Surveillance of hepatocellular cancer—why can’t we do better?

Hepatocellular carcinoma (HCC) has become a priority because of high case fatality and increasing incidence, especially in the United States. Because the best curative therapies are liver resection and transplantation, the Holy Grail of HCC is early identification. Finding smaller tumors allows for surgical intervention with better outcome and also allows time to wait for precious donor livers. In this recent article, Kanwal and Singal summarize the current best practices for HCC surveillance. They rightfully point out that the direct evidence for benefit of HCC surveillance has included only 2 large randomized controlled trials from Chinese patients with hepatitis B and multiple retrospective studies which inferred survival benefit (1,2).