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Prevention of hepatocellular carcinoma and recommendations for surveillance in adults with chronic liver disease

Author
Massimo Colombo, MD
Section Editor
Sanjiv Chopra, MD, MACP
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

Chronic liver disease is the major risk factor for the development of hepatocellular carcinoma (HCC) [1]. Preventing or treating liver disease can decrease the risk of HCC. In addition, surveillance of at-risk patients with modern imaging techniques permits the identification and characterization of early tumors that are smaller than 2 cm, which may have a better prognosis than larger lesions. The development of effective treatments for early-stage HCC has provided additional support for early detection. (See "Overview of treatment approaches for hepatocellular carcinoma".)

This topic will review the evidence regarding surveillance for HCC in patients with chronic liver disease and provide suggestions on the selection of patients for surveillance, approaches to surveillance, and additional testing to confirm the presence of HCC. The recommendations provided below are consistent with guidelines issued by the American Association of Liver Diseases (AASLD) in 2005 and updated in 2010 [2-4]. Other guidelines, including 2012 guidelines from the European Association for the Study of the Liver and the European Organization for Research and Treatment of Cancer [5] and 2003 guidelines from the British Society of Gastroenterology [6], are similar to the AASLD guidelines.

Issues related to surveillance and screening for HCC in general, the treatment of HCC, and the prognosis of patients with HCC are discussed elsewhere. (See "Clinical features and diagnosis of primary hepatocellular carcinoma", section on 'Screening and surveillance' and "Overview of treatment approaches for hepatocellular carcinoma" and "Staging and prognostic factors in hepatocellular carcinoma".)

PREVENTION OF HEPATOCELLULAR CARCINOMA

The single dominant risk factor for HCC is cirrhosis of any etiology. HCC is associated with, among other things, hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, exposure to environmental toxins, hereditary hemochromatosis, diabetes, overweight, tobacco use, and heavy alcohol use. Attempts to prevent HCC should focus on preventing infection with HBV and HCV, treating patients with viral hepatitis who are candidates for treatment, avoiding environmental toxins, cessation of heavy alcohol use, control of body weight, and removing excess iron from patients with hereditary hemochromatosis. (See "Epidemiology and etiologic associations of hepatocellular carcinoma", section on 'Risk factors'.)

HCC-related cirrhosis — The majority of patients with HCC have underlying cirrhosis, and treatment aimed at preventing the development of cirrhosis will decrease the risk of HCC. The risk of HCC in patients with cirrhosis is variable and depends in part on the etiology of the cirrhosis (table 1). (See "Epidemiology and etiologic associations of hepatocellular carcinoma", section on 'Risk factors'.)

                        

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Literature review current through: Nov 2016. | This topic last updated: Thu Apr 07 00:00:00 GMT+00:00 2016.
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