People with cirrhosis of any cause carry a substantial annual risk of hepatocellular carcinoma. Guidelines advise ultrasound every six months, with or without alpha-fetoprotein, for those who would be candidates for treatment if cancer were found. Some people with chronic hepatitis B without cirrhosis also qualify, depending on age, sex, family history and viral factors.
Surveillance adherence is often poor because nobody owns the recall. Early tumours found on surveillance are far more often curable than those found on symptoms.
- Book ultrasound every six months for patients with cirrhosis who would be treatment candidates.
- Consider adding alpha-fetoprotein to ultrasound.
- Check whether patients with hepatitis B without cirrhosis meet surveillance criteria.
- Use CT or MRI when ultrasound views are poor, as in obesity.
- Set a recall so surveillance does not lapse.
Why it matters
Liver cancer is curable mainly when it is small, and surveillance is how it is found small.
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