Hepatocellular carcinoma (HCC) is the sixth leading cause of cancer-related death in the United States and has one of fastest increasing incidence rates among all solid tumors. Surveillance (or screening) for HCC is recommended for patients with cirrhosis and subgroups of patients with chronic hepatitis B using ultrasound and a serum biomarker, alpha-fetoprotein, every 6 months. There are several cohort studies showing a strong association between HCC surveillance and early tumor detection, curative treatment delivery, and improved survival. However, significant gaps remain in adherence and test effectiveness, mitigating surveillance effectiveness in clinical practice. Although several promising blood-based biomarkers that may improve surveillance effectiveness are in development, they require further validation prior to routine use in practice. Once a diagnosis of HCC is made, staging is a central part of determining prognosis and treatment. Several staging systems have been proposed, and contemporary staging appears to have increased accuracy with a trade-off with simplicity and ease of use. Improvements in surveillance effectiveness and accurate staging for appropriate treatment allocation are central to improving HCC-related outcomes.
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