How should patients with chronic hepatitis C be monitored for hepatocellular carcinoma?

How should patients with chronic hepatitis C be monitored for hepatocellular carcinoma?

• A. Alkaline phosphatase monitoring.
• B. Serum alpha-fetoprotein and ultrasound.
• C. Liver biopsy every year.
• D. No surveillance.

Answer: (B)

Regular screening for hepatocellular carcinoma in chronic hepatitis C focuses on catching tumors early when treatment is most likely to be effective. Ultrasound is used because it is a safe, noninvasive way to visualize the liver and detect focal lesions. Adding serum alpha-fetoprotein helps improve detection, as some tumors produce AFP and may be found even when ultrasound alone misses abnormalities. Together, ultrasound with AFP provides better sensitivity for early HCC than either test alone, and the usual surveillance interval is about every six months to balance timely detection with practicality and cost. Alkaline phosphatase monitoring isn’t a reliable method to screen for HCC, since elevations are nonspecific and can occur with many liver, bone, or other conditions. A liver biopsy every year is invasive and not suitable for routine surveillance because it carries risk, and sampling may miss tumors due to heterogeneity. No surveillance would miss early cancers that are more amenable to curative treatment.

Regular screening for hepatocellular carcinoma in chronic hepatitis C focuses on catching tumors early when treatment is most likely to be effective. Ultrasound is used because it is a safe, noninvasive way to visualize the liver and detect focal lesions. Adding serum alpha-fetoprotein helps improve detection, as some tumors produce AFP and may be found even when ultrasound alone misses abnormalities. Together, ultrasound with AFP provides better sensitivity for early HCC than either test alone, and the usual surveillance interval is about every six months to balance timely detection with practicality and cost.

Alkaline phosphatase monitoring isn’t a reliable method to screen for HCC, since elevations are nonspecific and can occur with many liver, bone, or other conditions. A liver biopsy every year is invasive and not suitable for routine surveillance because it carries risk, and sampling may miss tumors due to heterogeneity. No surveillance would miss early cancers that are more amenable to curative treatment.