Screening for hepatocellular carcinoma in patients with cirrhosis

High incidence: Because of the high incidence of hepatocellular carcinoma ( HCC) in patients with cirrhosis (3 to 5% per year) and the fact that curati ve treatment is currently available only for small sized tumors careful scr eening is warranted in this high risk population. Earlier screening attempt s produced disappointing results in terms of cure and survival, particularl y in Europe. Progress in ultrasonography, a better understanding of the ris k of developing HCC, and most importantly the advent of local percutaneous treatments have greatly affected the data which should be reexamined. Screening methods: Patients with cirrhosis, particularly alcoholic or viral cirrhosis, should undergo regular ultrasound examinations, every six month s for most screening protocols although the best timing remains unknown. As say of serum alpha-fetoprotein is of limited use due to its low sensitivity and specificity. Diagnosis of HCC is basically based on helicoidal compute d tomography and/or magnetic resonance imaging findings, with or without pa thological proof (ultrasound-guided biopsy) that may be difficult to obtain . A probabilistic diagnosis is therefore retained if necessary, based on th e presence of risk factors and arterial hypervascularization of a liver nod ule. Early treatment: With ultrasound screening, the diagnosis of HCC can genera lly be established early, when curative transplantation, resection or local percutaneous destruction are still feasible. The percutaneous methods use chemical or physical agents to destroy the tumor. There are few contraindic ations so curative treatment can be proposed for a large number of patients . Large-scale prospective studies will be completed in the upcoming years a nd are expected to provide evidence validating the principle of screening a nd early treatment.