The importance of liver cancer screening in patients with hepatitis B

By John Leung, MD; Kathleen Coleman, NP and Dean Ehrlich


Hepatitis B, a viral infection that affects the liver, is a very common infection in people of Asian descent. Often passed along during childbirth, it is also spread by sexual contact, intravenous drug use or through other activities where you might become exposed to the blood of an infected person. In some cases, a hepatitis B infection that is inherited from infancy will remain dormant for a person’s entire life. However, many people do not realize that even if hepatitis B is not actively making you feel sick, or even if a health care provider has told you that your virus is not active, it can still cause the most common type of liver cancer, hepatocellular carcinoma (HCC). The World Health Organization (WHO) estimates that in 2005 there were 700,000 deaths from HCC, half of which were related to hepatitis B.

Image courtesy of the World Health Organization public database of human cancers. 圖片來自世界健康組織。

Image courtesy of the World Health Organization public database of human cancers.

One way to detect HCC is through an ultrasound. Ultrasound is a safe technology that uses sound waves to look for early signs of cancer in the liver, which is important because earlier diagnosis of HCC means more treatment options and higher survival rates. Given the relationship between hepatitis B and HCC, doctors are now recommending regular ultrasound screenings in patients who have tested positive for hepatitis B.

Additionally, your health care provider might recommend a blood test called AFP or Alpha Feto-protein. This is also referred to as a “tumor marker.” This test is most often recommended in cases of fast growing cells such as those seen in tumors. These tests in combination (ultrasound and AFP) can help your doctor catch early cancers before you ever feel ill.

The American Association for the Study of Liver Diseases recommends “surveillance” ultrasound screenings for those at risk (people with viral hepatitis or other known liver diseases) every six months. All patients with a history of hepatitis B infection are encouraged to bring this up with their doctor. A simple blood test can tell if hepatitis B is still a risk for you or if your body has already cleared the virus in the past.

The importance of these screenings was apparent with a recent patient. The patient was an adult male, who emigrated from China about 10 years ago. He had been diagnosed with hepatitis B in China, but because he felt no symptoms, did not follow up on the diagnosis with his doctor. When the patient finally went to the hospital for jaundice (yellowing of the skin), his CT scan showed cancer of the liver. Sadly, the cancer had already spread beyond his liver, and his prognosis was unfortunately very poor with this advanced stage of the cancer. This is a perfect example of somebody who would have benefitted from regular screening using ultrasound and AFP.

If you or someone you know has hepatitis B, please discuss with your caregiver the importance of HCC screening even if you feel well. If there is a family history of hepatitis B and liver cancer, your risk may be higher and a screening could save your life.

Quick facts about hepatitis B and hepatocellular carcinoma


Hepatitis B Worldwide 350 million people
Hepatitis B in China 120 million people
Hepatocellular Carcinoma (Liver Cancer) 3rd leading cancer worldwide
Hepatocellular Carcinoma detected by screening Greater than 50% survival at 5 years
HCC detected late (after symptoms start) 0-10% survival at 5 years


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