[Case] On October 19, 2012, I was chatting with a northeastern patient who told me that his routine physical examination in early July 2012 revealed negative tumor markers, and the physician told him that there was no problem, but at that time he did not have any discomfort, but he was still unsure and decided to have liver ultrasound examination, which revealed liver occupancy and further enhanced MRI examination confirmed small liver cancer. I secretly feel lucky for this patient, if he thought it was fine and relaxed his vigilance based on tumor markers only, he might have been in advanced stage of liver cancer when he was examined again when he was uncomfortable. [Analysis] There are two points from this case, the first point is that negative tumor markers can also be liver cancer. The most common tumor marker for primary liver cancer is alpha-fetoprotein, or AFP, and medical studies have found that about 75% of primary liver cancer patients have positive alpha-fetoprotein, that is, elevated, while about 25% of patients do not have elevated alpha-fetoprotein, that is, negative. Therefore, when a patient’s fetoprotein test is normal, do not assume that there is no hepatocellular carcinoma, as denial can easily lead to a missed diagnosis. It is also important to note that elevated fetoprotein does not necessarily mean liver cancer. For example, if hepatitis B virus is active or cirrhosis is active, fetoprotein may also be elevated, but the increase is not significant, often below 400. If a patient has elevated fetoprotein to tens of thousands or even hundreds of thousands, then it is almost always due to liver cancer. The second point is that liver cancer and symptoms are not necessarily related. Many people think that if there is no discomfort, there must be no disease. This is a wrong understanding, liver cancer can also be without any discomfort, there are too many such cases. Cancer is not an ordinary disease, and we cannot recognize it with ordinary thinking. In this case, the patient did not have any discomfort, but liver cancer was also detected.