Liver cancer surveillance means regular checks to find liver cancer early, in people who are at higher risk, before it causes any symptoms. The most common type of liver cancer is hepatocellular carcinoma (HCC). It is a common cancer in Singapore and across Asia, largely because of hepatitis B, and increasingly because of fatty liver disease.
Liver cancer usually causes no symptoms until it is large. Found early, while it is small, it can often be cured by surgery, ablation or a liver transplant. Found late, the options are far more limited. Regular surveillance shifts the odds towards finding it early.
Who needs surveillance
- Everyone with cirrhosis, whatever the cause. This includes people whose hepatitis C has been cured or whose hepatitis B is well controlled, because the risk falls but does not disappear.
- Some people with hepatitis B without cirrhosis, for example men over 40, women over 50, and anyone with a family history of liver cancer. Dr Chia will assess your risk.
- People with advanced scarring (bridging fibrosis) from hepatitis C or fatty liver, in some cases. A FibroScan helps decide.
How it is done
- An ultrasound scan of the liver every six months. It is safe, painless and uses no radiation. You may be asked not to eat for a few hours beforehand.
- An AFP (alpha-fetoprotein) blood test, usually at the same time. A rising AFP can be an early sign of liver cancer, although it can also rise for other reasons.
- CT or MRI may be used instead of ultrasound when the liver is hard to see on ultrasound, for example with severe fatty liver, a very nodular liver or excess weight.
Why every six months
Most liver cancers take several months to grow to a size that can be seen. A six-monthly scan gives the best chance of finding a cancer while it is still small and treatable. Scans spaced further apart are more likely to miss that window. Keep to the schedule even when you feel well, because early liver cancer causes no symptoms.
If something is found
- A new spot on the ultrasound, or a rising AFP, is followed by a CT or MRI scan with contrast, which can usually tell whether it is a cancer.
- Very small spots (under about 1 cm) are often watched with a repeat scan in about three months.
- Most spots found are not cancer, for example cysts, small blood vessel clusters (haemangiomas) or regenerating nodules.
- If a cancer is found, the treatment plan is decided together with liver surgeons, radiologists and oncologists.
Treatment of early liver cancer
- Surgery to remove part of the liver
- Ablation, which destroys a small tumour with heat through a fine needle
- Liver transplant, for selected people with cirrhosis
- Other treatments, delivered through the blood vessels or as medicines, for larger tumours
Making surveillance work
- Put the date of your next scan in your calendar as soon as one is done
- Have scans at the same centre where possible, so that images can be compared
- Bring previous reports if you have had scans elsewhere
- Keep treating the underlying cause, such as hepatitis B, hepatitis C, alcohol or fatty liver
Limitations
No test is perfect. Ultrasound can miss some small cancers, and sometimes finds spots that turn out to be harmless after more scans. Surveillance lowers the risk of a late diagnosis, but cannot remove it entirely.
Insurance
Dr Chia is on the specialist panels of AIA, Great Eastern, HSBC Life, Income, Prudential, Raffles Shield and Singlife for Integrated Shield Plans, and on many corporate insurance panels (see all panels). Check your coverage with your insurer.
General information only. Reviewed by Dr Chia Chung King, 2026-11-07. Book a consultation.