The epidemic of hepatitis B virus infection in China began in the late 1950s and has been going on for more than half a century. During the long years, only Chinese medicine and one or two enzyme-lowering drugs have moderated the disease, and in reality many people still have insidious and slowly progressing lesions, accumulating large numbers of chronic progressive liver disease. Antiviral therapy is only 16 years old, and the drugs used in previous years were ineffective and unaware of the need for long-term treatment, and still not adequately and effectively controlled. The current high prevalence of cirrhosis, in this context, liver cancer is mostly discovered unexpectedly and suddenly. Liver cancer is often discovered suddenly I. What kind of liver lesions can occur in order to develop liver cancer? Liver cancer will not occur in chronic hepatitis B virus carriers without lesions. The more severe the cirrhosis (i.e., the more severe the degree of liver fibrosis), the higher the probability of liver cancer, while mild compensated cirrhosis is relatively low and decompensated cirrhosis (patients with ascites) has the highest probability. Mr. Pretending to be strong, his father had “small triple-positive” hepatitis and did not undergo any tests or antiviral treatment for 30 years after the onset of the disease. Hepatitis “minor triplet” rarely recovers on its own, but can be insidious for a long time. Therefore, his apparently stable condition does not exclude the potential development of lesions. He had a CT examination in 2014 and probably did not go to CT without any discomfort. His CT examination in November 2015 revealed hepatocellular carcinoma about 5 cm in size, and the cancer group had invaded the portal vein branches and embolized the vessels. Presumably there was prior lesion activity, but liver cancer was not expected to occur. There was no regular checkup, and it was discovered suddenly and unexpectedly, but it was delayed to the point that it was difficult to cure. 2. Can liver cancer not occur if no virus is detected? During the period of lamivudine and adefovir treatment, there were nearly 300 patients with cirrhosis treated in our clinic every year, and about 10 of them had liver cancer, but most of them had normal liver function and the virus had turned negative. Virus is not the direct cause of liver cancer, and the virus may not be detected at the time of liver cancer. Liver cancer is caused by genetic abnormality of liver cells, and hepatitis B virus is the initiator of genetic abnormality of liver cells. How high is the risk of liver cancer inherited from close relatives? Mr. Pretending to be strong is also a “small triplet” hepatitis and is under long-term antiviral treatment. Liver cancer is hereditary, and the closer the blood line, the higher the risk. Heritability is not evenly distributed, but current clinical examinations are not yet able to determine to whom it is distributed. Patients with chronic hepatitis B liver disease (cirrhosis or hepatitis) whose close relatives have other malignancies are also at high risk for liver cancer, but the risk is not as high as that of patients whose close relatives have liver cancer, and patients with cirrhosis of hepatitis B whose fathers have liver cancer are at higher risk. Several people in a family can develop liver cancer successively, and since members of this family have both a higher chance of infection and the possibility of inheritance, this is fortunately uncommon. People with close relatives who have malignant tumors may have genetic factors, and liver cancer can also occur in those who do not have chronic hepatitis B liver disease and those who have alcoholic liver disease. The incidence is higher in those who have both hepatitis B liver disease and alcoholic liver disease; it is also higher in those who have both chronic liver disease and diabetes. Stomach cancer may occur in close relatives with liver cancer who do not have chronic hepatitis B liver disease themselves but have long-standing gastric ulcers, and cervical cancer may occur in those with chronic cervicitis. People whose close relatives have malignant tumors should have regular medical checkups. There are many cirrhotic patients without malignant tumors in their close relatives who have liver cancer, just not as high risk as those with genetic factors. How to prevent liver cancer in hepatitis patients with close relatives who have liver cancer? People with high risk of liver cancer need not be pessimistic, as liver cancer can be prevented. As long as it has not yet occurred, effective preventive measures should be taken according to the respective situation. Liver cancer rarely occurs in patients with effective interferon, and there are individual reports in the literature, but I have not seen any. In “minor triple-positive” hepatitis or mild cirrhosis, a smaller dose of 135 micrograms per week for a course of 1.5 years can be more than 50% effective, but about 70% of effective patients relapse, and 20% to 30% are consistently effective. The efficiency increases with the next course of treatment, and most patients can obtain a sustained effect with 3 courses of treatment. A few patients with only a few hundred units of hypersensitive surface antigen are worth fighting for a course of treatment, and a few may win antigen/antibody conversion (recovery), and the relapse rate is mostly low (but I have seen individual patients with “small triplets” who developed surface antibodies and still relapsed). The number of patients who can be treated with multiple courses of Peroxin is ultimately small; however, tenofovir is available for most patients with cirrhosis. As mentioned before, only lamivudine (or telbivudine) and adefovir in the 10 years, in my outpatient treatment of cirrhosis patients each year, about 10 people have liver cancer; the last 4 years I only use the first-line drug entecavir, there are 5 people with liver cancer, cirrhosis mostly with tenofovir for the time being no one has liver cancer. It is possible that the stronger the drug, the lower the incidence of liver cancer, and it is an indisputable fact that strong nucleoside analogues can significantly reduce the incidence of liver cancer. In more than ten years of outpatient practice, the cumulative incidence of liver cancer has been about a hundred people. Ultrasound and fetoprotein are checked regularly every 6 months, and in case of small hepatocellular carcinoma less than 2 cm, it can be cured by surgery or radiofrequency ablation. Most of the more than a hundred people were able to continue working and are still alive today; there are a few people who are not registered as known to have passed away, and there are about a dozen people with recurrence of liver cancer.