What screening measures should be implemented for hepatocellular carcinoma in patients with cirrhosis?

For patients with cirrhosis, the recommended screening measure for hepatocellular carcinoma (HCC) is surveillance using hepatic ultrasound every 6 months, with or without serum alpha-fetoprotein (AFP) measurement. This approach aims to detect HCC at an early stage when curative treatment is more feasible. Surveillance should be offered routinely to all patients with cirrhosis who do not have concomitant chronic hepatitis B virus (HBV) infection. In cases where chronic HBV infection coexists, the decision to initiate HCC surveillance is individualized by specialists based on factors such as the degree of liver fibrosis or cirrhosis, patient age, family history of HCC, and HBV DNA levels NICE NG50,NICE CKS,NICE CG165.

This 6-monthly interval for ultrasound and AFP testing is supported by evidence demonstrating improved early detection rates of HCC in cirrhotic patients, which can lead to better clinical outcomes Tzartzeva et al. 2018. The use of AFP alongside ultrasound may enhance sensitivity, although ultrasound remains the primary modality for surveillance Vogel et al. 2018. Recent literature also highlights barriers to surveillance uptake and evolving aetiologies of liver disease, emphasizing the need for consistent application of these screening measures in clinical practice Huang et al. 2023.

Surveillance is not recommended for patients receiving end-of-life care due to limited benefit NICE NG50. Additionally, surveillance strategies should be integrated within specialist hepatology care to ensure appropriate interpretation of results and timely management of detected lesions NICE CKS.