Hepatocellular carcinoma found by surveillance is far more often treatable by resection or ablation than one found because of symptoms. Major guidelines advise ultrasound every six months, with or without alpha-fetoprotein, for adults with cirrhosis of any cause who would be fit for treatment, and for selected people with chronic hepatitis B without cirrhosis.
The weak point is adherence: surveillance is often started and then lapses. A recall system matters more than the choice of test.
- Arrange ultrasound every six months for patients with cirrhosis who would be fit for treatment
- Include selected patients with chronic hepatitis B even without cirrhosis
- Add alpha-fetoprotein where available
- Set up a recall system so six-monthly surveillance does not lapse
Why it matters
Every curative option in the HCC guideline depends on finding the tumour while it is small.
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