Liver Cancer

Hepatocellular carcinoma (HCC) is the most common primary liver cancer, accounting for approximately 75-85% of all liver cancer cases worldwide. HCC is the sixth most common cancer globally and the fourth leading cause of cancer-related deaths. It is more prevalent in developing countries, particularly in East Asia and sub-Saharan Africa. HCC prevalence varies geographically, with the highest rates found in regions where chronic hepatitis B and C infections are endemic. 

Chronic viral hepatitis: Chronic hepatitis B and C infections are the leading risk factors for HCC. These infections cause liver inflammation and can progress to cirrhosis, increasing the risk of HCC development. 

• Cirrhosis: Cirrhosis, often resulting from chronic alcohol abuse, non-alcoholic fatty liver disease (NAFLD), or viral hepatitis, significantly increases the risk of HCC. 

• Hepatotoxic substances: Exposure to certain chemicals, such as aflatoxins (produced by molds in food) and vinyl chloride (used in plastics manufacturing), can contribute to HCC development. 

• Metabolic disorders: Conditions like NAFLD, obesity, and diabetes are associated with an increased risk of HCC. 

• Genetic factors: Certain genetic disorders, such as hereditary hemochromatosis and alpha-1 antitrypsin deficiency, can predispose individuals to HCC. 

Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) scans are commonly used to detect liver tumors and assess their characteristics. Alpha-fetoprotein (AFP) levels are measured as a significant biomarker. For patients with early-stage HCC and underlying cirrhosis, liver transplantation can be curative. Otherwise the treatment options are surgical resection, ablation, transarterial chemoembolization (TACE) and transarterial radioembolization (TARE). Targeted therapies and immunotherapies are listed as very important treatment options in advanced HCC. 

References

1. Forner, A., Reig, M., & Bruix, J. (2018). Hepatocellular carcinoma. The Lancet, 391(10127), 1301-1314. 

2. Singal, A. G., El-Serag, H. B., & Hepatocellular Carcinoma From Epidemiology to Prevention: Translating Knowledge into Practice. Clinical Gastroenterology and Hepatology, 13(12), 2140-2151. 

3. European Association for the Study of the Liver. (2018). EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. Journal of Hepatology, 69(1), 182-236. 

4. Bruix, J., & Sherman, M. (2011). Management of hepatocellular carcinoma: an update. Hepatology, 53(3), 1020-1022.