Department of Internal Medicine I, University Medical Center Mainz, Germany.
In Philip K. Dick's short story The Minority Report (later made into a movie by Steven Spielberg), 3 fortune tellers called "precogs" predict crime before it happens, which allows the police to arrest criminals before any harm is done. Needless to say, treating malignancy before it occurs is any oncologist's ultimate dream. While such prognostic capabilities are not at our disposal today, hepatocellular carcinoma (HCC) is a kind of cancer, which typically occurs in a specified population which in turn can be kept under surveillance. Therefore, all international guidelines recommend screening measures for patients at risk who are suited for treatment.(1-3) The guidelines differ to some extent regarding patient selection, but cirrhotic patients with Child-Pugh stage A and B, noncirrhotic hepatitis B virus infected patients at increased risk of HCC, and noncirrhotic F3 patients with bridging fibrosis based on an individual risk assessment appear to be good candidates for surveillance. Here, the most widely accepted procedure is ultrasound-sometimes in combination with serum alpha-fetoprotein (AFP) measurements.