liver cancer

Last edited 10/2020 and last reviewed 06/2023

The most usual form of liver cancer is the result of secondaries; however of those cancers arising primarily in the liver, hepatoma accounts for over 90%. The distribution of hepatocellular carcinoma is linked to that of hepatitis B virus.

Hepatocellular carcinoma is an important complication of liver cirrhosis. Sustained stimulation of hepatocytes to regenerate results in a neoplastic mutant, with dire consequences. It is another result of the relatively limited way in which the liver is able to react to insult.

• cirrhosis remains the most important risk factor for the development of hepatocellular carcinoma regardless of aetiology
• hepatitis B and C are independent risk factors for the development of cirrhosis
• alcohol consumption is an important additional risk factor
for development of cirrhosis - and hence hepatocellular carcinoma

Primary liver cancer is the fourth leading cause of cancer related deaths in the world (1)

• also the leading cause of cancer related death in low resource countries (1)
• more than 80% of all cases occur in low and middle resource countries -there are notably high incidence rates in East Asia and sub-Saharan Africa (2)
• HCC occurred more often in males than females (2.4:1) (3)
  • a higher incidence in Eastern and Southern Asia, Middle and Western Africa, Melanesia, and Micronesia/Polynesia

Screening includes both radiologic tests, such as ultrasound, computerized tomography, and magnetic resonance imaging, and serological markers such as alph-fetoprotein

Options for potential cure:

• orthotopic liver transplantation, surgical resection, ablation

Reference:

• Fitzmaurice C, Allen C, Barber RM, et al, Global Burden of Disease Cancer Collaboration. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease Study. JAMA
  Oncol 2017;3:524-48.
• Yang JD, Hainaut P, Gores GJ, Amadou A, Plymoth A, Roberts LR. A global view of hepatocellular carcinoma: trends, risk, prevention and management. Nat Rev Gastroenterol Hepatol 2019;16:589-604.
• Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–2971