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CION Cancer Clinics
Why you still need liver scans even on antiviral treatment | CION Cancer Clinics
Antiviral tablets for hepatitis B lower your risk of liver cancer, but they do not remove it. A normal viral load shows the virus is quiet, not that the liver is free of a tumour. Regular ultrasound scans are how a cancer is found early, while it is small and often curable. This page explains why the scans continue and who needs them. At CION Cancer Clinics, our specialists help you understand your own risk and plan regular liver checks that fit it.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- If my hepatitis B is under control, why do I still need scans?
- Why does the risk not disappear once the virus is quiet?
- What does liver cancer surveillance actually involve?
- Which test is watching the virus, and which is watching for cancer?
- Four things people on antivirals often tell us
- What this page cannot tell you
- Common questions about scans on antiviral treatment
The short answer
If my hepatitis B is under control, why do I still need scans?
Because antiviral tablets lower the risk of liver cancer but do not remove it. A normal viral load tells you the virus is quiet. It does not tell you whether a small tumour has already started to grow. Only a scan can see that.
The tablets and the scan do two different jobs
Tenofovir and entecavir hold the virus down, which protects the liver from further damage. Over time that lowers the chance of cancer. But years of infection before treatment have already left changes in the liver cells, and some of those changes can still turn into cancer later. The tablets cannot undo that history. Surveillance is how a cancer is found while it is small, when it is often curable with surgery or ablation.
Who this page is for
This page is for adults with hepatitis B who are on antiviral treatment, or who have been told they need it. It is about preventing a first liver cancer, which doctors call primary liver cancer or HCC (hepatocellular carcinoma, the common cancer that starts in the liver cells). If you already have cancer and are asking how hepatitis affects treatment, read immunotherapy with hepatitis B or cirrhosis instead.
A good viral load is a reason to keep going, not a reason to stop the scans.Who stays at risk
Why does the risk not disappear once the virus is quiet?
Your doctor weighs several things to decide whether you need regular scans. Treatment changes some of them. It cannot change the others.
Cirrhosis
Cirrhosis is scarring of the liver that has built up over years. A scarred liver keeps a raised cancer risk even when the virus is fully suppressed. Anyone with hepatitis B and cirrhosis is usually advised to stay on surveillance for life.
Years of infection before treatment
Many people in India were infected at birth or in early childhood and found out only as adults. Hepatitis B can leave its own genetic material inside liver cells. That damage happened before the first tablet, and the tablets do not reverse it.
Age, sex and family history
Older age, being male and having a close relative with liver cancer all raise risk. None of these change with treatment.
Other things your doctor asks about
- Alcohol, now or in the past
- Diabetes and fatty liver
- Hepatitis C or hepatitis D as well
What treatment does change
A suppressed virus slows further scarring and lowers the cancer risk over the years. That is real and worth having. It is why you stay on the tablets and on the scans together.
Not sure whether this applies to you?
Ask an oncologistHow it works
What does liver cancer surveillance actually involve?
An ultrasound of the liver
A simple scan with gel and a probe on the abdomen. It takes a few minutes, uses no radiation and needs no injection. You are usually asked to come with an empty stomach.
An AFP blood test, often at the same visit
AFP (alpha-fetoprotein) is a protein that some liver cancers release into the blood. It is not reliable on its own, so it is used beside the ultrasound rather than instead of it. See why ultrasound and AFP are used together.
Repeated on a fixed rhythm
Guidelines usually advise a scan every six months for people in the at-risk groups. The gap matters, because it is short enough to catch most cancers while they are still small.
A closer look if anything is seen
If the ultrasound shows a new spot, the next step is usually a triple-phase CT or an MRI. Most spots turn out to be harmless, but each one is followed up properly.
Review with your doctor
The scan, the AFP and your viral load are read together. CION arranges these scans through accredited diagnostic partners and goes through the results with you.
Two kinds of test
Which test is watching the virus, and which is watching for cancer?
- HBV DNA (viral load)
- How much virus is in your blood. It shows whether the tablets are working. It says nothing about a tumour.
- ALT and AST
- Liver enzymes that rise when liver cells are inflamed. Normal values are reassuring about the virus, not about cancer.
- Ultrasound
- A picture of the liver. This is the test that looks for a new spot or nodule.
- AFP
- A blood marker that rises in some liver cancers. A normal AFP does not rule cancer out.
- FibroScan (elastography)
- A scan that measures how stiff, and so how scarred, the liver is. It helps decide whether you are in the group that needs regular surveillance.
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Did you know
Liver cancer is one of the few cancers where regular screening in a known risk group clearly helps. The people at risk can be named in advance, the test is cheap and safe, and a cancer found small has far more treatment options than one found because it caused pain.
