| Potentially curative treatments for hepatocellular carcinoma (HCC) is only available when a tumor is found in an early stage. In Japan, an intensive surveillance policy has been applied to those with a high risk of HCC. Japanese clinical practice guideline for HCC recommends a surveillance protocol comprised of ultrasonography and three tumor markers every 3-4 months for extremely high-risk population and 6 months for high-risk populations. When a nodule is detected by ultrasonography, dynamic CT or MRI should be performed. Tumor maker elevation also contributes to early diagnosis, especially when the quality of ultrasonography is suboptimal. Recently, it has been recognized that AFP becomes highly specific in patients with sustained response to antiviral therapy. EOB-Gd-DTPA enhanced MRI showed superior diagnostic ability in the diagnosis of early-stage HCC compared to conventional CT and MRI. The variable surveillance interval based on the HCC risk is still controversial. However, for those with coarse liver parenchyma, a shorter surveillance interval may compensate the risk of false-negative results by ultrasonography. When HCC was diagnosed within 3 cm in diameter, radiofrequency ablation (RFA) can provide comparable local tumor control to surgical resection. The latest randomized control trial conducted in Japan showed almost identical recurrence-free survival in HCC patients treated with RFA or surgery. Long-term survival of up to 20 years has also been confirmed in RFA. |
