Hepatocellular carcinoma is the eighth most common malignancy worldwide. This article will review the epidemiology, clinical presentation, staging, pathology, laboratory findings, radiology, and treatment of hepato-cellular carcinoma.
Hepatocellular carcinoma represents 6% of all cancers and is the most common primary hepatic malignancy worldwide. A geographic bias is seen, with an increased incidence of hepatocellular carcinoma in the Far East, Southeast Asia, and sub-Saharan Africa (90 cases per 100,000 population vs 2.4 cases per 100,000 in the United States) [1-4].
The most important risk factors include cirrhosis and hepatitis B and C viruses. Additional risk factors include hemochromatosis; excessive androgens; ocj-antitrypsin deficiency; and exposure to aflotoxins, thorotrast, oral contraceptives, and vinyl chloride [4]. The latter is associated with all types of liver tumors, including angiosarcomas [5]. Hepatitis B virus is considered to be the primary cause of 80% of cases worldwide. The peak age of incidence is 50-70 years, with a male predominance of 4:1. The incidence in the United States has increased approximately 70% during the past two decades, from 1.4 per million in 1976-1980 to 2.4 per million in 1991-1995 [6]. Surveillance Epidemiology and End Results of the National Cancer Institute evaluation of 7389 cases of hepatocellular carcinoma reported an improvement in the 1-year survival rate from 14% to 23% during the same periods [1]. This improvement is thought to be a reflection of the earlier detection of small resect-able tumors, a more aggressive surgical approach, and the wider availability of liver transplantation. The 5-year survival rate has increased from 2% to 5%, and the increase has resulted in a slight change in the still-very-low median survival rate from 0.57 to 0.64 years.