Hepatocellular cancer: optimal strategies for screening and surveillance

Hepatocellular carcinoma (HCC) is a challenging malignancy of global importance and is associated with a high rate of mortality. Individuals with chronic viral hepatitis and other forms of liver disease are at risk for developing HCC. The stage of cancer dictates the therapeutic choice, making early detection a primary objective. Many observational studies have reported that HCC is diagnosed at an earlier stage in patients who received surveillance. The guidelines of the American Association for the Study of Liver Diseases suggest that surveillance should be performed using ultrasonography at an interval of every 6-12 months. This interval is based upon mainly observational data and the expected growth rates of HCC. Patients with abnormal screening tests require additional investigation using computed tomography scanning, magnetic resonance imaging, or liver biopsy. Although the optimal methods of screening and the cost-effectiveness of surveillance for HCC remain to be established, systematic screening still offers the best hope for early diagnosis, treatment eligibility, and improved survival.