AGA Updates Guidance on Hepatocellular Carcinoma

The American Gastroenterological Association (AGA) has published a significant update in the journal Gastroenterology regarding hepatocellular carcinoma (HCC).

Key Details of the Update

HCC is the leading cause of cancer-related death in patients with cirrhosis and the third most common cause of cancer-related death worldwide.

The update underscores that early detection is critical because curative treatments are available for HCC diagnosed at an early stage. Currently, the report indicates that 30–40% of HCC cases are diagnosed early.

A notable shift in the epidemiology of liver disease is also highlighted. Non-viral liver diseases are now the fastest-growing drivers of HCC.

Clinical Recommendations: Eight Best-Practice Statements

The update outlines eight best-practice advice statements for clinicians concerning HCC risk stratification and surveillance.

Prevention efforts should focus on reducing cirrhosis through vaccination and treatment of hepatitis C and B viruses, treatment of alcohol-related liver disease, and management of metabolic dysfunction–associated steatotic liver disease.

For surveillance, semiannual ultrasound and alpha‑fetoprotein testing remain the standard approach.

Regular HCC surveillance improves outcomes for patients with cirrhosis and selected patients with chronic hepatitis B.

However, the update notes a persistent challenge: real-world use of surveillance remains low.

Evolving Tools and Future Needs

The report discusses emerging technologies and unmet needs in the field.

Novel blood- and imaging-based biomarkers show promise, and ongoing trials will help determine their integration into clinical practice.

Furthermore, the update identifies a need for more precise risk stratification tools to determine which patients require more or less intensive monitoring.

Looking ahead, new models and machine-learning tools show potential to improve risk prediction but will require additional validation before widespread adoption.