Primary liver cancer is among the most common cancers globally. It is the sixth-most common malignancy encountered and the third-most common cause of cancer-related death. Hepatocellular carcinoma (HCC) is the most common primary liver malignancy, accounting for about 90% of primary liver cancers. The majority of HCCs occur in patients with underlying cirrhosis, which results from chronic liver diseases such as fatty liver, hepatitis B and hepatitis C infections, and chronic alcohol use, which are the leading causes. The obesity pandemic has led to an increased prevalence of nonalcoholic fatty liver disease (NAFLD), which leads to nonalcoholic steatohepatitis and could progress to cirrhosis. As HCC is among the most common cancers and occurs in the setting of chronic liver disease in most patients, screening the population at risk could help in early diagnosis and management, leading to improved survival. Screening for HCC is performed using biochemical marker testing such as α-fetoprotein (AFP) and cross-sectional imaging. It is critical to emphasize that HCC could potentially occur in patients without cirrhosis (non-cirrhotic HCC), which can account for almost 20% of all HCCs. The lack of cirrhosis can cause a delay in surveillance, which could potentially lead to diagnosis at a later stage, worsening the prognosis for such patients. In this article, we discuss the diagnosis of cirrhosis in at-risk populations with details on the different modalities available for screening HCC in patients with cirrhosis, emphasizing the role of abdominal ultrasounds, the primary imaging modality in HCC screening.
原发性肝癌是全球最常见的癌症之一，其发病率位列恶性肿瘤第六位，致死率居癌症相关死亡原因第三位。肝细胞癌（HCC）是最常见的原发性肝脏恶性肿瘤，约占原发性肝癌的90%。绝大多数HCC发生于肝硬化患者，其根本病因主要源于脂肪肝、乙型肝炎、丙型肝炎感染及长期酗酒等慢性肝病。全球肥胖症的流行导致非酒精性脂肪性肝病（NAFLD）患病率上升，该疾病可进展为非酒精性脂肪性肝炎并最终发展为肝硬化。鉴于HCC的高发性及其与慢性肝病的密切关联，对高危人群进行筛查有助于实现早期诊断和治疗，从而改善患者生存率。目前HCC筛查主要采用甲胎蛋白（AFP）等生化标志物检测及横断面影像学检查。需要特别强调的是，约20%的HCC可发生于非肝硬化患者（非肝硬化型HCC），此类患者因缺乏肝硬化指征可能导致监测延迟，造成疾病晚期确诊，从而恶化预后。本文重点探讨高危人群肝硬化的诊断策略，系统阐述肝硬化患者HCC筛查的多种检测方法，并着重分析作为主要影像学筛查手段的腹部超声在HCC筛查中的关键作用。
肿瘤(癌症)患者之家