What are the current guidelines for the management of early-stage HCC in a primary care setting?

In the primary care setting, the management of early-stage hepatocellular carcinoma (HCC) primarily involves identification, surveillance, and timely referral to specialist hepatology or oncology services for definitive diagnosis and treatment. Primary care clinicians should focus on surveillance in at-risk populations, such as those with cirrhosis or chronic hepatitis B or C infections, by arranging 6-monthly hepatic ultrasound scans with or without serum alpha-fetoprotein measurement to detect early HCC ⁵. Surveillance is particularly recommended for people with cirrhosis without hepatitis B virus (HBV) infection, while for those with HBV, surveillance decisions depend on fibrosis stage, age, family history, and viral load ¹,⁵.

Once early-stage HCC is suspected or detected, primary care's role is to ensure prompt referral to specialist hepatology or multidisciplinary liver cancer teams for further assessment and management, as curative treatments such as surgical resection, liver transplantation, or local ablative therapies require specialist input ¹,⁵. Primary care should also support patients by providing information on liver disease, lifestyle modifications (e.g., alcohol cessation, weight management), and coordinate shared care for underlying liver conditions such as hepatitis B or C and cirrhosis ¹,³,⁴.

Current UK guidelines do not recommend initiating HCC-specific treatment in primary care but emphasize surveillance and referral pathways ¹,⁵. The specialist management of early-stage HCC may include radiotherapeutic strategies, as recent literature suggests, tailored to Barcelona Clinic Liver Cancer (BCLC) staging, with options such as radiofrequency ablation or stereotactic body radiotherapy for patients unsuitable for surgery (Jihye and Jinsil, 2012). However, these advanced treatments remain within secondary or tertiary care settings.

In summary, primary care's critical functions in early-stage HCC management are risk-based surveillance, patient education, and ensuring timely specialist referral for diagnosis and treatment, while ongoing management of underlying liver disease and cirrhosis is coordinated collaboratively with specialists ¹,³,⁴,⁵.