How to follow up after liver cancer resection

The recurrence rate after liver cancer resection is relatively high. However, if the recurrence can be detected in the early stage, timely treatment can be given to achieve good treatment results. Therefore, correct and regular follow-up after surgery is very important.

Follow-up after liver cancer resection usually uses the method of testing alpha-fetoprotein and ultrasound examination. For patients with positive alpha-fetoprotein before surgery, postoperative testing of alpha-fetoprotein can sensitively detect recurrence. Some patients believe that if the alpha-fetoprotein is negative before surgery, there is no need to test alpha-fetoprotein after surgery. In fact, this is wrong. We have found in clinical practice that many patients have negative alpha-fetoprotein before surgery, but after recurrence, alpha-fetoprotein is positive. This is because the recurrence of liver cancer can originate from a single center, which is what we often call intrahepatic metastatic lesions; the recurrence of liver cancer can also originate from multiple centers, that is, liver cancer lesions reoccur on the basis of liver cirrhosis, which results in some patients with negative alpha-fetoprotein before surgery, but the recurrent lesions are positive for alpha-fetoprotein. Similarly, some patients have positive alpha-fetoprotein before surgery, but the recurrent lesions may also be negative for alpha-fetoprotein. Therefore, for patients with negative alpha-fetoprotein before surgery, even if the alpha-fetoprotein is negative, it cannot be considered that there is no recurrence during the postoperative follow-up. Therefore, ultrasound examination is required at the same time as alpha-fetoprotein testing. Of course, if the alpha-fetoprotein level is elevated or there are suspicious lesions on ultrasound examination, further ultrasound angiography, CT or MRI examination will be needed.

Since liver cancer is prone to lung metastasis, lung X-rays should be done regularly, and chest CT scans should be performed when necessary.

Generally speaking, alpha-fetoprotein and ultrasound tests should be done every 2 to 3 months, and a chest X-ray examination should be done every six months.