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HCC is a common malignancy worldwide with nearly equal numbers of new cases and cancer-related death each year.
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Most HCCs arise in the background of chronic liver disease caused by hepatitis B virus, hepatitis C virus, and chronic excessive alcohol intake.
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A detailed understanding of these risk factors and how they lead to cancer development is necessary to improve the screaming, prevention, early identification and management of HCC.
Epidemiology of Hepatocellular Carcinoma
Section snippets
Key points
Incidence
The incidence of HCC is not evenly distributed throughout the globe. A great preponderance of cases occur in sub-Saharan Africa and Eastern Asia (>80%), and China is believed to account for approximately 50% of all cases of HCC worldwide. Conversely, North and South America, as well as Europe, have a comparatively low incidence of HCC. These marked differences can be attributed to several specific factors.
Risk factors
HCC is a genetically heterogeneous tumor. Hepatocarcinogenesis is complex, requiring multiple genetic and epigenetic alterations and the involvement of several signal transduction pathways, including p53, Ras, MAPK, JAK/STAT, Wnt/β-catenin, and hedgehog.13, 14 Multiple predisposing causes of HCC have been defined, including HBV, HCV, excessive alcohol consumption, obesity, and aflatoxins, and the prevalence/contribution of these risk factors vary by region (Fig. 2).
Metabolic Syndromes
Although worldwide, most HCC is related to hepatitis viral infection and alcoholic liver disease, many patients (5%–20%) with HCC are negative for both HBV and HCV. Nonalcoholic fatty liver disease (NAFLD) and the more severe form, biopsy proven nonalcoholic steatohepatitis (NASH), are characterized by liver disease in the absence of a history of significant alcohol use, or liver disease of unknown cause, and have become the most common cause of cryptogenic chronic liver disease in the United
Economic/public health aspect
The burden of HCC on the health systems of Western countries will likely increase in the coming years as a result of disease progression of HCV-positive baby boomers, and the 20-year to 40-year lag time between viral infection and development of HCC. Because of HCV, as well as other risk factors discussed earlier, it is projected that both compensated cirrhosis and HCC will increase by more than 80% from 2000 to 2020 in the United States.99 Although the figure is dated, the total cost of
Summary
HCC is a common malignancy worldwide, with nearly equal numbers of new cases and cancer-related death each year. Most HCCs develop in the setting of chronic underlying liver disease, the cause of which can differ widely based on multiple factors. The principal causal factors for carcinogenesis in HCC are HBV, HCV, and alcohol abuse, although there seems to be an increasing incidence of NASH-associated HCC in Western countries. A detailed understanding of these risk factors and how they lead to
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Cited by (0)
Funding sources: none (Dr T.M. Pawlik, Dr K.J. Lafaro); Speaker’s Bureau – Bayer, Speaker’s Bureau – Aptalis (Dr A.N. Demirjian).
Conflicts of interest: none.