Digestive disorders

I./4.5.: Screening

Early detection of the tumor is of great significance. Due to the development of diagnostics and therapy that occurred in the recent years, the prognosis of HCC has improved. Liver cancer detected timely, in very early and early stages, can be cured with the available therapeutic modalities; the survival can be increased significantly. Therefore screening of the patients at risk is of eminent importance. At-risk patients include HBV-carrier Asian men over 40 years of age; Asian women over 50 years, African patients over 20 years, patients with chronic hepatitis B and those with cirrhosis due to it, particularly in the presence of high concentrations of HBV-DNA. Patients with hepatitis C are at risk even after the occurrence of a sustained virological response, and similarly at risk are all these patients in whom hepatic cirrhosis has already developed, and their oncologic family history is positive for HCC.

The development of primary hepatocellular carcinoma can be avoided by excluding or treating all environmental factors which may lead to cirrhosis (alcohol consumption, obesity, hepatic steatosis, steatohepatitis, type 2 diabetes mellitus), by preventing HBV, HDV and HCV infections; by active immunization against HBV and by complying with the hygienic precautions. The incidence of liver cancer may be reduced by timely initiated and appropriately applied, targeted therapy against HBV, HDV and HCV as well.

In the screening for primary hepatocellular carcinoma the imaging examinations such as ultrasound, MDCT, MR are of essential significance. Ultrasonography is a primary procedure, the sensitivity and specificity of which in the detection of HCC are 59–89% and 75–94% respectively. Ultrasonography with contrast media further increases the sensitivity of the technique and the accuracy of the diagnosis. Abdominal ultrasound examination of patients with hepatic cirrhosis is necessary in every 6 months. The frequency of follow-up examinations can be increased to 3 months depending on the risk and change of the tumor.