Hepatocellular carcinoma surveillance: current practice and future directions

Area of Science:

• Hepatology
• Oncology
• Medical Diagnostics

Background:

• Hepatocellular carcinoma (HCC) is a major global cause of cancer mortality.
• Early detection through surveillance improves survival rates in high-risk populations, such as those with cirrhosis.
• Current standard surveillance methods have limitations in sensitivity for early-stage HCC.

Purpose of the Study:

• To provide a comprehensive overview of hepatocellular carcinoma surveillance.
• To discuss the rationale, indications, and standard methods for HCC surveillance.
• To explore alternative and emerging surveillance strategies and associated challenges.

Main Methods:

• Review of current literature on HCC surveillance.
• Analysis of standard surveillance techniques (ultrasonography, alpha-fetoprotein).
• Evaluation of alternative methods including cross-sectional imaging and biomarkers.

Main Results:

• Standard HCC surveillance methods have suboptimal sensitivity for early detection.
• Alternative imaging and circulating biomarkers show promise but require further validation.
• Under-utilization and potential harms of surveillance are significant concerns.

Conclusions:

• Optimizing HCC surveillance requires a multi-faceted approach, considering individual risk and method limitations.
• Emerging biomarkers and advanced imaging may enhance early HCC detection.
• Addressing surveillance under-utilization and harms is critical for effective HCC management.