Hepatocellular cancer (HCC) is the 4th leading cause of cancer-related death worldwide and the fastest growing cause of cancer deaths in the U.S. The overall prognosis of HCC remains dismal except for the subset of patients who are diagnosed at early stage and receive potentially curative therapies such as surgical resection and liver transplantation. Given this, expert society guidelines recommend HCC surveillance every 6 months in at-risk individuals. Despite these recommendations, the effectiveness of HCC surveillance remains a subject of debate.