Diagnosis and surveillance of hepatocellular carcinoma

The diagnosis of hepatocellular carcinoma (HCC) in patients without liver cirrhosis is based on histopathological and immuno-histological findings. When liver cirrhosis is present HCC can be diagnosed based on typical contrast dynamics in cross-sectional imaging. In contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) HCC shows enrichment of contrast agent in the arterial phase and a typical wash out in the portal venous or late phase. Therapeutic options and prognosis depend on tumor stage at the time of diagnosis. Patients with a higher risk of developing HCC, such as patients with chronic liver diseases with advanced fibrosis or cirrhosis or those with chronic hepatitis B (delta) and C virus infec-tions should be enrolled in surveillance programs. Non-alcoholic steatohepatitis (NASH) was recently recognized as an risk factor for HCC development. Already in precirrhotic stages, surveillance should be performed by conventional ultrasound examination every 6 months. As very small hepatic masses < 1 cm do not correlate with HCC in most cases, follow-up examinations should be performed promptly. Regular surveillance examinations can significantly reduce HCC-related mortality.