Hepatocellular carcinoma surveillance in cirrhosis

What it is

Cirrhosis, from any cause, puts the patient under surveillance for hepatocellular carcinoma. Patients with cirrhosis should undergo ultrasonography screening for HCC every 6 months. The same 6 months is repeated in every place where cirrhosis appears in the material: in chronic hepatitis C, in PSC, and in the general follow-up of cirrhosis itself. The two methods of surveillance to name are regular 6-monthly liver US and AFP measurement.

Causes and risk

The risk factors for HCC are liver cirrhosis, chronic hepatitis B and haemochromatosis.

Hepatitis C rarely causes HCC in the absence of cirrhosis, which is why the surveillance follows the cirrhosis rather than the virus.

Hepatitis B is different, because surveillance may be indicated before cirrhosis. The characteristics associated with an increased risk for HCC in patients with HBV, and therefore indications 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, and a family history of HCC.

Hereditary hemochromatosis is a genetic disorder of iron regulation and subsequent iron overload, and its possible 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.