[Early detection of hepatocellular carcinoma--high risk group and mass survey]

Most hepatocellular carcinomas (HCC) in Japan are found in chronic liver diseases with persistent infection of hepatitis B or C virus. Thus, the high risk group for HCC is evident and most small HCC, less than 2 cm in diameter, are detected by a regular follow-up of every three months using ultrasonography (US) in patients with liver cirrhosis or chronic hepatitis over 40 years of age. Approximately half of localized lesions less than 2 cm in diameter found by US are not HCC. Thus, liver biopsy using fine needles is important to make a definite diagnosis in such small lesions. The most important factor in mass survey for HCC is to select people with risk factors for HCC from the whole population. We selected people for a mass survey using US who have risk factors such as 1) abnormal liver function tests, 2) past history of liver diseases, 3) HBV or HCV carrier, 4) past history of blood transfusion, and 5) excessive drinking. About one percent of the people surveyed showed HCC. The detection rate is excellent. In future, serum tumor markers for HCC such as AFP and PIVKA-II will be useful for diagnosis of small HCC because recent studies indicate that such small HCC also produce such tumor markers in about half of the cases.