrosis
Hepatitis B, Chronic
Humans
Liver
Liver Neoplasms
Mass Screening
Prognosis
Ultrasonography
alpha-Fetoproteins
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