Surveillance or screening - there’s no alternative yet!

Two weeks ago I saw a patient who is known to be a carrier of hepatitis C virus (HCV). He was diagnosed in 2005 but for the last few years had not had regular surveillance of his liver. He had felt bloated for a few months and saw his doctor recently. Subsequent investigations showed he had bilobe liver cancer (hepatocellular carcinoma, HCC) in a cirrhotic liver. Curative surgical resection was not an option as he had lesions in both the right and left lobes of the liver. [The best scenario for any patient with HCC is the presence of a small (< 2cm in diameter) tumour confined to one lobe of the liver (i.e. stage I / II cancer).] Would the situation be different if he had had regular surveillance?

Researchers from Hiroshima Prefectural Hospital reported the results of a study evaluating the usefulness of regular check-ups by ultrasonography and contrast-enhanced imaging for early detection of HCC in patients infected with HCV (J Gastroenterol 2009, Oct 29; epub). From April 2001 to March 2007, 240 consecutive HCV patients with HCC were studied. These patients could be classified into 3 groups:- Group A patients had their HCC diagnosed by regular, imaging surveillance; Group B patients had their HCC detected during scheduled doctor visits for liver disease or other diseases such as diabetes and Group C patients had their HCC detected when they felt a need to visit a doctor. The study found that the prevalence of single tumour at the time of diagnosis was 66% in group A patients. Group B patients had a prevalence of 48% while it was only 24% in group C patients. The percentage of stage I and II patients were 83% for group A, 53% for group B and 24% for group C. The number of patients who underwent curative procedure (surgical resection / ablation) was 99/124 (80%) in group A, 42/79 (53%) in group B and 10/37 (27%) in group C.

At the present moment, we cannot, with one blood or x-ray test, predict the risk of developing HCC in anyone who is a carrier of the hepatitis B (HBV) or C virus. The only way we can help these carriers is to perform regular blood and x-ray screening at 6 monthly intervals. The surveillance / screening is to afford us a chance to detect the liver cancer at an earlier stage. It does not stop the development of the cancer. If the liver cancer can be detected at an earlier stage, the chance of having a curative treatment is much higher.     

To all HBV & HCV carriers and people with liver cirrhosis, please remember to go for regular screening. Please do not wait until you have symptoms. It could be a bit late by then.