A blood test for liver cancer can look for biological signals associated with hepatocellular carcinoma (HCC)—the most common primary liver cancer. For people at increased risk, the goal is to identify a warning signal while cancer may still be small and before noticeable symptoms develop. The MoleculeDx Liver Cancer Fusion Predictor is a blood-based HCC surveillance test that assesses a pattern of cancer-associated cell-free fusion transcripts.
Unlike a test that measures only the protein alpha-fetoprotein (AFP), the Fusion Predictor examines molecular RNA signals associated with cancer and integrates those signals through a predictive model. A positive result indicates that an HCC-associated molecular signal was detected; the blood test does not by itself confirm a cancer diagnosis, determine tumor size, or locate a lesion. [1]
Who should consider a liver cancer surveillance blood test?
HCC may cause no symptoms in its early stages. Ongoing surveillance is most relevant to individuals at sufficiently high risk, such as:
- People with cirrhosis from hepatitis, alcohol-related disease, or metabolic-associated liver disease.
- Selected people with chronic hepatitis B, including some who do not have cirrhosis; eligibility depends on individual risk.
- Patients who have had HCC before, whose follow-up is directed by their treatment team.
- Others with liver cancer risk factors, such as advanced chronic liver disease or a family history, after discussion with a healthcare professional.
Having one risk factor does not automatically mean that every person needs the same surveillance program. Your clinician can assess liver disease, age, prior imaging, and other risk factors. Current AASLD guidance recommends ultrasound plus AFP approximately every six months for eligible patients; updated 2026 AGA advice also identifies that combination as the preferred current surveillance strategy. [2] [3]
How does a liver cancer blood test work?
There are several kinds of blood tests used in liver care, and they do not answer the same question.
AFP: a conventional protein marker
AFP can rise in people with HCC, but it may also increase with noncancer liver conditions. A normal AFP does not exclude liver cancer. For surveillance, AFP is interpreted with ultrasound and the patient's clinical history—not as a definitive diagnosis by itself. [2]
Fusion-detect™: cancer-associated RNA signals
MoleculeDx's Fusion-detect™ technology analyzes selected cell-free fusion-transcript signals in blood. An HCC-associated pattern may be present even when traditional protein markers are not markedly elevated. A peer-reviewed 2024 American Journal of Pathology study evaluated serum fusion transcripts and machine-learning models using samples from patients with HCC and people without HCC. Its performance findings depend on the model, the cohort, and the assay configuration; published research results are not an individual guarantee of detection. [1]
What will my MoleculeDx report tell me?
The Liver Cancer Fusion Predictor reports a clear Positive or Negative surveillance result. These terms describe whether the test detected its qualifying HCC-associated molecular pattern in that blood sample.
Positive: HCC-associated signal detected
A molecular pattern associated with HCC was detected. HCC may be present and should be investigated promptly with your healthcare professional, who can determine whether contrast-enhanced imaging or other clinical evaluation is appropriate. A positive surveillance result is not a confirmed HCC diagnosis.
Negative: HCC is less likely
No qualifying HCC-associated pattern was detected in this sample. That is a reassuring surveillance result, but some cancers may be missed. If you are at high risk, continue periodic monitoring with your clinician and discuss whether repeat Liver Cancer Fusion Predictor testing fits your plan. Follow current guideline-recommended surveillance unless your clinical team advises otherwise.
Importantly, the test does not provide a tumor's location, stage, or exact size. These are determined through clinical evaluation and imaging, sometimes with pathology. In at-risk patients, AASLD recommends HCC diagnosis on the basis of appropriate imaging criteria and/or pathology, rather than biomarkers alone. [2]
What does research say about detecting small HCC?
Smaller tumors are clinically important because identifying HCC at a lower tumor burden may expand the opportunity for potentially curative evaluation and treatment. MoleculeDx has explored detection performance in HCC-positive research subgroups defined by tumor size and Milan criteria.
