Surveillance Eligibility
Cirrhosis or chronic HBV infection opens the door to routine HCC screening.
- ~866K: Global HCC cases per year (sixth most common cancer)
- ~80%: HCC arising in cirrhosis (majority of cases)
- 2–4%: Annual HCC risk in cirrhosis (per patient-year)
- ~254M: People with chronic HBV (worldwide)
Who is screened
Cirrhosis of any cause qualifies a patient for surveillance.
Chronic HBV carriers can qualify even without cirrhosis.
Why cirrhosis matters
Scarred liver tissue drives most malignant transformation.
Risk stratification
Age, sex, and viral load refine who benefits most.
Biannual Schedule Begins
Every six months, an AFP blood draw pairs with a liver ultrasound.
- 6 mo: Screening interval (twice yearly)
- Low: AFP test cost (simple blood draw)
- ~78%: Ultrasound sensitivity (for any-stage HCC)
- ~97%: Combined test sensitivity (AFP plus ultrasound)
Why six months
Matches typical HCC doubling time to catch tumors early.
Annual screening misses tumors that double faster.
The two tests
Blood AFP and B-mode ultrasound run together each visit.
Adherence matters
Skipped visits let nodules grow undetected between checks.
AFP Monitoring
Alpha-fetoprotein rises as tumor cells secrete it into the bloodstream.
- <10: Normal AFP (ng/mL baseline)
- 20: Common HCC cutoff (ng/mL flag level)
- ~60%: AFP sensitivity alone (misses many early tumors)
- Rising slope: Trend beats single value (more informative than one draw)
What AFP measures
A fetal protein re-expressed by dividing liver tumor cells.
A rising trend across visits matters more than one number.
False negatives
Some HCCs never raise AFP at all.
Why pair with imaging
Ultrasound catches nodules AFP alone would miss.
Ultrasound Nodule Detection
A nodule becomes visible on ultrasound once it crosses a detectable size.
- ~1 cm: Typical detection size (minimum reliable threshold)
- 4–12 mo: Doubling time (HCC) (wide biological range)
- Repeat scan: Nodule < 1cm workup (short-interval follow-up)
- CT / MRI: Nodule > 1cm workup (confirmatory imaging)
Detectable threshold
Nodules under a centimeter are hard to characterize.
Faster-growing tumors slip past more screening rounds.
Flagging a finding
A new or growing nodule triggers confirmatory imaging.
Operator dependence
Ultrasound quality varies with machine and skill.
Early Detection Outcome
Regular surveillance shifts diagnosis toward earlier, curable disease stages.
- ~70%: 5-yr survival, early stage (with curative treatment)
- <15%: 5-yr survival, late stage (without surveillance)
- Resection, ablation, transplant: Curative options at early stage (treatable options)
- Significant: Surveillance survival benefit (consistent across studies)
Stage shift
Screened patients are diagnosed at smaller tumor size.
Slower growth plus frequent screening yields the earliest catch.
Skipped screening
Missed visits let tumors reach late, harder-to-treat stages.
The takeaway
Consistent biannual screening saves lives in at-risk patients.