Liver cancer is the second most common malignant tumor in China, and due to the large number of liver disease patients in China, more than half of the new cases of liver cancer in the world are found in China every year. Early detection and early treatment is still the most effective way to improve the long-term prognosis of liver cancer. Due to the lack of obvious symptoms in the early stage of liver cancer, the vast majority of liver cancer patients have already developed to the middle and late stages when they are diagnosed, resulting in a low surgical resection rate and a relatively low 5-year survival rate for other palliative treatments. How to increase the early detection rate of liver cancer more effectively is an important way to improve the long-term prognosis of liver cancer patients in China. And excessive screening is bound to increase the economic and psychological burden of patients. Based on the results of a large number of clinical studies on hepatocellular carcinoma, the establishment of graded early warning indicators for hepatocellular carcinoma with reference to the internationally recognized early warning system may be a feasible way to prevent and treat hepatocellular carcinoma effectively. At present, the international warning system is divided into four levels: blue, yellow, orange and red. Referring to the international early warning system, the early warning of liver cancer can also be divided into four levels accordingly. I. Blue warning – chronic hepatitis B/hepatitis C virus infection Based on: Current research shows that chronic hepatitis B/hepatitis C virus infection has high incidence rate, and more than 80% of patients with liver cancer have chronic hepatitis B/hepatitis C virus infection background, while those without chronic hepatitis B/hepatitis C virus infection background have lower incidence rate of liver cancer. Risk classification: ① Chronic inactive hepatitis B surface antigen carriers: normal liver function, HBV-DNA negative, lower chance of liver cancer; ② Chronic hepatitis B virus carriers: HBeAg-positive, HBV-DNA-positive, higher rate of liver cancer; ③ Chronic hepatitis B virus carriers: HBeAg-negative, HBV-DNA-positive, higher rate of liver cancer; ④ Family history of liver cancer, Obesity, diabetes, alcohol consumption, exposure to hepatotoxic substances (aflatoxin, hepatotoxic drugs, hepatotoxic chemicals) any one of them have increased risk index. Response: ① Follow-up screening every six months, including: liver function, hepatitis B five, HBV-DNA quantitative, alpha-fetoprotein, ultrasound, routine blood. ② control obesity, diabetes, alcohol, hepatotoxic substances exposure (aflatoxin, hepatotoxic drugs, hepatotoxic chemicals) and other carcinogenic factors. Yellow alert – chronic hepatitis B / hepatitis C Criteria: chronic hepatitis B / hepatitis C, long-term abnormal liver function, HBV-DNA positive or HCV-RNA positive. Rationale: Long-term active inflammation of the liver is an important cause of liver cancer (please refer to my article “How Liver Cells Become Malignant”). Hepatitis C generally requires cirrhosis before liver cancer occurs, and hepatitis C now has a higher cure rate with the introduction of new antiviral drugs, so the relative risk of liver cancer is low. In contrast, some patients with hepatitis B can develop liver cancer directly without cirrhosis. Risk classification: On the basis of chronic hepatitis, if there is a family history of liver cancer, obesity, diabetes mellitus, alcohol consumption, exposure to hepatotoxic substances (aflatoxin, hepatotoxic drugs, hepatotoxic chemicals), each of them increases the risk of cancer. Countermeasures: ① antiviral treatment; ② half-yearly follow-up screening, including liver function, Hepatitis B five, HBV-DNA quantitative, alpha-fetoprotein, ultrasound, blood routine. ③Control obesity, diabetes, alcohol consumption, exposure to hepatotoxic substances (aflatoxin, hepatotoxic drugs, hepatotoxic chemicals) and other cancer-causing factors. Orange warning – cirrhosis Based on: Cirrhosis occurring on the basis of chronic hepatitis B/hepatitis C is a high-risk group of liver cancer, and the cancer rate of male patients is higher than that of females. With the prolongation of cirrhosis, the longer the time, the higher the chance of liver cancer. Risk classification: Cirrhosis on the basis of liver cancer, if there is a family history of liver cancer, obesity, diabetes mellitus, alcohol consumption, exposure to hepatotoxic substances (aflatoxin, hepatotoxic drugs, hepatotoxic chemicals), each of which increases the risk of cancer. Response: ① antiviral treatment; ② half-yearly follow-up screening, including liver function, Hepatitis B 5, HBV-DNA quantification, alpha-fetoprotein, ultrasound, routine blood tests. At least one CT or MRI examination should be conducted every year; ③ Control obesity, diabetes, alcohol consumption, exposure to hepatotoxic substances (aflatoxin, hepatotoxic drugs, hepatotoxic chemicals) and other cancer-causing factors. Red alert – precancerous liver lesions Cirrhosis based on liver cirrhosis, accompanied by imaging findings of suspicious occupancy or elevated alpha-fetoprotein, known as precancerous liver lesions. Rationale: This group of people has a particularly high chance of developing liver cancer in the near future if they are not actively treated and tested. Some of these patients are likely to have early-stage or atypical hepatocellular carcinoma if they are examined in detail. Risk classification: On the basis of cirrhosis, if there is a family history of liver cancer, obesity, diabetes mellitus, alcohol consumption, exposure to hepatotoxic substances (aflatoxin, hepatotoxic drugs, hepatotoxic chemicals), each of them increases the risk of developing cancer. Countermeasures: ① antiviral treatment; ② control of obesity, diabetes, alcohol consumption, exposure to hepatotoxic substances (aflatoxin, hepatotoxic drugs, hepatotoxic chemicals) and other cancer-causing factors; ③ at least once every three months for follow-up screening, including liver function, hepatitis B five, HBV-DNA quantification, alpha-fetoprotein, ultrasound, routine blood tests. It should be noted that negative alpha-fetoprotein cannot exclude hepatocellular carcinoma, and it is recommended to combine the serologic examination of various hepatocellular carcinoma markers, such as AFP-L3, etc. CT or nuclear magnetic resonance, PET-CT and other examinations can increase the detection rate of hepatocellular carcinoma and reduce the leakage of diagnosis. However, CT examination is not recommended to be too intensive, so as not to promote the occurrence of liver cancer instead. ⑤ Traditional Chinese medicine treatment can reverse some precancerous liver lesions.