What people at increased risk should know about surveillance, follow-up, and advances in blood-based testing.
Liver cancer can develop without noticeable symptoms, particularly in people who already have chronic liver disease. That is why liver cancer screening—more precisely called hepatocellular carcinoma (HCC) surveillance—matters for people at increased risk. Regular surveillance cannot guarantee early detection, but it can help clinicians identify concerning changes before symptoms appear and arrange further evaluation.
What is hepatocellular carcinoma?
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. It often develops in a liver affected by cirrhosis (extensive scarring). Some people with chronic hepatitis B also face an increased HCC risk even without cirrhosis. Other liver conditions can contribute to risk, but the need for surveillance depends on a person’s underlying disease and clinical circumstances.
Why does early identification matter?
When HCC is found at an earlier stage, a patient may have more treatment options. Depending on tumor size and number, liver function, overall health, and other findings, clinicians may consider surgical removal, liver transplantation, or ablation, which destroys tumor tissue using a targeted technique. None of these options is appropriate for every patient, and a complete diagnostic assessment is needed before treatment decisions are made.
Surveillance is not the same as a diagnosis. A suspicious ultrasound or blood-test result may lead to contrast-enhanced CT or MRI, and sometimes biopsy. A screening result alone does not establish that someone has liver cancer.
How does routine liver cancer surveillance work?
For many eligible high-risk patients, surveillance commonly involves an abdominal ultrasound at approximately six-month intervals. Ultrasound uses sound waves to generate pictures of the liver without ionizing radiation. A blood test measuring alpha-fetoprotein (AFP) is also commonly used as part of conventional surveillance.
Neither method is perfect. Some people with HCC have AFP levels within the normal range, while AFP can be elevated for noncancer reasons. Ultrasound may also have difficulty identifying small lesions when the liver is hard to visualize because of body habitus, cirrhosis, or fatty changes. Clinicians may recommend additional imaging when ultrasound findings are suspicious or the study is limited.
Who should ask about surveillance?
Surveillance is generally intended for selected higher-risk groups, not everyone in the general population. People with cirrhosis and certain people with chronic hepatitis B are important examples. The risk associated with hepatitis C, metabolic dysfunction-associated steatotic liver disease, alcohol-related liver disease, and other chronic conditions varies with the extent of liver damage and other factors.
If you have a chronic liver condition, ask your hepatologist, gastroenterologist, or primary-care clinician whether you qualify for surveillance, which tests are appropriate, and how often you should return. Screening is most useful as an ongoing program rather than a one-time event.
What role can newer blood-based testing play?
New molecular approaches can evaluate cancer-associated biological signals in blood, including circulating cell-free RNA fusion transcripts. Published work has demonstrated the potential of these signals for HCC classification and monitoring, although results from a particular research model should not automatically be equated with the performance of a commercial test.
MoleculeDx developed Fusion-detect™, a proprietary multivariable blood-based approach used in its Liver Cancer Fusion Predictor. The specific combination of measurements and the prediction algorithm are proprietary. MoleculeDx is developing this approach as a potentially more informative blood-based option than conventional AFP testing.
In clinical validation results reported by MoleculeDx, Fusion-detect™ demonstrated 96.7% overall accuracy, 94.2% sensitivity, and 98.1% specificity. Sensitivity is the proportion of people with HCC correctly classified as positive; specificity is the proportion of people without HCC correctly classified as negative; overall accuracy is the proportion correctly classified in the evaluated population.
These are company-reported validation figures, not a guarantee of performance for every patient or risk group. False-positive and false-negative results remain possible. An abnormal result warrants appropriate clinical follow-up, and a negative result does not eliminate future cancer risk. The test is not a stand-alone cancer diagnosis and does not replace clinically indicated imaging or other diagnostic evaluation.
What should patients do after a screening result?
Ask how and when you will receive the result, what a positive or unclear finding would mean, and whether follow-up imaging is needed. If your result is negative but you remain at increased risk, continue the surveillance schedule recommended by your clinician. Do not delay medical assessment for new symptoms while waiting for the next scheduled test.
The key message
Liver cancer surveillance gives healthcare professionals an opportunity to investigate possible abnormalities before symptoms appear. Earlier identification may expand treatment options, but every testing method has limitations. For people at increased risk, an individualized surveillance plan, timely follow-up, and appropriate interpretation of both imaging and blood-based findings remain essential.
Medical information disclaimer: This article is for general education and does not replace individualized advice from a qualified healthcare professional.
References
[1] Singal AG, et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023;78:1922–1965. doi:10.1097/HEP.0000000000000466.
[2] Rich NE, Villanueva A, Marrero JA, Kanwal F. AGA Clinical Practice Update on Risk Stratification and Emerging Surveillance Strategies for Hepatocellular Carcinoma: Expert Review. Gastroenterology. 2026;170:1606–1615. doi:10.1053/j.gastro.2026.03.006.
[3] Yu YP, Liu S, Geller D, Luo JH. Serum Fusion Transcripts to Assess the Risk of Hepatocellular Carcinoma and the Impact of Cancer Treatment through Machine Learning. Am J Pathol. 2024;194:1262–1271. doi:10.1016/j.ajpath.2024.02.017.
Educational information only; consult a qualified healthcare professional. Screening does not establish or exclude a diagnosis.