HCC surveillance (liver monitoring)

About HCC (hepatocellular carcinoma)

HCC (hepatocellular carcinoma) is the most common type of liver cancer. It often occurs in a scarred or damaged liver.

Causes

Common causes include the following:

• alcohol related liver disease
• fatty liver disease
• hepatitis infections.

About surveillance (liver monitoring)

Surveillance means we monitor your liver to look for any complications.

Surveillance can help us diagnose HCC early, before symptoms develop. This makes treatment easier and more successful for people who need it.

We will not give you HCC surveillance unless you choose to have it.

Not everyone is eligible. Reasons for not being eligible include:

• a patient already has advanced liver cancer
• a patient has other serious health conditions, which means we cannot offer treatment for HCC
• increasing frailty
• a patient is no longer at risk of liver cancer.

In these situations, we will discuss this with you.

What surveillance involves

If you choose surveillance, you can expect the following every 6 months:

• a blood test
• a painless, external liver ultrasound.

Why we recommend it

Patients with liver disease are at risk of developing liver cancer (HCC).  The risk is around 1 to 8 people out of every 100 (depending on the cause of the liver disease).

We offer surveillance (monitoring) to these at-risk patients because this helps us to detect HCC at an early stage and offer more effective treatment.

How effective is it?

Surveillance is not perfect, but it is the best system we currently have.

The combination of blood tests and ultrasound increases the chances of our detecting small HCCs, but we may miss extremely small tumours.

Some patients will still develop inoperable cancer. 

Outcomes of surveillance 

Most people tested (95 out of every 100) will have no signs of cancer and will not need additional tests.

Some people (5 out of every 100) will need further tests, usually an MRI scan.  

• Of these 5 people, 1 will be diagnosed with cancer.
• We will continue to monitor the other 4 people. 

If we find cancer

If we diagnose cancer, most patients (4 out of every 5) will have cancer that we can potentially cure.

1 out of 5 people will have cancer that we cannot cure.

Treatment

Treatment depends on the size and number of tumours, and on liver function and overall fitness.

Types of treatment include:

• surgery
• ablation (the use of heat into the tumour)
• chemotherapy 
• radiotherapy
• liver transplantation (less common).

Getting your results

We will send you the results within a few weeks of your surveillance investigations (blood test and ultrasound). We will do this by either phone or letter.

If the surveillance has found abnormalities, the hospital liver team will arrange for you to have an MRI (Magnetic Resonance Imaging) scan or a CT (Computerised Tomography) scan.

When these further tests are finished and if they confirm a cancer diagnosis, we will give you an appointment at the Liver Clinic to discuss the results and plan appropriate treatment.

Risks of HCC surveillance

Blood tests and ultrasound are safe and cause minimal discomfort.

If surveillance detects an abnormality in the liver which turns out not to be cancer, this can cause you to worry until the situation is resolved.

If surveillance diagnoses HCC, it may not be at an early stage and we may not be able to cure it.

More information

Liver Cancer UK offers useful information (including videos) on liver cancer surveillance.