Hepatoma (Hepatocellular Carcinoma)
Basics
Basics
Basics
Description
Description
Description
Hepatoma, also known as hepatocellular carcinoma (HCC), is the most common primary malignant tumor of the liver, arising from hepatic parenchymal cells (hepatocytes); 80% are associated with underlying chronic liver disease, most commonly cirrhosis related to hepatitis B and C (exception: rare fibrolamellar type).
Epidemiology
Epidemiology
Epidemiology
Incidence
- Second leading cause of cancer-related death worldwide
Fifth most common malignancy worldwide, >700,000 new cases per year worldwide (
1)[
A]
- 4 to 5 new cases per 100,000 per year of the U.S. population; 120 new cases per 100,000 per year in Asia and sub-Saharan Africa
- Among known cirrhotics, 2 to 5 cases per 100 cirrhotics per year
- Incidence increasing since 1980s in the United States (due to increase in hepatitis C infection)
- In the United States, estimate is 28,720 new cases of primary liver cancer were diagnosed in 2012 and 20,550 deaths.
- Male > female (mean 3.7:1 for incidence and 2:1 for deaths)
Prevalence
- Asians/Pacific Islanders > African Americans > Native American > Hispanics > Caucasians
- Predominant age: median age 65 years in the West, 4th to 5th decades in Asia and Africa
- Predominant sex: male > female (3 to 4:1)
Etiology and Pathophysiology
Etiology and Pathophysiology
Etiology and Pathophysiology
- Cirrhosis accounts for 80–90% of HCC. Alcoholic cirrhosis is most common in the Western world. Reported risk in patients with alcoholic cirrhosis is 3–10% with micronodular pattern.
- Hepatitis B virus (HBV) and hepatitis C virus (HCV) are independent and synergistic risk factors for HCC.
- Associated with >70% of cases worldwide
- Most important factor in Africa and Asia
- Chronic alcohol use
- Obesity, type 2 DM, and nonalcoholic fatty liver disease (NAFLD)
- Chronic tobacco abuse
- Betel nut chewing (common in Asia)
- Mycotoxins (aflatoxins): metabolite of the fungus Aspergillus flavus that contaminates foods
- Vinyl polymers associated with angiosarcoma and, less commonly, HCC
Genetics
No known genetic pattern
Risk Factors
Risk Factors
Risk Factors
For HCC
80–90% of HCC associated with cirrhosis (
2)[
B]
- Cirrhosis can be from any etiology: hepatitis B and C, alcoholism, hemochromatosis, nonalcoholic steatohepatitis (NASH), α1antitrypsin deficiency, biliary cirrhosis, autoimmune hepatitis, Wilson disease, glycogen storage disease.
- Fungal aflatoxins (contaminants of grain in Africa and Asia): synergistic effect with other causes of liver disease
- Vinyl chloride
- Thorium dioxide
- Anabolic steroids
- Arsenic
- NAFLD/NASH (3)[C]
- For fibrolamellar type: no identified risk factors
- For angiosarcoma: vinyl chloride
General Prevention
General Prevention
General Prevention
- The major risk factor for HCC is cirrhosis. Prevention of cirrhosis and tumor surveillance in patients with or at risk for cirrhosis is key.
- Prevent HBV and HCV infection through safe sexual practices, avoidance of shared IV drug paraphernalia, and HBV vaccination.
- Treat chronic HBV with lamivudine, adefovir, entecavir, tenofovir, or DAA (direct acting antiviral) therapies for chronic HCV, according to guidelines.
- Avoid excessive alcohol use.
- Treatment of obesity, NAFLD, NASH
Drink >3 cups of coffee per day (
4)[
A].
- Statin use is associated with decreased risk of HCC.
- High-risk individuals
- Chronic hepatitis with HBV or HCV
- Alcoholic cirrhosis
- Genetic hemochromatosis
- Exposure to vinyl chloride >10 years (Screen every 6 months.)
- Primary biliary cirrhosis
- Morbid obesity
Screen high-risk patients by ultrasound (US) and
α-fetoprotein (AFP) every 6 months (
5)[
B].
- HCC progresses from dysplastic nodules to vascular invasion (after tumor is >2 cm in diameter).
There's more to see -- the rest of this topic is available only to subscribers.
© 2000–2025 Unbound Medicine, Inc. All rights reserved