Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. Since early disease may cause no symptoms, appropriate surveillance is important for people at elevated risk.
But risk is not the same for everyone. The most important question is not whether every adult needs a liver cancer blood test; it is whether your individual risk warrants an ongoing HCC surveillance plan.
Who Is at Increased Risk for HCC?
Cirrhosis is a major risk factor regardless of whether it arises from viral hepatitis, alcohol-associated liver disease, or metabolic dysfunction-associated steatotic liver disease.
Chronic hepatitis B can increase HCC risk even without cirrhosis. Age, sex, family history and other clinical features may influence whether surveillance is recommended.
Chronic hepatitis C is associated with progressive fibrosis and cirrhosis. Successful antiviral treatment reduces HCC risk, but people with established cirrhosis may still require ongoing surveillance after cure.
Metabolic dysfunction-associated steatohepatitis (MASH), alcohol-associated liver disease, diabetes and family history can also influence overall risk. However, having a risk factor does not automatically establish a surveillance indication.
What Is HCC Surveillance?
Surveillance means periodic testing in people known to be at increased risk. In many eligible patients, guidelines recommend surveillance roughly every six months, commonly with liver ultrasound and, in some guidance, AFP blood testing.
An abnormal surveillance result may prompt diagnostic imaging, such as multiphase CT or contrast-enhanced MRI. A blood test alone does not establish a diagnosis.
What If AFP Is Normal?
AFP is a protein biomarker that can be elevated in HCC, but it may remain normal in some patients with cancer. Normal AFP should not be used as a reason to stop recommended imaging surveillance.
Beyond Conventional Blood Markers
Molecular research investigates DNA and RNA signals associated with cancer. One example is circulating fusion transcripts, RNA molecules produced from cancer-related genomic rearrangements.
The MoleculeDx Liver Cancer Fusion Predictor uses Fusion-detect™ technology to analyze multiple cancer-associated fusion-transcript signals. These signals provide a molecular perspective on HCC biology. The detailed commercial assay composition is proprietary, and results must still be interpreted alongside clinical evaluation.
Discuss Your Risk With Your Provider
Useful questions include: Do I have cirrhosis or advanced fibrosis? Does my hepatitis status affect my HCC risk? Should I undergo periodic ultrasound? What follow-up is appropriate if an imaging or blood result is abnormal?
Knowing your risk is the first step toward choosing appropriate surveillance.