A liquid-biopsy approach for a cancer that Hong Kong still sees too often, in patients who often cannot spare another invasive procedure.
Hong Kong context Liver cancer was the fifth most common cancer in Hong Kong in 2023, with 1,700 new cases, and remains a leading cause of cancer death, particularly in men (1,273 male cases). Chronic hepatitis B is still the dominant local risk factor, even as antiviral therapy has reduced incidence from its earlier peak. |
Why this cancer is hard to manage with a single protocol
Hepatocellular carcinoma is usually found in a damaged liver. That single fact limits surgery, ablation, TACE, and systemic therapy. AFP helps when it is elevated and tracks disease; a large minority of HCCs are AFP-negative.
Systemic options have improved — atezolizumab plus bevacizumab, durvalumab plus tremelimumab, TKIs such as lenvatinib, sorafenib, regorafenib, cabozantinib — but sequencing is still largely empirical once first-line immunotherapy fails.
Biopsy is not always done, and repeat biopsy of a cirrhotic liver is not trivial. A blood test that can enumerate circulating tumour cells and test their sensitivity is therefore operationally attractive, provided nobody pretends it replaces multiphase CT / MRI or a hepatology work-up.
What circulating tumor cells add
HCC sheds CTCs into the bloodstream. Those cells can be counted and phenotyped with Oncotrace (the general solid-tumour panel) or monitored more simply with Oncocount. Oncotrail’s listed cancer-type panels do not name HCC as a dedicated panel, so the correct language on a clinic page is Oncotrace / Oncocount for monitoring, and Onconomics Plus when the question is drug selection.
Because many HCC patients are not surgical candidates, the value of a non-invasive serial marker is high — especially between imaging intervals, or when AFP is uninformative.
The RGCC pathway for this cancer
A typical sequence is screening or baseline first, then a comprehensive profile when treatment choices matter, then serial follow-up. The exact panel is chosen by the accredited practitioner.
Clinical question | RGCC test to consider |
Chronic HBV / HCV / cirrhosis; screening conversation | Onco-D-clare as an adjunct to ultrasound and AFP — it does not replace six-monthly HCC surveillance |
Confirmed HCC or intrahepatic cholangiocarcinoma; baseline and follow-up | Oncotrace (full phenotype + stemness) or Oncocount (burden only) |
Choosing or sequencing systemic therapy or integrative agents | Onconomics Plus |
Metastatic pattern | Metastat |
Broader mutational context | CAMBISeq |
What the report can change in practice
A baseline CTC profile before TACE, TKI or immunotherapy gives the team something to compare three months later. If the scan is mixed and AFP is flat, the CTC trend is another vote.
Onconomics Plus is most useful at the move from locoregional therapy to systemic therapy, and again at first systemic progression, when several TKIs and IO combinations are still on the table.
Cholangiocarcinoma and mixed tumours should be labelled honestly on the request form. Phenotype markers on Oncotrace can support origin questions when the radiology is ambiguous, but tissue and imaging remain the reference.
Who this article is for
• Patients with confirmed HCC about to start TACE, TKI or immunotherapy.
• AFP-negative disease that is hard to monitor.
• People who cannot safely be biopsied again.
• HBV carriers already in ultrasound surveillance who want to understand what an additional blood-based screening test can and cannot do.
Next step
Bring your latest multiphase scan, AFP trend, viral-hepatitis serology and Child-Pugh / ALBI status. The RGCC-accredited practitioner will not override your hepatologist; they will add a blood-based layer the MDT can use.
Disclaimer. This article is educational and is intended for patients, families, and referring practitioners. RGCC tests are laboratory investigations that support clinical decision-making. They do not replace imaging, tissue diagnosis, or a treating oncologist’s judgement. Results must be interpreted by an RGCC-accredited practitioner in the context of the full medical history. RGCC circulating tumor cell (CTC) assays are not designed to detect primary cancers of the brain or central nervous system. Always discuss findings with your own doctor before changing any treatment.