Today is November 12, 2014, I work in the general outpatient department of the hospital, there are not many patients, but it makes me feel very deep. Today’s outpatients include two liver cancer patients, both from Guangfeng, Jiangxi Province, both male, a 48-year-old, a 65-year-old. Another two patients with hepatitis “small triple positive”, one patient’s father died of liver cancer, one patient’s brother died of liver cancer. The more chronic hepatitis B patients I treated, the more liver cancer patients I came into contact with! As I organized the data of these liver cancer patients, I gradually realized that most of them were delayed at the stage of “small triple positive” hepatitis! The vast majority of chronic hepatitis B virus carriers in China occur at an early age (less than 5 years old), and it takes a long time for chronic hepatitis B virus carriers to develop liver cancer: triple positive carriers —- triple positive hepatitis —- minor triple positive hepatitis —- active cirrhosis —- liver cancer. Li is 35 years old and was found to have liver cancer when he first came to our hospital for an outpatient examination. For this kind of bolt from the blue, Xiao Li sadly asked me, “Dr. Wang, I have regular checkups every six months, every liver function test is normal, and ultrasound is also normal, how come I suddenly got liver cancer?!” Liver cancer usually doesn’t come out of nowhere, liver cancer often occurs with repeated episodes of hepatitis. Xiao Li said his liver function and color ultrasound tests are normal, is it really normal? Nonetheless! I carefully went through the checklist of Li’s last five years, Li’s AAT has always fluctuated between 35 – 45, healthy men’s AAT is usually not more than 30, Li does not have other liver diseases such as hepatitis C, fatty liver, and other long-term AAT is more than 30, a more plausible explanation is that his liver because of chronic hepatitis B has been in an inflammatory state, mild inflammation accompanied by mild fibrosis, the accumulation of which has led to the liver cancer in the past five years. Over time, the liver will become inflamed in five years, ten years or even 20 years, and in the long run, cirrhosis or even liver cancer will occur, do you think it’s rare? A drop of water can penetrate a stone! Xiao Li said that every ultrasound examination was normal, is it really normal? I arranged for Li to have an MRI scan, and the results of the MRI told us clearly: liver metastasis (high possibility of liver cancer); cirrhosis. Ultrasound is very insensitive to the detection of cirrhosis, and very often one must rely on MRI-enhanced scans, liver fibrosis scans and liver histology to detect cirrhosis in a more accurate and timely manner. All chronic hepatitis B virus carriers should be on high alert for liver cancer. As long as they undergo regular follow-ups and interpret the results of various tests thoroughly and accurately with the help of their doctors, it is possible to detect chronic inflammation of the liver in a timely manner, and it is possible to detect cirrhosis at an early stage. Early detection of the problem, timely and long-term antiviral treatment, and standardized regular checkups can greatly reduce the incidence of liver cancer and mortality rate of hepatitis B patients.