How do I manage liver cancer screening?
Key takeaways:
- Hepatocellular carcinoma (HCC) remains a risk for people living with hepatitis B, including those on treatment and without cirrhosis.
- Without proper management and monitoring, 1 in 4 people living with hepatitis B will develop liver cancer or cirrhosis.
- The risk of liver cancer is increased in people with cirrhosis and hepatitis B and other cofactors (smoking, diabetes, fatty liver disease, co-infection (HIV and hepatitis C) and alcohol-related liver disease).
Which patients require HCC screening?
HCC screening is recommended for people living with hepatitis B who are willing* and suitable** to receive HCC treatment in these groups:
- People with cirrhosis including those with HBsAg loss
- Asian-Pacific males > 40 years
- Asian-Pacific females > 50 years
- Sub-Saharan African people > 20 years
- Aboriginal people > 50 years
- Aboriginal people with high-risk features*** > 40 years
- Anyone aged > 40 years with a family history of HCC (first-degree relatives)
Consider offering HCC surveillance 10 years prior to earliest case in a family.
* ‘Willing’ means someone who is willing to receive a HCC diagnosis and if diagnosed, to undergo HCC treatment.
** ‘Suitable’ is defined as: someone who is well enough to receive HCC treatment (including patients with Child-Pugh stage A or B cirrhosis or patients with Child-Pugh stage C awaiting liver transplantation) and is without significant comorbidities and therefore has a non-HCC-related life expectancy of > 6 months.
**High-risk features include: a family history of HCC or a high-risk HBV genotype individually confirmed (eg C4) or epidemiologically likely.
Do not routinely offer HCC surveillance for people who have limited projected life expectancy of < 6 months.
Quick Links
Decision making in hepatitis B | PDF| ASHM
Detailed Information
Clinical practice guidelines for hepatocellular carcinoma surveillance for people at high risk in Australia | Website | Cancer Council Australia
Why is HCC screening important?
Hepatocellular carcinoma (HCC) is a low survival cancer with a 5-year survival of < 30% in Victoria from 2017–2021.
Hepatitis B is an oncogenic virus that increases the risk of HCC and can occur in a liver without cirrhosis. HCC can progress rapidly and present at an advanced stage in the absence of symptoms.
The aim of HCC surveillance is to detect tumours at an early stage when curative treatment can be offered including resection and liver transplant.
Quick Links
B Positive: Hepatitis B related hepatocellular carcinoma | Website | ASHM
How is HCC screening done?
HCC screening is a 6-monthly liver ultrasound with or without an alpha fetoprotein (AFP) blood test.
It is important to empower patients to understand the purpose of screening. This can be managed in both the community and tertiary setting.
For information on who is recommended for HCC screening see here.
If a patient with hepatitis B commences HCC screening, it is recommended to continue this on a lifelong basis.
“I have found setting reminders in our practice software for the next time tests are required, can really help my patients keep on top of the required monitoring, such as HCC screening. 6 months comes around surprisingly quickly and without a system in place it can be easy for everyone to forget!” – Hepatitis B s100 Community Prescribing GP | Melbourne
Quick Links
Decision making in hepatitis B | PDF | ASHM
Clinical practice guidelines for hepatocellular carcinoma surveillance for people at high risk in Australia | Website | Cancer Council Australia
Detailed Information
B Positive: Hepatitis B related hepatocellular carcinoma | Website | ASHM
How do I support my patients with information about HCC screening?
“I have other more important health issues and the doctor doesn’t have much time so I don’t need to do anything about Hepatitis B since it doesn’t cause me any problems. I later found out I have liver cancer. I didn’t know that regular monitoring could’ve picked this up before it got to this stage. How do I tell my family this?” – Community member with lived experience of hepatitis B
This flipchart is designed for healthcare workers to use with patients who have been diagnosed with hepatitis B. It provides practical information on managing hepatitis B to prevent liver damage and liver cancer.
See below for a list of relevant community resources.
Further Information
Preventing hepatitis B-related liver cancer: Flipchart | PDF | Cancer Council
Hepatitis B & liver cancer | Website | Cancer Council
Understanding liver cancer: A guide for people with cancer, their families and friends | PDF | Cancer Council
