Screening

Screening is the use of tests in an asymptomatic person to see if that person is developing liver cancer. If liver cancer is identified early, there is a better chance of successful treatment.

People with certain conditions that put them at a higher risk of developing HCC or CCA should be screened—for example, those with cirrhosis and primary sclerosing cholangitis (PSC).

Medical imaging scans can help discover both HCC and CCA. Transabdominal ultrasound is most commonly used to discover HCC. On the other hand, medical imaging scans are not used for routine CCA screening because it is hard to tell the difference between inflammation and cancer.

Due to the lack of standardised screening programs in most countries or lack of screening possibilities, patients are usually diagnosed late. Currently, half of all people with HCC and CCA are diagnosed when the cancer is already at an advanced stage (51% for HCC). However, there is ongoing research on the use of blood tests for screening. This could help discover diseases earlier and be a more accurate and cost-effective method than medical imaging.

HCC screening in groups of high-risk people is recommended by The European Society for Medical Oncology (ESMO) and The European Association for the Study of the Liver (EASL). Specifically, they advise that people with liver cirrhosis have an ultrasound screen every six months. However, in most countries, there is no standardised screening program.

Some Asian countries with an exceptionally high rate of HCC (due to a high prevalence of hepatitis B) have introduced nationwide screening programs. These are Japan, China, and South Korea. For example, South Korea’s screening program is for groups at high risk of contracting hepatitis B, hepatitis C, or other liver diseases. It uses liver ultrasounds and blood tests (serum alpha-fetoprotein tests).

The prognosis of HCC correlates closely with the tumour stage: early diagnosis is associated with a more than 70% survival rate at five years, but advanced stages have less than a 20% survival rate at five years.

Primary sclerosing cholangitis (PSC) is a risk factor for CCA in Western and European regions. Guidelines for surveillance of PSC generally recommend that people with PSC have a yearly scan and biopsy. Further information on these tests is in the Tests and Diagnosis sections.

Research into CCA screening is ongoing but promising. International collaborative networks of multidisciplinary organisations are working to accelerate scientific knowledge on this cancer; thus, screening programs may develop in the future.