• Cancer originating from the liver

• Physical signs are hepatomegaly & ascites
• Usually asymptomatic for much of its natural history
• Nonspecific symptoms include:
  
  • Jaundice
  • Anorexia
  • Weight loss
  • Malaise
  • Upper abdominal pain

• Presence of cirrhosis is the key risk factor for the development of hepatocellular carcinoma

High-risk Groups for Hepatocellular Carcinoma CC Screening & Surveillance

• Asian male ≥40 years old who are hepatitis B carriers
• Asian female ≥50 years old who are hepatitis B carriers
• Hepatitis B carriers w/ family history of hepatocellular carcinoma
• Africans & African Americans w/ hepatitis B
• Cirrhotic hepatitis B & C carriers
• Individuals w/ stage 4 primary biliary cirrhosis
• Individuals w/ genetic hemochromatosis & cirrhosis
• Individuals w/ alpha 1-antitrypsin deficiency & cirrhosis
• Individuals w/ cirrhosis from other etiologies
• Alcoholic cirrhosis
• Nonalcoholic fatty liver disease
• Environmental exposure to aflatoxin which is a natural product of the Aspergillus fungus found in various grains

• Liver cancer is the second most common cause of cancer-related mortality worldwide & hepatocellular carcinoma accounts for >90% of liver cancers
  • It is the sixth most common cancer worldwide; 5th most common in males & 9th most common in females
  • In Singapore, from 2009-2013, it is the 3rd most common cause of cancer death in males & 4th in females
  • About 83% of new hepatocellular carcinoma cases in 2012 occurred in less developed countries w/ East & South Asia & Saharan Africa having the highest incidence; Northern Europe & South Central Asia have the lowest incidence
  • Asia has the highest incidence of hepatocellular carcinoma relative to blacks, Hispanics & whites

• There is a >2:1 ratio of male-to-female predominance
• Approximately 80% of hepatocellular carcinoma cases are caused by hepatitis B virus (HBV) &/or hepatitis C virus (HCV) infection especially in those w/ cirrhosis