Hepatocellular carcinoma: new insights into prevention and surveillance

Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, is one of the few cancers with a 5-year survival below 25%, largely driven by frequent late-stage diagnoses. Historically, viral etiologies have been the leading causes of HCC; however, the rising prevalence of metabolic risk factors including obesity and diabetes, in parallel with increasing alcohol misuse, has resulted in increasing proportions of HCC due to non-viral etiologies.

This review summarizes HCC prevention, including established approaches such as hepatitis B vaccination and antiviral therapies, as well as emerging strategies tailored to non-viral etiologies. The review also discusses existing surveillance modalities and highlights emerging strategies including blood-based biomarkers, imaging modalities, and artificial intelligence (AI) models.

Traditional prevention strategies face challenges with the shifting liver disease patterns. Emerging approaches, including lifestyle modifications and pharmacological therapies, show promise but require further evaluation in contemporary populations. Advances in surveillance may help overcome underutilization, improve early-HCC detection, and increase curative treatment receipt.