Predisposing Factors/ Prevention and Screening/Early Detection

Patients with cirrhosis due to hepatitis B virus (HBV) or hepatitis C virus (HCV) have an annual risk of developing HCC of approximately 5%. However, all patients with cirrhosis are at increased risk for developing HCC
Patients with HBV infection without cirrhosis have a 0.5% annual risk of HCC that rises with age
Patients with cirrhosis, and some carriers of HBV without cirrhosis, are recommended to undergo surveillance with liver ultrasound every 6 months. Nodules <1cm should be evaluated q3 (should this be 6 months?) months with ultrasound. Nodules >1cm should be investigated with dynamic phase imaging, either 4 phase CT or contrast-enhanced MRI (see section 9.2 below)
Serum alpha-fetoprotein (AFP) as a screening tool has a high false-positive rate in patients with active hepatitis and typically begins to rise with vascular invasion making it less sensitive for detection of early lesions at a curable stage

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