Surveillance for Hepatocellular Carcinoma
Surveillance for hepatocellular carcinoma (HCC) in patients with cirrhosis is recommended with the aim to reduce mortality. The evidence that supports surveillance is of low quality, and the test used, 6-monthly ultrasound scanning, has inherent limitations that reduce its efficacy. Those limitations affect both sensitivity, meaning that not all early stage cancer is diagnosed, and also specificity, leading to false-positive testing and downstream harm. The factors that limit the effectiveness of surveillance are discussed in this chapter, together with proposals to improve the outcomes for patients with cirrhosis and undergoing surveillance for HCC.
KeywordsLiver cancer Benefit Harm Ultrasound AFP
- 1.Global Burden of Disease Mortality, Causes of Death Collaboration. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117–71.CrossRefGoogle Scholar
- 3.European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56(4):908–43.Google Scholar
- 4.NICE. Clinical Guideline 50: Cirrhosis in over 16s: Assessment and management. 2016; https://www.nice.org.uk/guidance/ng50/evidence/full-guideline-2546537581. Accessed 12 Jul 2016.
- 14.Cross TJ, Villanueva A, Shetty S, et al. A national survey of the provision of ultrasound surveillance for the detection of hepatocellular carcinoma. Frontline Gastroenterol. 2016;7:82–9.Google Scholar