What lowers your risk
- Get the hepatitis B vaccine — one of the few true cancer-preventing vaccines that exists, and it works
- Get tested for hepatitis B and C if you never have; treating chronic infection lowers your future risk
- Limit alcohol, and get help if drinking has become hard to control
- Manage weight, type 2 diabetes and fatty liver disease — these now drive cirrhosis even without viral hepatitis
- Store grains and nuts properly and avoid visibly moldy food, which reduces aflatoxin exposure
- If you already have cirrhosis or chronic hepatitis, do not skip surveillance — it is the single highest-value thing you can do
Who is at higher risk
- Anyone with cirrhosis, from any cause
- People with chronic hepatitis B, sometimes even before cirrhosis develops
- People with chronic hepatitis C — HCV-related cirrhosis carries higher risk than cirrhosis from hepatitis B or alcohol alone
- People with heavy, long-term alcohol use
- People with fatty liver disease, obesity or type 2 diabetes
- People with significant aflatoxin exposure through contaminated food
Surveillance actually works here
There is no general-population screening for liver cancer. But for adults with cirrhosis of any cause, the American Association for the Study of Liver Diseases gives a strong recommendation: abdominal ultrasound plus an AFP blood test about every six months. Any suspicious spot 1 cm or larger, or an AFP at or above 20 ng/mL, gets followed up with multiphase CT or MRI (PMID 37199193).
Surveillance is also recommended for many people with chronic hepatitis B before cirrhosis develops, because the virus can drive liver cancer directly.
If you have cirrhosis and are not on a six-month surveillance schedule, that is the single most useful thing to fix at your next appointment.
Signs worth reporting promptly
- Unexplained weight loss and loss of appetite
- Pain or fullness in the upper right belly
- A lump you can feel under the right ribs
- Yellowing of the skin or eyes
- New swelling in the belly or legs
- Unusual fatigue or weakness that does not lift
What treatment involves
For small, early tumors in a liver that still works well, treatment can be curative: surgical removal, ablation (destroying the tumor with heat), or liver transplant for those who meet strict criteria. The Milan criteria — one tumor 5 cm or smaller, or up to three each 3 cm or smaller, without spread — identify patients who do very well after transplant. In the original study, patients meeting them had 85% overall survival and 92% recurrence-free survival at four years, against 50% and 59% for those who exceeded them (PMID 8594428).
Because the wait for a donor liver is long and tumors can grow during it, many candidates get bridge treatment. Two main options are transarterial chemoembolization (TACE), which delivers chemotherapy straight into the tumor's blood supply, and stereotactic body radiation therapy (SBRT), a small number of precisely targeted high-dose treatments given as an outpatient without entering the body. Evidence suggests SBRT can control tumors about as well as TACE while sparing a hospital stay, but head-to-head randomized data is still thin — so this should be a shared decision with your transplant and radiation oncology teams rather than a foregone conclusion.
For tumors that cannot be removed or transplanted but have not left the liver, TACE, ablation and SBRT are used to control disease directly, sometimes with each other and sometimes with newer systemic drugs including immunotherapy.
Honest framing: five-year relative survival is about 22% overall — 37% localized, 13% regional, 3% distant. Which is precisely why surveillance in high-risk people matters as much as it does.
Questions to ask your care team
- Do I have cirrhosis, and am I getting imaging and blood work every six months?
- Have I been tested for hepatitis B and C, and if positive, am I on treatment?
- Am I a candidate for surgery, ablation or transplant?
- If I am waiting for a transplant, what bridge treatment makes sense for me?
- What is my Child–Pugh score, and how does my liver function affect my options?
- Would SBRT or TACE suit my tumor and liver function better?
Where these numbers come from
Surveillance guidance: AASLD Practice Guidance, Hepatology 2023 (PMID 37199193). Transplant criteria: Mazzaferro et al., New England Journal of Medicine 1996 (PMID 8594428). Hepatitis B vaccination and liver cancer: Chang et al., Gastroenterology 2016 (PMID 27269245). Survival: American Cancer Society SEER-based statistics.
Talk with our team
If you have cirrhosis or chronic hepatitis, surveillance is the conversation to have now.