PREVENTION, SURVEILLANCE, AND EARLY DETECTION OF HEPATOCELLULAR CARCINOMA – A BRAZILIAN MULTIDISCIPLINARY CONSENSUS

Alexandre Ferreira  Oliveira; Rafael Soares Nunes Pinheiro; Renata D’Alpino  Peixoto; Munir   Murad Júnior; Joaquim Maurício da  Motta-Leal-Filho; Marcos Roberto de  Menezes; Cristina Melo  Rocha; Guilherme Lopes Pinheiro Martins; Agnaldo Soares Lima; Marcelo Bruno Rezande; Héber Salvador de Castro  Ribeiro; Mario Rino  Martins; Paulo Herman; Anelisa Kruschewsky  Coutinho; Ângelo Alves de  Mattos; Luiz Augusto Carneiro  D’albuquerque; Orlando Jorge Martins  Torres; Luiz Arnaldo Szutan; Arthur Accioly  Rosa; Duilio Reis da  Rocha Filho; Antonio Nocchi Kalil; Cássio Virgílio Cavalcante de Oliveira; Mauro Monteiro  Correia; Paulo Cezar Galvão do  Amaral; Francisco Tustumi; Wellington  Andraus; Ilka de Fátima Santana Ferreira  Boin; Rodrigo Nascimento  Pinheiro; Heládio  Feitosa Neto; Paulo Henrique de Sousa  Fernandes; André Luís de  Godoy; Carlos Eduardo Brandão-Mello; Alexcia Camila  Braun; Maria Ignez Braghiroli; Tércio Genzini; José Huygens Parente  Garcia; Daniel Neves  Fortes; Alessandro Landskron  Diniz; Guilherme Moura  Cunha; Flair José  Carrilho; Carla Caparroz; Luis César Bredt; Felipe José Fernández Coimbra

