If your clinician recommends a test for liver cancer, you may wonder how to prepare, what happens at the appointment, and what the results mean. Liver cancer screening—often called surveillance—checks people at increased risk for hepatocellular carcinoma (HCC), the most common type of primary liver cancer, even when they feel well. Screening can identify findings that need closer evaluation, but a screening result is not, by itself, a cancer diagnosis.
Before Screening: Who May Need It?
Surveillance is generally recommended for people at sufficiently high risk of HCC, especially those with cirrhosis and certain people with chronic hepatitis B. Other liver conditions may also affect risk. Whether screening is appropriate depends on factors such as the underlying liver disease, age, family history, and overall health. Having fatty liver disease or a history of hepatitis does not automatically mean everyone needs the same screening schedule.
For eligible patients, the American Association for the Study of Liver Diseases (AASLD) recommends liver ultrasound together with an alpha-fetoprotein (AFP) blood test approximately every six months. [1] Regular follow-up matters because liver cancer may develop without noticeable symptoms, and previous imaging and laboratory findings help your care team interpret new results.
Preparation is usually straightforward. Your imaging center may ask you to avoid food for several hours before an ultrasound, although instructions vary. Ask whether fasting is necessary and whether to take your usual medicines. If a blood test is ordered, follow the laboratory’s collection instructions. Tell your care team about any difficulty lying flat or other concerns that could affect the examination.
During Screening: What Happens at the Visit?
Routine HCC surveillance typically includes an abdominal ultrasound and an AFP blood test. Your clinician may also discuss other tests depending on your personal risk and prior results.
Abdominal Ultrasound
For a liver ultrasound, you lie on an examination table while a sonographer applies gel to your upper abdomen and moves a handheld device, called a transducer, across your skin. Sound waves produce images of the liver. The examination does not use ionizing radiation and is usually painless, although you may feel some pressure.
Ultrasound is widely used, but it cannot detect every liver cancer. Image quality may be reduced by factors such as body habitus, bowel gas, or fatty changes in the liver. When the liver cannot be adequately evaluated, your clinician may recommend another imaging approach rather than relying on a limited examination. [1]
AFP Blood Testing
AFP is a protein measured with a routine blood draw. An elevated AFP level can be a reason for additional evaluation, but AFP alone cannot confirm liver cancer. Some people with HCC have normal AFP levels, and AFP may also be elevated for reasons other than cancer. Your clinician interprets the blood test together with ultrasound findings and your medical history. [1]
After Screening: What Do the Results Mean?
A normal result means that no concerning finding was identified by the tests performed at that visit. It does not guarantee that liver cancer is absent or will not develop later. If you remain in a high-risk group, your care team will usually recommend continued surveillance, often about six months later. Report new symptoms or important health changes rather than waiting for your next scheduled screening.
An abnormal or unclear result does not automatically mean cancer. For example, an ultrasound may show a benign nodule or an area that is difficult to characterize. Depending on the finding, your clinician may recommend repeat imaging, a contrast-enhanced MRI, or a multiphasic CT scan. Biopsy is reserved for selected circumstances and is not necessary for every suspicious finding. [1]
If you receive a blood-based molecular screening result, a positive finding should likewise prompt discussion with a healthcare professional and any appropriate follow-up testing. A negative molecular result should not be used as a reason to stop recommended surveillance.
What About Newer Blood-Based Tests?
Researchers are evaluating blood-based approaches that analyze cancer-associated molecular signals, including circulating cell-free fusion transcripts. A 2024 peer-reviewed study investigated the use of serum fusion transcripts and predictive models to assess HCC risk. [2] Such research supports further development of molecular screening tools, although performance depends on the particular test and the population studied.
MoleculeDx has developed the Liver Cancer Fusion Predictor using Fusion-detect™ technology, a proprietary multivariable approach for evaluating blood-based signals associated with HCC. The test is designed to help identify individuals who may need further clinical evaluation. Its specific model inputs and analytical methods are proprietary.
According to the clinical validation results reported by MoleculeDx, Fusion-detect™ demonstrated 96.7% overall accuracy, 94.2% sensitivity, and 98.1% specificity. [3] Sensitivity describes the proportion of people with HCC correctly identified by the test; specificity describes the proportion of people without HCC correctly identified. Overall accuracy is the proportion of correct classifications in the evaluated study population.
These figures describe performance in the population used for validation; they are not a guarantee of the result for an individual patient. The chance that a positive result truly indicates cancer depends partly on the person’s underlying risk. False-positive and false-negative results remain possible. Molecular screening results should be interpreted with clinical findings and appropriate imaging.
Questions to Ask Your Clinician
Before you leave your appointment, consider asking: Why am I considered at risk for liver cancer? Which tests are recommended for me, and how often? When and how will I receive my results? What happens if an ultrasound is limited, AFP is abnormal, or a molecular blood test is positive? Understanding the follow-up plan can make screening more useful and less stressful.
This article is for general education and does not replace advice from a qualified healthcare professional. Surveillance and follow-up recommendations vary according to individual risk and clinical circumstances.
References
- 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. https://pmc.ncbi.nlm.nih.gov/articles/PMC10663390/
- 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. https://pubmed.ncbi.nlm.nih.gov/38537933/
- MoleculeDx. Liver Cancer Fusion Predictor—Frequently Asked Questions. Company-reported clinical validation performance. https://www.moleculedx.com/faq/ (accessed October 28, 2026).