Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Criteria for referring a patient with suspected hepatocellular carcinoma (HCC) to a specialist:
- Refer any person diagnosed with cirrhosis to a hepatologist or gastroenterologist with an interest in hepatology for specialist assessment, as they are at increased risk of HCC. This includes those diagnosed by transient elastography or imaging, if not already under specialist care NICE CKS,NICE NG50.
- Arrange urgent referral or specialist assessment if there are signs of decompensated liver disease (such as ascites, encephalopathy, or gastrointestinal hemorrhage), which may be associated with advanced liver disease and HCC NICE CKS,NICE NG50.
- In people with chronic hepatitis B, refer all adults who are hepatitis B surface antigen (HBsAg) positive to a hepatologist or gastroenterologist with an interest in hepatology, including those undergoing surveillance for HCC with hepatic ultrasound and alpha-fetoprotein testing NICE CG165.
- Perform 6-monthly surveillance for HCC by hepatic ultrasound and alpha-fetoprotein testing in people with significant fibrosis (METAVIR stage ≥F2 or Ishak stage ≥3) or cirrhosis; consider referral if surveillance detects suspicious lesions NICE CG165.
- Refer patients with suspected HCC detected on surveillance imaging or with clinical suspicion for further specialist evaluation and management NICE CKS,NICE CG165.
In summary, referral to a specialist for suspected HCC is indicated in patients with cirrhosis or significant fibrosis, those with chronic hepatitis B infection under surveillance, and any patient with signs of decompensated liver disease or suspicious imaging findings NICE CKS,NICE CG165,NICE NG50.