doi:10.1590/0102-672020260000018e1947

##article.authors##

Alexandre Ferreira Oliveira Universidade Federal de Juiz de Fora https://orcid.org/0000-0002-7500-6752
- Writing – Review & Editing
Rafael Soares Nunes Pinheiro University of São Paulo https://orcid.org/0000-0001-8632-3529
- Writing – Review & Editing
Renata D’Alpino Peixoto University of British Columbia https://orcid.org/0000-0003-0053-7951
- Writing – Review & Editing
Munir Murad Júnior Federal University of Minas Gerais https://orcid.org/0009-0002-1791-8814
- Writing – Review & Editing
Joaquim Maurício da Motta-Leal-Filho University of São Paulo https://orcid.org/0000-0001-9844-6833
- Writing – Review & Editing
Marcos Roberto de Menezes University of São Paulo https://orcid.org/0000-0001-7548-8774
- Writing – Review & Editing
Cristina Melo Rocha Federal University of Amazonas https://orcid.org/0000-0002-3772-362X
- Writing – Review & Editing
Guilherme Lopes Pinheiro Martins Instituto do Câncer do Estado de São Paulo https://orcid.org/0000-0002-2617-2316
- Writing – Review & Editing
Agnaldo Soares Lima Federal University of Minas Gerais https://orcid.org/0000-0001-6421-3062
- Writing – Review & Editing
Marcelo Bruno Rezande Albert Einstein Israelite Hospital https://orcid.org/0000-0001-5594-033X
- Writing – Review & Editing
Héber Salvador de Castro Ribeiro Department of Surgical Oncology, Abdominal Surgery, HPB & Upper GI Oncology Reference Center. A.C. Camargo Cancer Center https://orcid.org/0000-0002-3412-7451
- Writing – Review & Editing
Mario Rino Martins Hospital de Câncer de Pernambuco https://orcid.org/0000-0001-8705-8210
- Writing – Review & Editing
Paulo Herman University of São Paulo https://orcid.org/0000-0003-2859-5846
- Writing – Review & Editing
Anelisa Kruschewsky Coutinho Mater Dei Hospital https://orcid.org/0000-0003-2988-0446
- Writing – Review & Editing
Ângelo Alves de Mattos Federal University of Health Sciences of Porto Alegre https://orcid.org/0000-0003-2417-9765
- Writing – Review & Editing
Luiz Augusto Carneiro D’albuquerque University of São Paulo https://orcid.org/0000-0001-7607-7168
- Writing – Review & Editing
Orlando Jorge Martins Torres Federal University of Maranhão https://orcid.org/0000-0002-7398-5395
- Writing – Review & Editing
Luiz Arnaldo Szutan Faculdade de Ciências Médicas da Santa Casa de São Paulo https://orcid.org/0000-0002-1529-0579
- Writing – Review & Editing
Arthur Accioly Rosa Hospital Santa Izabel https://orcid.org/0000-0002-6958-832X
- Writing – Review & Editing
Duilio Reis da Rocha Filho Federal University of Ceará https://orcid.org/0000-0001-7756-1891
- Writing – Review & Editing
Antonio Nocchi Kalil Hospital de Clínicas de Porto Alegre https://orcid.org/0000-0002-2658-0731
- Writing – Review & Editing
Cássio Virgílio Cavalcante de Oliveira Federal University of Paraíba https://orcid.org/0000-0001-8385-7656
- Writing – Review & Editing
Mauro Monteiro Correia Brazilian National Cancer Institute https://orcid.org/0009-0005-4365-6899
- Writing – Review & Editing
Paulo Cezar Galvão do Amaral Department of Surgery of the Upper Digestive System, São Rafael Hospital/Rede D'Or Hospital Group, Salvador (BA), Brazil https://orcid.org/0000-0002-2510-0193
- Writing – Review & Editing
Francisco Tustumi University of São Paulo https://orcid.org/0000-0001-6695-0496
- Writing – Review & Editing
Wellington Andraus University of São Paulo https://orcid.org/0000-0002-5162-138X
- Writing – Review & Editing
Ilka de Fátima Santana Ferreira Boin State University of Campinas (UNICAMP) https://orcid.org/0000-0002-1165-2149
- Writing – Review & Editing
Rodrigo Nascimento Pinheiro Department of Surgical Oncology, Hospital de Base do Distrito Federal, Brasília (DF), Brazil https://orcid.org/0000-0002-2715-7628
- Writing – Review & Editing
Heládio Feitosa Neto Department of Surgical Oncology, Instituto do Câncer do Ceará, Fortaleza (CE), Brazil https://orcid.org/0000-0001-6455-916X
- Writing – Review & Editing
Paulo Henrique de Sousa Fernandes Federal University of Uberlândia https://orcid.org/0000-0001-5476-2017
- Writing – Review & Editing
André Luís de Godoy AC Camargo Hospital https://orcid.org/0000-0002-7154-1184
- Writing – Review & Editing
Carlos Eduardo Brandão-Mello Federal University of Rio de Janeiro https://orcid.org/0000-0001-8965-6556
- Writing – Review & Editing
Alexcia Camila Braun AC Camargo Hospital https://orcid.org/0000-0002-9028-2026
- Writing – Review & Editing
Maria Ignez Braghiroli Instituto do Câncer do Estado de São Paulo https://orcid.org/0000-0001-6366-8786
- Writing – Review & Editing
Tércio Genzini Hospital Leforte https://orcid.org/0000-0002-3589-3983
- Writing – Review & Editing
José Huygens Parente Garcia Federal University of Ceará https://orcid.org/0000-0002-5057-7903
- Writing – Review & Editing
Daniel Neves Fortes University of São Paulo https://orcid.org/0000-0003-1996-7193
- Writing – Review & Editing
Alessandro Landskron Diniz AC Camargo Hospital https://orcid.org/0000-0001-9671-2026
- Writing – Review & Editing
Guilherme Moura Cunha University of Washington https://orcid.org/0000-0001-6403-5155
- Writing – Review & Editing
Flair José Carrilho University of São Paulo https://orcid.org/0000-0002-7682-3105
- Writing – Review & Editing
Carla Caparroz Beneficência Portuguesa de São Paulo https://orcid.org/0000-0002-0628-2016
- Writing – Review & Editing
Luis César Bredt Western Paraná State University https://orcid.org/0000-0002-8587-1790
- Writing – Review & Editing
Felipe José Fernández Coimbra AC Camargo Hospital https://orcid.org/0000-0001-5068-0639
- Conceptualization
- Investigation
- Methodology
- Data Curation
- Writing – Original Draft Preparation
- Writing – Review & Editing

DOI:

https://doi.org/10.1590/0102-672020260000018e1947

Keywords:

Fígado, Carcinoma Hepatocelular, Consenso, Guias como Assunto, Detecção Precoce de Câncer, Epidemiologia

Abstract

Background: Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality and represents a growing public health challenge.

Aims: To develop multidisciplinary evidence-based recommendations for the prevention and early detection of HCC.

Methods: This consensus was coordinated by the Brazilian Society of Surgical Oncology, with the participation of 13 additional national societies. A steering committee defined the key clinical questions addressing prevention, surveillance, and early detection strategies. Recommendation statements were informed by a comprehensive, non-systematic review of the literature conducted using PubMed, Scopus, and the Cochrane Library.

Results: Eighteen recommendations reached consensus, covering three main domains: (1) Primary prevention, including HBV vaccination, timely antiviral therapy for viral hepatitis, and lifestyle interventions for metabolic dysfunction. (2) Secondary prevention, outlining risk-based surveillance strategies for patients with advanced fibrosis or cirrhosis due to HBV, HCV, or MASLD. (3) Operational standards for surveillance, emphasizing ultrasound as the cornerstone of monitoring, the importance of structured reporting, management of small nodules, and the selective use of cross-sectional imaging.

Conclusions: These multidisciplinary recommendations provide practical, adaptable guidance for HCC prevention, surveillance, and early detection. This guidance document aims to reduce the burden of HCC and support better clinical outcomes across diverse healthcare settings.