”Doctor, please take a look for me. Yesterday’s medical report said that an occupancy was found on my liver. I haven’t slept a wink since I got the report, could it be liver cancer?” In the clinic, I often meet such anxious patients who come to the clinic with ultrasound reports. What is hepatic occupancy? It refers to the abnormal echogenic area or density area found on the basis of normal liver parenchyma during physical examination or ultrasound, CT, MRI and other examinations of other diseases. Occupational lesions of the liver is actually a rather general term, which includes benign and malignant hepatic occupations. In fact, most of the liver occupations found during physical examination are benign liver occupations, most commonly liver cysts, hepatic hemangiomas, and cirrhotic nodules. Of course, there are also some rare benign hepatic occupying lesions, such as focal nodular hyperplasia, hepatic adenoma, inflammatory pseudotumor, hepatic purpura, and so on. The incidence of these benign hepatic occupancies varies in different populations. Malignant hepatic occupying lesions include primary hepatocellular carcinoma, intrahepatic cholangiocarcinoma, hepatoblastoma, hepatic sarcoma, lymphoma, and various metastatic liver cancers. Primary hepatocellular carcinoma and metastatic hepatocellular carcinoma are the most prevalent among malignant liver-occupying lesions. Which groups of people should pay special attention when liver occupancy is found? Since China is a major hepatitis B country, 50% of new liver cancer patients worldwide originate from China. Therefore, for those who are hepatitis B carriers or have a family history of liver cancer, medical examination reveals occupying liver lesions, further tumor markers such as methemoglobin/abnormal prothrombin and enhanced CT/magnetic resonance imaging of the liver are needed to clarify the diagnosis. In addition, people who develop cirrhosis due to various reasons (hepatitis C infection, alcoholic liver disease, non-alcoholic fatty liver disease, metabolic liver disease, autoimmune liver disease) are also at high risk of developing liver cancer. Therefore, it is recommended that patients with cirrhosis should undergo liver disease checkups every six months for men over the age of 40 and women over the age of 50. If liver occupancy is found during the physical examination, it is necessary to exclude the possibility of liver cancer. Because of the rich blood supply to the liver, tumors from various parts of the body can metastasize to the liver through blood dissemination and liver metastases can occur. Therefore, for patients who already have other primary tumors, especially those with digestive system tumors, liver imaging is recommended every six months for early detection of metastatic liver cancer. Clinical studies have shown that patients with liver metastases who are able to receive early treatment have significantly better treatment outcomes than those who have developed symptoms and then undergo treatment. How to determine whether a liver occupancy is a benign occupancy or a malignant tumor? The first confirmatory diagnosis of hepatic occupying lesions is very important. In addition to liver puncture pathology biopsy, the most accurate examination method in clinical examination is currently enhanced MRI. The diagnostic imaging results of MRI in experienced imaging centers can reach more than 90% compliance with the pathology of liver occupancy. In addition to the enhanced MRI, we need to perform tumor marker examinations and make clinical judgments in conjunction with the patient’s previous history of liver disease, comorbid underlying diseases and family history. What should I do if a liver-occupying lesion is found? In the case of hepatic occupying lesions, it is important to have a clear diagnosis before treatment can be developed. For example, in the case of liver cysts, as long as there are no symptoms of distension and pressure in the liver area and the cyst is less than 5 cm, no specific treatment is needed, as long as the size of the cyst is followed up regularly. If the cyst is significantly enlarged or if symptoms of compression appear, liver aspiration or laparoscopic treatment may be considered. Similarly, for slowly developing hepatic hemangiomas with focal nodular hyperplasia, no specific treatment is needed for asymptomatic people because malignancy rarely occurs. Surgical resection is required only if the diagnosis is considered unclear, if malignancy is suspected, or if the occupancy is significantly enlarged. In case of malignant hepatic occupying lesions such as hepatocellular carcinoma, since most patients are found by physical examination and the disease is still in its early stage, there is no need to be overly panic and early surgical resection or minimally invasive ablation treatment is required for a better prognosis. For metastatic hepatocellular carcinoma, a systematic treatment plan combined with local treatment of the liver (surgery, intervention, ablation) and systemic treatment (chemotherapy, targeted, immunotherapy) is needed to prolong the overall survival of patients. At the end of this article, I would like to tell you that the detection of liver-occupying lesions on physical examination is not a cause for panic, as most liver-occupying lesions found on physical examination are benign diseases. It is very important to confirm the diagnosis of hepatic occupying lesions. If the clinical diagnosis is clearly benign, most of the hepatic occupying lesions can be followed up regularly without special treatment. In contrast, if they belong to a group of people with high risk of tumor, liver disease physical examination every six months can lead to early diagnosis, detection of disease and early treatment to obtain the best prognosis.