Hepatocellular carcinoma (HCC) is responsible for a large proportion of cancer deaths worldwide. HCC is frequently diagnosed after the development of clinical deterioration at which time survival is measured in months. Long-term survival requires detection of small tumors, often present in asymptomatic individuals, which may be more amenable to invasive therapeutic options. Surveillance of high-risk individuals for HCC is commonly performed using the serum marker alfafetoprotein (AFP) often in combination with ultrasonography. Various other serologic markers are currently being tested to help improve surveillance accuracy. Diagnosis of HCC often requires more sophisticated imaging modalities such as CT scan and MRI, which have multiphasic contrast enhancement capabilities. Serum AFP used alone can be helpful if levels are markedly elevated, which occurs in fewer than half of cases at time of diagnosis. Confirmation by liver biopsy can be performed under circumstances when the diagnosis of HCC remains unclear.

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The natural history of hepatocellular carcinoma has evolved considerably over past decades. Patient presentation is highly dependent on the severity of underlying hepatic function, although many patients are now diagnosed by screening programmes prior to the development of symptoms. Growth and maturation of hepatocellular carcinoma is variable and involves a complex network of hepatic vasculature. Staging systems have been developed to predict disease progression and survival and continue to undergo investigation.