Published online Oct 28, 2013. doi: 10.3748/wjg.v19.i40.6744
Revised: September 2, 2013
Accepted: September 15, 2013
Published online: October 28, 2013
Primary liver cancer is the sixth most common cancer in the world and the third cause of cancer-related death. Hepatocellular carcinoma (HCC) represents more than 90% of primary liver cancers and generally occurs in patients with underlying chronic liver disease such as viral hepatitis, hemochromatosis, primary biliary cirrhosis and non-alcoholic steatohepatitis. Especially cirrhotic patients are at risk of HCC and regular surveillance could enable early detection and therapy, with potentially improved outcome. We here summarize existing evidence for surveillance including ultrasound, other radiological modalities and various serum biomarkers, and current international guideline recommendations for surveillance. Ultrasound and α-fetoprotein (alone or in combination) are most frequently used for surveillance, but their sensitivities and specificities are still far from perfect, and evidence for surveillance remains weak and controversial. Various other potential surveillance tools have been tested, including serum markers as des-carboxyprothrombin, lectin-bound α-fetoprotein, and (most recently) circulating TIE2-expressing monocytes, and radiological investigations such as computed tomography-scan or magnetic resonance imaging-scan. Although early results appear promising, these tools have generally been tested in diagnostic rather than surveillance setting, and in most cases, no detailed information is available on their cost-effectiveness. For the near future, it remains important to define those patients with highest risk of HCC and most benefit from surveillance, and to restrict surveillance to these categories.
Core tip: Hepatocellular carcinoma is a frequent phenomenon in cirrhotic patients. Survival is generally poor, and curative options only exist if the tumor is detected in an early stage (Barcelona Clinic Liver Cancer stage 0 or A). This review summarizes existing evidence for surveillance including ultrasound, other radiological modalities and various serum biomarkers, and current guideline recommendations for surveillance. Selection of the appropriate high risk populations remains an important tool for cost-effective surveillance.