Early Detection of Hepatocellular Carcinoma

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Abstract
Hepatocellular carcinoma (HCC) has a poor prognosis once it becomes symptomatic. Attempts have been made to screen high risk populations in order to detect asymptomatic HCC, some of which may be amenable to surgery. The screening tests usually used are serum α-fetoprotein estimation and ultrasonography of the liver. Asymptomatic HCC has a relatively good prognosis even without treatment for at least the first 2 years after detection, probably reflecting lead time bias. This makes it difficult to assess the benefit of surgical treatment and hence of the screening itself. Although HCC detected by screening tends to be smaller and is more likely to be resectable compared to symptomatic HCC, some asymptomatic HCC are already inoperable at the time of detection by screening. While HCC screening is being carried out in many centers, its cost-effectiveness in terms of prolongation of life remains unproven.

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