Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2019; 25(13): 1550-1559
Published online Apr 7, 2019. doi: 10.3748/wjg.v25.i13.1550
Hepatocellular carcinoma surveillance: An evidence-based approach
Patrick S Harris, Ross M Hansen, Meagan E Gray, Omar I Massoud, Brendan M McGuire, Mohamed G Shoreibah
Patrick S Harris, Ross M Hansen, Tinsley Harrison Internal Medicine Residency Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, United States
Meagan E Gray, Omar I Massoud, Brendan M McGuire, Mohamed G Shoreibah, Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, United States
Author contributions: Harris PS and Shoreibah MG contributed to the conception and design of the study; Harris PS and Hansen RM contributed to literature review, analysis and drafting of manuscript; Shoreibah MG, Gray ME, Massoud OI and McGuire BM contributed to critical revision and editing; all authors equally contributed to approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Mohamed G Shoreibah, MD, Assistant Professor, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, 1808 7th Avenue South, BDB 391, Birmingham, AL 35294, United States.
Telephone: +1-205-9755676 Fax: +1-205-9759777
Received: February 21, 2019
Peer-review started: February 22, 2019
First decision: March 5, 2019
Revised: March 9, 2019
Accepted: March 16, 2019
Article in press: March 16, 2019
Published online: April 7, 2019

Hepatocellular carcinoma (HCC) makes up 75%-85% of all primary liver cancers and is the fourth most common cause of cancer related death worldwide. Chronic liver disease is the most significant risk factor for HCC with 80%-90% of new cases occurring in the background of cirrhosis. Studies have shown that early diagnosis of HCC through surveillance programs improve prognosis and availability of curative therapies. All patients with cirrhosis and high-risk hepatitis B patients are at risk for HCC and should undergo surveillance. The recommended surveillance modality is abdominal ultrasound (US) given that it is cost effective and noninvasive with good sensitivity. However, US is limited in obese patients and those with non-alcoholic fatty liver disease (NAFLD). With the current obesity epidemic and rise in the prevalence of NAFLD, abdominal computed tomography or magnetic resonance imaging may be indicated as the primary screening modality in these patients. The addition of alpha-fetoprotein to a surveillance regimen is thought to improve the sensitivity of HCC detection. Further investigation of serum biomarkers is needed. Semiannual screening is the suggested surveillance interval. Surveillance for HCC is underutilized and low adherence disproportionately affects certain demographics such as non-Caucasian race and low socioeconomic status.

Keywords: Liver cancer, Hepatocellular carcinoma, Surveillance

Core tip: Hepatocellular carcinoma (HCC) is a leading cause of cancer related death and 80%-90% of new cases occur in patients with cirrhosis. Surveillance programs have been developed on the basis that earlier detection of disease provides more curative treatment options and a better prognosis. This comprehensive review focuses on current literature regarding the utility of HCC surveillance, high-risk populations, surveillance modalities and adherence and recall.