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Diagnosis & Management

Liver Cancer Screening

Regular screening for liver cancer and early detection is the only effective means of improving treatment outcomes and survival rates.

For people living with chronic hepatitis B, early detection of primary liver cancer greatly improves the chances of survival after treatment. For patients in whom the liver cancer is detected early while the tumor is small and able to be surgically removed (this is usually before symptoms occur), the 5-year survival can sometimes be more than 50%. This is why regular liver cancer screening is so important it can save lives!

Who should be screened?
Liver cancer is a serious complication of chronic HBV infections, so be sure to talk to your doctor about regular liver cancer screening. The general recommendation is that liver cancer screening start in HBV-infected men at 40 years and women at age 50 years. For some groups of patients, however, there is a higher risk for liver cancer, so screening may be started earlier and more frequently.

Family History of Liver Cancer and Individuals with Cirrhosis
Any patient who has a family history of liver cancer and/or has been diagnosed with cirrhosis, regardless of age, should be regularly screened for liver cancer.

Asian and Pacific Islanders
Asian and Pacific Islanders have the highest incidence rate for chronic HBV infections and liver cancer. In China, liver cancer is the leading cause of cancer death among men. In the U.S., it is the 3rd leading cause of cancer deaths among Asian Americans (compared to the 8th leading cause of cancer deaths among Caucasians).

Africans with chronic HBV infection seem to progress to liver cancer at a younger age, so regular screening among these patients should also start at a younger age.

Co-Infections with HIV and/or Hepatitis C
Liver disease may progress more rapidly in people who are co-infected with HIV and/or the hepatitis C virus, and they are also at greater risk for developing liver cancer, so regular screening is essential.

How often is liver cancer screening done?
A reasonable approach to liver cancer screening includes:

  • Alpha-fetoprotein (AFP) blood test every 6 months
  • Liver ultrasound at least once or twice a year

Either test alone can miss liver cancer, so doctors may order both tests every six months. Once a person develops cirrhosis, more frequent screening is recommended because the risk of developing liver cancer increases. However, liver cancer can occur even in the absence of cirrhosis, so routine screening is important.

How is liver cancer diagnosed?
Ultrasound of the liver and conventional CT scan are regularly obtained in the diagnosis of liver cancer, but they are often too insensitive to detect multi-focal small lesions and for treatment planning.

Thorough assessment with a biphasic spiral CT scan of the abdomen is essential. The fast spiral scanner allows scanning of the liver at the arterial phase shortly after the patient is given an intravenous bolus of contrast.

A liver biopsy may be indicated in cases when the diagnosis of primary vs. metastatic liver cancer is uncertain, providing that it can be safely performed. Post-biopsy bleeding can be life-threatening in cirrhotic patients with low platelet count, prolonged clotting time, and enlarged blood vessels that are under high pressure (portal hypertension). In general, metastatic liver lesions are rare in patients with cirrhosis.

Additional Information About Liver Cancer Treatments

Visit Liver Cancer Connect, the Hepatitis B Foundation's dedicated patient-focused liver cancer website.

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Page last modified March 6, 2014

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