Hepatocellular carcinoma is the most common malignant tumor in hepatobiliary and pancreatic surgery, which usually includes primary hepatocellular carcinoma (the lesion originates from the liver) and secondary or metastatic hepatocellular carcinoma (the tumor is metastasized from other parts of the body, the most common primary focus is the gastrointestinal system). People are afraid of talking about cancer, and liver cancer is called the “king of cancer” because of the unsatisfactory treatment effect. China is a large country with hepatitis B, and there are many patients with primary liver cancer. In clinical work, we often see patients with liver cancer and their family members holding too pessimistic attitude, often giving up active treatment or listening to some false advertisements and missing the best time for treatment. As long as liver cancer is detected at an early stage and correct treatment methods are chosen in time, better treatment effect can be achieved. It is not uncommon to see patients surviving for a long time after primary liver cancer surgery. 1.Who are prone to develop primary liver cancer and need regular checkups? In China, hepatitis B virus infection is the most common cause of primary liver cancer. Therefore, chronic hepatitis B patients are a high risk group for primary liver cancer. Especially for hepatitis B patients transmitted through mother-to-child transmission, the age of onset of liver cancer is younger, and sometimes several siblings are seen to be diagnosed with liver cancer one after another. Next are patients with alcoholic cirrhosis and other causes of cirrhosis. There is evidence that fatty liver (especially non-alcoholic fatty liver) is closely related to primary liver cancer. In addition, environmental and food contamination (aflatoxin) is also a cause of primary liver cancer. In conclusion, people with the above factors have a high incidence of primary liver cancer and need to have timely and regular (6 months) hepatobiliary ultrasound and blood alpha-fetoprotein (AFP) checkups for early detection of liver cancer. 2.Common diagnostic methods of primary liver cancer The diagnosis of the disease requires the clinician to synthesize the medical history, physical examination, laboratory tests (blood tests) and imaging tests (ultrasound, CT, MRI, etc.) to make judgment. Specifically for primary liver cancer, tumor marker tests AFP and CA199 are of certain value for diagnosis, but high values of these two indicators do not necessarily indicate liver cancer, and normal indicators cannot exclude the possibility of liver cancer. Although the higher the value of AFP and CA199, the patient’s treatment effect is relatively poor, but there is no direct relationship between the value of indicators and the size of tumor. The diagnosis of primary liver cancer needs to rely on imaging examinations. Ultrasound is a common method to detect liver cancer, which often suggests intrahepatic occupying lesions (hypoechoic or mixed echogenic nodules) but cannot make a definite diagnosis, while ultrasonography has relatively greater diagnostic value for liver cancer, but also has limitations and can be used for patients who cannot perform enhanced CT or MRI. PET-CT has limited diagnostic value for primary liver cancer, but has some value for the presence of systemic metastasis. The clinical diagnosis of primary hepatocellular carcinoma often requires a combination of two or more imaging examinations, and sometimes CT or magnetic resonance angiography is required for preoperative judgment. For patients who cannot exclude malignant lesions after a series of examinations, percutaneous puncture biopsy can be considered. However, this test has the possibility of false negatives and may lead to tumor dissemination, so it is not used as a routine diagnostic tool and should be carefully chosen by the physician based on the patient’s specific situation. In fact, the emphasis of different examinations is different, and a comprehensive and correct diagnosis before surgery is the basis for choosing appropriate and effective treatment.