Key Points
��The incidence of hepatocellular carcinoma (HCC) is rising in many countries.
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��Care of the patient with HCC involves physicians from different disciplines
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including hepatologists, surgeons, liver transplant teams, oncologists,
interventional radiologists, and to some extent radiation oncologists.
����Assessing the degree of liver function impairment prior to, during and after
therapy is important since HCC usually appears in the setting of underlying
liver disease.
Surveillance and Assessment
Table 1. Groups for Whom HCC Surveillance in Recommended or
in Whom the Risk of HCC is Increased, but in Whom
Efficacy of Surveillance Has Not Been Demonstrated
Population Group
Threshold Incidence for
Efficacy of Surveillance
(> 0.25 LYG) (%/year)
Incidence of HCC
Surveillance recommended
Cirrhotic hepatitis B carriers
0.2-1.5
3-8%/year
Hepatitis C cirrhosis
1.5
3-5%/year
Stage 4 primary biliary cirrhosis
1.5
3-5%/year
Genetic hemachromatosis and
cirrhosis
1.5
Unknown, but probably
> 1.5%/year
Alpha 1-antitrypsin deficiency
and cirrhosis
1.5
Unknown, but probably
> 1.5%/year
Other cirrhosis
1.5
Unknown
Asian male hepatitis B carriers
> age 40
0.2
0.4-0.6%/year
Asian female hepatitis B carriers
> age 50
0.2
0.3-0.6%/year
Hepatitis B carrier with family
history of HCC
0.2
Incidence higher than
without family history
African/North American Blacks
with hepatitis B
0.2
HCC occurs at a younger age
Hepatitis C and stage 3 fibrosis
1.5
< 1.5%/year
Non-cirrhotic NAFLD
1.5
< 1.5%/year
Hepatitis B carriers < 40 (males)
or < 50 (females)
0.2
< 0.2%/year
Surveillance benefit uncertain
