hepatocellular%20carcinoma
HEPATOCELLULAR CARCINOMA

Hepatocellular carcinoma is malignancy that originates from the liver.

Physical signs are hepatomegaly and ascites. It is usually asymptomatic for much of its natural history.

Liver cancer is the second most common cause of cancer-related mortality worldwide & hepatocellular carcinoma accounts for >90% of liver cancers.

 

Definition

  • Cancer originating from the liver

Signs and Symptoms

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

Risk Factors

  • 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

Epidemiology

  • 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
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