Is it possible to detect early lesions effectively?

The primary objective of detecting small liver cancers at an early stage should be to reduce mortality as much as possible in patients who actually develop the cancer and in an acceptably cost-effective fashion. To attain this objective, two distinct issues deserve meticulous consideration: the target population and the mode of surveillance. High-risk populations for hepatocellular carcinoma (HCC) have been clearly identified in many epidemiological studies and statistical analyses. HCC is a suitable disease for surveillance programmes because it is relatively common, at least in patients with liver disease. The early detection and diagnosis of HCC allow patients to be treated curatively. Nonetheless, whether routine screening and surveillance for HCC actually improve outcome would be best determined by prospective, randomised controlled trials.