Hepatocellular carcinoma (HCC) often develops in people with underlying liver disease. Early-stage disease may cause few symptoms, making surveillance important for individuals at increased risk.

Three particularly important factors are chronic viral hepatitis, cirrhosis and family history of HCC. Their effects on risk are related but not identical.

What Is Liver Cancer Surveillance?

For people known to have elevated risk, surveillance means periodic testing intended to identify suspicious findings before symptoms develop. Many eligible patients undergo ultrasound surveillance at about six-month intervals, sometimes accompanied by AFP.

A concerning surveillance finding may lead to diagnostic imaging, such as contrast-enhanced CT or MRI. Surveillance and diagnosis are distinct processes.

How Does Hepatitis B Affect HCC Risk?

Chronic hepatitis B virus (HBV) infection can cause persistent liver inflammation and injury, but HCC can also develop in some patients with chronic HBV who have not developed cirrhosis.

Age, sex, family history, viral activity, fibrosis and other clinical factors can influence risk. Certain patients with chronic HBV may qualify for surveillance without cirrhosis.

Effective antiviral treatment reduces HCC risk but does not eliminate it for everyone. A provider may still recommend surveillance when risk remains elevated.

Hepatitis C and Cancer Risk

Chronic hepatitis C virus (HCV) infection can lead to progressive fibrosis and cirrhosis. Modern antiviral treatment can cure HCV infection in most treated patients and substantially reduce HCC risk.

However, patients who already have cirrhosis may continue to require HCC surveillance after viral cure. Follow-up depends on disease stage and other clinical features.

Why Cirrhosis Matters

Cirrhosis is advanced liver scarring arising from sustained injury. Causes include chronic viral hepatitis, alcohol-associated liver disease, metabolic dysfunction-associated steatotic liver disease (MASLD) and other chronic conditions.

For many patients, cirrhosis is an important reason to undergo regular HCC surveillance. Eligibility also depends on whether detection could lead to potentially beneficial treatment.

What Does Family History Tell Us?

A first-degree relative with HCC is particularly relevant for people with chronic hepatitis B. Family history may influence the age at which surveillance begins and other risk decisions.

It does not mean that an individual will develop cancer, nor does family history by itself automatically establish a surveillance indication.

What Tests Are Used?

Ultrasound and, in some settings, alpha-fetoprotein (AFP) are used for surveillance. Ultrasound sensitivity can vary with patient and liver characteristics, and AFP can remain normal despite HCC.

Researchers are investigating molecular approaches that examine signals beyond these conventional methods.

Where Could Molecular Blood Testing Fit?

One research approach analyzes circulating fusion transcripts, RNA molecules associated with cancer-related genomic rearrangements. MoleculeDx's Liver Cancer Fusion Predictor uses Fusion-detect™ technology to examine multiple selected fusion-transcript signals in blood.

Molecular results should be interpreted along with liver disease, imaging, medical history and other clinical findings, rather than as stand-alone diagnoses.

Understanding Your Risk Is the First Step

If you have chronic hepatitis B or C, cirrhosis, or significant family history, discuss your personal HCC risk and appropriate surveillance with a qualified healthcare professional.

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