a torso showing a liver with a question mark indicating unknown cancer status

Should I Be Screened for Liver Cancer?

Liver cancer is common cancer worldwide. And the number of cases and deaths from liver cancer is increasing in the United States.1

As with other cancers, some people may benefit from screening tests for liver cancer. Screening tests may help your doctor diagnose and treat your liver cancer in its early stages.2,3

Liver cancer and hepatitis C

The hepatitis C virus (HCV) is a common cause of liver cancer. About 30 percent of all cases of hepatocellular carcinoma (HCC) are caused by HCV. HCC is the most common type of liver cancer. HCC may be caused by the effects of the virus itself. It may also be related to the body’s response to HCV-related damage.1,2,4,5

Over time, HCV causes damage to liver cells (hepatocytes). These cells try to regenerate or repair themselves in response. But the process of regeneration and repair sometimes causes mutations. Mutations are changes in a cell that can lead to cancer.2,4,5

Damage or scarring that is reversible is called fibrosis. Scarring that is permanent is called cirrhosis. HCV-related cases of liver cancer tend to only happen in people with cirrhosis. Treatment with direct-acting antiviral drugs may help reduce the risk of both cirrhosis and HCC.2,4-6

What is a screening test?

A screening test is used before symptoms start. Screening tests are helpful when finding and treating a health issue early and can lead to better results. For example, a mammogram is a screening test for breast cancer and a colonoscopy is a screening test for colon cancer.7,8

Liver cancer does not always have obvious symptoms. By the time symptoms do occur, cancer may have already spread. Being able to detect liver cancer early – before symptoms start – may be helpful in reducing the risk of serious illness or death.

Your doctor will use guidelines based on factors that are personal to you to decide which screening tests you may need and when. These factors include:

  • Age
  • Risk factors for liver cancer
  • Other details of your medical history

Screening tests for liver cancer

Some health conditions have specific screening tests and guidelines for their use. Other conditions, like liver cancer, do not have clear options. There is no 1 screening test that is perfect for detecting liver cancer. Instead, several tests may be used and their timing may vary from person to person.7

The most common screening tests used for liver cancer are ultrasound and blood testing for alpha-fetoprotein (AFP) levels.2,7

In ultrasound imaging, a small device (probe) is placed on the outside of the body. It gives off sound waves that bounce off different things inside the body to create images. Ultrasound images are not as clear as other options, such as magnetic resonance imaging (MRI) scans. But they can be a quick way to get a basic idea of what is going on. Your doctor can use ultrasound to look at your liver for:2,7,9

  • Masses (like tumors)
  • Damage
  • Other changes
  • AFP is a type of protein in the blood. In some cases of liver cancer, AFP will be higher than normal. This may be an early sign that something is wrong.2,7

    AFP does not always change in liver cancer. It can also change as a result of other health conditions. That means a person can have a high AFP level, but not have liver cancer.2,7

    Who should be screened?

    Doctors have different opinions on who should be screened and how often. This is because guidance about screening for liver cancer is not as clear as for some other types of cancer. Many doctors agree that people at higher risk for liver cancer should be screened. This includes people with:2,7

  • Cirrhosis (from HCV or other causes)
  • Liver-related health conditions
  • Family history of liver cancer
  • Heavy alcohol use
  • Tobacco use
  • People with cirrhosis or who are at high risk may need to be screened with ultrasound or AFP blood tests every 6 months. But this depends on the specific person. If you are concerned about your risk of liver cancer, talk with your doctor about your screening options and timeline.2,7

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    This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The HepatitisC.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
    Written by: Casey Hribar | Last reviewed: February 2022

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