Hepatocellular carcinoma surveillance in hepatitis B

What it is

Hepatocellular carcinoma in chronic hepatitis B is looked for under surveillance. Surveillance is done with US every 6 months in the patients who carry the characteristics of increased risk, and the lifetime risk of hepatocellular carcinoma in hepatitis B is put at around 20%.

Causes and risk

The risk factors given for hepatocellular carcinoma are liver cirrhosis, chronic hepatitis B and haemochromatosis. Hereditary hemochromatosis is a genetic disorder of iron regulation and of the iron overload that follows it, and its end-organ damage includes cardiomyopathy, cirrhosis of the liver and hepatocellular carcinoma; identification of such patients and proper ongoing treatment with phlebotomy may prevent the development of hepatocellular carcinoma. Chronic hepatitis C infection can cause cirrhosis and is itself a risk factor for hepatocellular carcinoma. Hepatitis D coinfection occurs only with hepatitis B and leads to more severe disease. The characteristics associated with an increased risk in hepatitis B, and so an indication for surveillance with US every 6 months, are:

• Cirrhosis
• Asian men over 40 years and Asian women over 50 years
• Black patients over 20 years
• An elevated ALT level with HBV DNA levels above 10,000 U/mL
• A family history of hepatocellular carcinoma

A second page gives the same two ages with no group named, giving men over 40 and women over 50 along with all patients who have cirrhosis and a family history of hepatocellular carcinoma.