# HCC surveillance in cirrhosis (ultrasound + AFP)

Source: https://onco.cc/technologies/hcc-surveillance/  
OnCo record `hcc-surveillance` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

People with cirrhosis or chronic hepatitis B get a liver ultrasound and a blood test every six months so cancer is caught while it is still curable.

## Summary

Six-monthly ultrasound with or without AFP is recommended by AASLD, EASL and APASL; it detects HCC at an early stage in ~60-70% of adherent patients and is associated with better survival in cohort studies (no randomised trial outside China). Uptake is under 25% in many health systems. Abbreviated MRI, GALAD (gender, age, AFP-L3, AFP, DCP) and cfDNA methylation tests are being evaluated to improve sensitivity in obese and fatty-liver patients.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-07
- Principle: Risk-stratified imaging of a defined at-risk population (cirrhosis of any cause, HBV carriers) at an interval matched to tumour doubling time.
- Strengths: Cheap, non-invasive; Stage shift toward curative options
- Limitations: Ultrasound sensitivity falls in obesity and steatosis; Poor adherence and under-diagnosed cirrhosis (especially MASLD)

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Hepatocellular_carcinoma
- Wikipedia: https://en.wikipedia.org/wiki/Hepatocellular_carcinoma

## Connected records

- cancers: [Early hepatocellular carcinoma (BCLC 0 and A)](https://onco.cc/cancers/hcc-early/), [Hepatoblastoma](https://onco.cc/cancers/hepatoblastoma/), [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- technologies: [Coffee and tea intake](https://onco.cc/technologies/coffee-intake-cancer/), [MRI](https://onco.cc/technologies/mri/), [Multi-cancer early detection (MCED)](https://onco.cc/technologies/mced/), [Serum tumour markers: proper use and misuse](https://onco.cc/technologies/serum-tumour-markers/), [Ultrasound](https://onco.cc/technologies/ultrasound/)
- terms: [Alpha-fetoprotein (AFP)](https://onco.cc/terms/afp/), [Hepatitis B and C as cancer causes](https://onco.cc/terms/hbv-hcv/)
- ideas: [Blood-based HCC surveillance to replace six-monthly ultrasound](https://onco.cc/ideas/idea-hcc-blood-surveillance/)
- bottlenecks: [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- pathways: [Oncogenic viruses](https://onco.cc/pathways/oncogenic-viruses/)
- roadmaps: [Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers](https://onco.cc/roadmaps/prevention-roadmap/)

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