Liver cancer is a complication of cirrhosis and does not occur in patients with mild or moderate liver fibrosis (stage 0,1 or 2). A few patients with stage 3 get liver cancer but almost all cancers occur in stage 4 cirrhosis. About 2% of patients with HCV cirrhosis get liver cancer each year or about 20% over ten years.

Screening for liver cancer is done with imaging tests typically with an abdominal ultrasound examination. A CT examination with intravenous contrast is often performed if the ultrasound reveals a heterogeneous appearance or if there is excessive fat in the liver. A triple phase contrast examination is needed called hemangioma protocol. Liver cancers will show up as bright spots a few seconds after injecting the intravenous contrast. A few seconds later they contrast washes out and the cancers blend into the rest of the liver. This is why the images must be obtained before, immediately after contrast injection and a few minutes later.

Hemangiomas are benign common lesions in the liver that can be mistaken for liver cancer. They do not light up quickly with contrast and the contrast persists and puddles in hemagiomas. Hemangioms do not grow and if there is a question about an abnormality a repeat CT can be done 3-6 months later. Liver cancers get larger and hemangiomas do not grow.