Hepatocellular carcinoma surveillance in a western population with hepatitis B

Hepatocellular carcinoma (HCC) is a malignant tumor arising primarily in cirrhotic livers as a consequence of chronic hepatitis B or C virus infection or alcohol-induced cirrhosis. Unlike the majority of other common cancer types, the incidence of HCC in the United States is still rising, with peak incidence expected for 2020. Although hepatitis B is a less common etiology for the development of HCC in the West, it is the most common risk factor among certain ethnic groups in the United States. Given the high case fatality of HCC, surveillance efforts have been recommended. Specifically, HCC surveillance has demonstrated a survival benefit in patients with chronic hepatitis B. In this review, we discuss the demographics of patients with HCC in the United States, the evidence promoting surveillance, and recent literature identifying the best surveillance test.