Commonly believed
Four things people on antivirals often tell us
"My viral load is undetectable, so I am safe from cancer."
An undetectable viral load means the tablets are working. Your cancer risk is lower than it was, but it is not zero, especially if you have cirrhosis or were infected for many years.
"I feel perfectly well, so nothing can be wrong."
Early liver cancer almost never causes symptoms. By the time there is pain, weight loss or jaundice, the tumour is usually larger. Surveillance exists for people who feel well.
"My last scan was normal, so I can skip the next one."
Each scan only tells you about that day. The rhythm of regular scans is what makes surveillance work. If you miss one, book the next as soon as you can. See what happens if you miss a scan.
"Hepatitis B tablets clear the virus for good."
Hepatitis B is controlled, not removed. The virus stays in the liver in a quiet form. This is why treatment is usually long term and why the scans continue.
Being straight with you
What this page cannot tell you
It cannot tell you whether you personally need surveillance, or how often. That depends on whether you have cirrhosis, your age, your family history and other things your hepatologist or physician will weigh. Some younger people with an inactive infection and a healthy liver may not need regular scans at all. Your doctor should tell you which group you are in, and you are entitled to ask.
It cannot read your report
If an ultrasound report mentions a nodule, a lesion or an SOL (space-occupying lesion, meaning a spot), do not wait for the next routine scan. Take it to your doctor that week. Most spots are harmless, but each one needs a proper follow-up scan. Our page on a nodule found on surveillance explains what usually happens next.
Who this does not apply to
This page is not about children, people with hepatitis C alone, or people whose cancer has spread to the liver from another organ. Those groups have their own pages. Decisions about antiviral tablets belong to a hepatologist or physician, not to this page.
If you are not sure whether you should be on surveillance, call the helpline and someone will help you find out.Questions we are asked
Common questions about scans on antiviral treatment
How often should I have a liver scan on hepatitis B treatment?
For most people in the at-risk groups, guidelines advise an ultrasound every six months, often with an AFP blood test. Your doctor sets the exact plan. Some people with a healthy liver and an inactive infection may not need regular scans, so ask which group you are in.
If my viral load is undetectable, can I stop the scans?
Usually not, especially if you have cirrhosis. An undetectable viral load lowers your cancer risk but does not remove it. The scans look for a tumour, which the viral load test cannot see. Only your doctor should change the surveillance plan.
Is a blood test enough instead of an ultrasound?
No. AFP alone misses many early cancers, and a normal AFP does not rule cancer out. Liver function tests and viral load say nothing about a tumour. The ultrasound is the main test, and AFP is used beside it to add a second signal.
Do the antiviral tablets themselves cause cancer?
No. Tenofovir and entecavir lower the risk of liver cancer over time by protecting the liver. The scans continue because of the damage left by years of infection before treatment, not because of the tablets. Keep taking them as prescribed.
My ultrasound is always normal. Why keep going?
A normal result is the most common outcome, and it is good news each time. Surveillance works because it is repeated. A cancer that starts between scans is found while it is still small, which is when it has the most treatment options.
Can I get a CT scan instead of an ultrasound?
Sometimes. If your liver is hard to see on ultrasound, for example because of body shape or a very scarred liver, your doctor may suggest CT or MRI instead. For most people ultrasound is enough, safer and cheaper. Do not swap tests without asking.
What if I live far from Hyderabad?
The ultrasound and AFP can usually be done at a good diagnostic centre near home. What matters is that the same doctor sees every result in order. Keep all your reports in one folder and bring them to each visit. Our page on surveillance outside a big city may help.
Should my family members also have scans?
First they should be tested for hepatitis B, and those who are negative can be vaccinated. Scans are decided for each person separately, by their own doctor. A family history of liver cancer is one of the things that can move someone into the surveillance group.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- AASLD — Practice Guidelines
- EASL — EASL Clinical Practice Guidelines: management of hepatocellular carcinoma
- NHS — Hepatitis B
- Liver UK (formerly British Liver Trust) — Hepatitis B in adults
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Antiviral treatment lowers cancer risk but does not remove itHow much the tablets actually change your riskSurveillance for hepatitis B carriers without cirrhosisWhether you need scans if your liver is not scarredStopping hepatitis B medicine: why it is riskyWhy the tablets themselves should not be stopped on your ownThe six-monthly ultrasoundWhat the scan is and why the gap is six months
Talk to us
Not sure whether you should still be having scans?
Bring your viral load and scan reports and we will help you understand where you stand and set up a surveillance plan that fits. One helpline serves every CION centre.