Surveillance for and diagnosis of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a common complication of cirrhosis, regardless of its aetiology. In Australia, chronic hepatitis B and C are the most common causes of hepatocellular carcinoma. The annual risk of hepatocellular carcinoma in patients with cirrhosis is 2 to 5%.

Surveillance for hepatocellular carcinoma in patients with cirrhosis (from any cause) is strongly recommended, because early diagnosis offers the best chance of cure. Perform liver ultrasound every 6 months; combining measurement of blood alpha-fetoprotein (AFP) concentration with 6-monthly liver ultrasound may be consideredAustralian hepatocellular carcinoma consensus statement 2020Australian hepatitis B consensus statement 2022. If a nodule smaller than 10 mm is detected on ultrasound, repeat ultrasound every 3 months to check for an increase in nodule size. If a nodule 10 mm or larger is detected, further investigation with contrast-enhanced dynamic imaging (ie quad-phase computed tomography or gadolinium magnetic resonance imaging) is required.

Note: Perform liver ultrasound and measure blood alpha-fetoprotein concentration every 6 months in patients with cirrhosis to check for hepatocellular carcinoma. Early diagnosis offers the best chance of cure.

Diagnosis of hepatocellular carcinoma in a patient with cirrhosis is made by a characteristic appearance on contrast-enhanced dynamic imaging. Biopsy is not usually required for diagnosis but may be considered when evaluating small lesions with uncharacteristic features on imaging.

For more detailed information about diagnosis and management of hepatocellular carcinoma, see the Australian recommendations for the management of hepatocellular carcinoma: A consensus statement, available online.