Small-tumor subgroup from the MoleculeDx research dataset
These findings are from only nine people with confirmed HCC and are sensitivity observations, not screening accuracy or positive predictive value. The research combination included AFP; the AFP-only comparator used a 200 ng/mL cutoff. These numbers do not compare the marketed assay with ultrasound-plus-AFP surveillance or establish 100% sensitivity in future patients. See The Test for all four subgroups, confidence intervals, and limitations.
Can blood testing replace ultrasound and AFP?
MoleculeDx's proposed FDA development objective is to evaluate the Liver Cancer Fusion Predictor alone or together with ultrasound as a potential replacement for the current ultrasound-plus-AFP surveillance strategy. This is the proposed intended use under evaluation—not an FDA marketing authorization and not evidence that replacement has already been proven superior. FDA Breakthrough Device processes can support device development and review but do not waive requirements for evidence of safety and effectiveness. [4]
At present, patients eligible for routine HCC surveillance should follow their clinician's established surveillance recommendations. Surveillance is different from diagnostic imaging: even if a blood test eventually replaces some routine surveillance visits, a concerning positive result may still require CT, MRI, or other diagnostic assessment to locate or confirm a tumor. [2]
How do you order a liver cancer blood test?
Use the secure MoleculeDx booking portal and provide the required patient information. The current listed self-pay package is $160.
Mobile blood collection is available through participating phlebotomy partners where service is offered.
Your blood sample is transported to the laboratory, where molecular signals are assessed using the applicable assay process.
Review the secure positive or negative report and share concerning findings with your clinician. Timing varies with collection, shipping, analysis, and review.
Screening versus diagnosis: A blood test can provide a reason to investigate for HCC or a reassuring negative signal; it cannot by itself determine whether a tumor is present with certainty. A clinician integrates blood findings, imaging, history, and other tests.
For high-risk individuals, remaining engaged in periodic surveillance is important even after a negative result.
Frequently asked questions
Can liver cancer be present when AFP is normal?
Yes. AFP can be normal in people with HCC. A normal AFP level is not sufficient to exclude HCC, which is one reason AFP is used together with ultrasound in current surveillance guidance. [2]
Does a positive Liver Cancer Fusion Predictor mean I have cancer?
Not necessarily. A positive result detects a cancer-associated molecular pattern and raises concern that HCC may be present; diagnostic evaluation is needed to determine whether cancer exists and where it is located.
Does a negative result mean I can stop surveillance?
No. Negative means that the qualifying signal was not detected in this sample and HCC is less likely at that time. People at high risk should continue their clinician-directed surveillance plan, including discussion of repeat testing where appropriate.
Is there a guaranteed 24-hour result time?
No fixed turnaround is guaranteed in this article. Timing can depend on collection appointments, specimen transport, laboratory processing, and report review. Confirm current expectations when ordering.
What should I ask my clinician before ordering?
Ask whether you meet HCC surveillance criteria, whether the test is appropriate for your care plan, what action to take after a positive result, and how your usual imaging and blood testing should continue.
References and further reading
- Yu Y-P, Liu S, Geller D, Luo J-H. Serum Fusion Transcripts to Assess the Risk of Hepatocellular Carcinoma and the Impact of Cancer Treatment through Machine Learning. Am J Pathol. 2024;194(7):1262–1271. DOI: 10.1016/j.ajpath.2024.02.017.
- Singal AG, Llovet JM, Yarchoan M, et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023;78(6):1922–1965. DOI: 10.1097/HEP.0000000000000466.
- Rich NE, Villanueva A, Marrero JA, Kanwal F. Risk stratification and emerging surveillance strategies for HCC. American Gastroenterological Association Clinical Practice Update, April 15, 2026. Clinical guidance.
- U.S. Food & Drug Administration. Breakthrough Devices Program. FDA program overview.
Ready to learn more about HCC surveillance?
Learn how the Liver Cancer Fusion Predictor works, review the small-tumor research, or begin an order through the secure patient booking portal.