Diagnosis of Small Hepatocellular Carcinoma

Abstract

Hepatocellular carcinoma (HCC) is the third most common malignancy worldwide and the second leading cause of cancer-related deaths [1]. Globally, there are approximately 750,000 new cases of liver cancer reported each year. Consensus guidelines have been published by different organizations, including the American Association for the Study of Liver Disease (AASLD), National Comprehensive Cancer Network (NCCN), and European Association for the Study of the Liver (EASL) to standardize the approach for diagnosis and treatment [2–4]. HCC is more effectively treated when it is diagnosed at an early stage, and the best chance for early diagnosis comes from surveillance of patients known to be at high risk. This includes patients with cirrhosis from any cause and carriers of hepatitis B or C [3]. The 2012 NCCN guidelines recommend screening high-risk patients with serum a-fetoprotein (AFP) and liver ultrasound (US) every 6 months to 12 months. A rising AFP associated with a liver nodule measuring larger than 1 cm raises suspicion for HCC and warrants evaluation with cross-sectional imaging [3]. The tests used to diagnose HCC include radiology, biopsy, and AFP serology. The diagnosis of HCC based on imaging can be challenging because of the imaging characteristics of a background of liver cirrhosis. A CT or MRI should be performed in cirrhotic patients with an ultrasound showing a lesion of > 1 cm, an elevated or rising AFP in the absence of a liver lesion on US, or when there is a clinical suspicion for the presence of HCC.