New insights on hepatocellular carcinoma: epidemiology and clinical aspects

Abstract

Primary liver cancer represents the 4th most common tumor in males (4% of all cancers) and the 7th most common tumor in females (2.3% of all cancers), with a prevalence of 53/100,000 in males and 22/100,000 in females (male-to-female ratio = 2:1). In the majority of the cases, hepatocellular carcinoma (HCC) develops in patients with cirrhosis and thus the risk factors for HCC and chronic liver disease are overlapping. Viral infections (hepatitis B virus, hepatitis C virus), alcohol and fat (nonalcoholic fatty liver disease/non-alcoholic steatohepatitis) represent the main risk factors for development of HCC on cirrhotic liver. Several prospective studies reported that at present HCC does represent the first cause of death of cirrhotic patients, while in the past morbidity and mortality in cirrhosis were mainly determined by other non-neoplastic complications of the disease. From a clinical point of view, staging systems in HCC should define outcome prediction and treatment assignment. Due to the nature of HCC, the main prognostic variables are the tumor stage, liver function and performance status. The most accepted clinical classification of HCC has been proposed by the Barcelona Clinic Liver Cancer. The BCLC staging system has come to be widely accepted in clinical practice and is also being used for many clinical trials of new drugs to treat HCC. Therefore, it has become the de facto staging system that is used.

Keywords

Alcohol / cirrhosis / hepatitis B virus / hepatocellular carcinoma / hepatitis C virus / non-alcoholic steatohepatitis

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