Issues in screening and surveillance for hepatocellular carcinoma.

Individuals with chronic viral hepatitis and other forms of liver disease are at risk for developing hepatocellular carcinoma (HCC). When HCC presents with clinical symptoms, the tumor is typically very far advanced and the patient has few therapeutic options. Thus, screening and surveillance for HCC would appear to very appropriate. However, there is no definitive evidence that surveillance improves patient outcomes and current techniques lack sensitivity and specificity. Nonetheless, serial measurement of alpha-fetoprotein (AFP) levels in serum and hepatic ultrasound have become routine practice, despite a lack of evidence of their overall benefit. Clearly, better methods are needed for early diagnosis of HCC. Improved technology will ultimately have to be tested for improved patient outcome before becoming widely recommended.