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BACKGROUND

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Hepatocellular carcinoma (HCC) is the fifth most common cancer globally and accounts for the third most cancer deaths worldwide (Fig. 127-1). Although geographic variability exists in the incidence of the disease, occurring less commonly in the United States and Europe, its incidence is steadily rising, having tripled in the United States since the 1970s and projected to increase over the next 20 years (Table 127-1). The current incidence of HCC in the Western world is estimated at 3% to 4% with 5-year survival estimated to be 16% for all-comers.1

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FIGURE 127-1

Estimated age-standardized rates of liver cancer per 100,000. (Reproduced with permission from Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0: Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon: International Agency for Research on Cancer; 2013. Available at: http://globocan.iarc.fr. Accessed January 13, 2015.)

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TABLE 127-1:

Estimated Incidence, Mortality, and Prevalence of Liver Cancer World-Widea

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Up to 90% of HCC develops in cirrhotic livers.2 Therefore, risk factors related to the development of chronic liver disease account for the majority of HCC cases worldwide. This chapter examines the risk factors for development of HCC, clinical manifestations of the disease, and therapeutic modalities available in the armamentarium of clinicians who encounter HCC, the most common primary liver cancer. Management of HCC, with a focus on indications and outcomes of common therapeutic modalities including liver transplantation, resection, and ablation, will be described. Upon reviewing this chapter, the reader should be able to suggest appropriate therapeutic modalities for treatment of HCC, which is individualized based on underlying liver functional status and extent of malignant disease in a given patient.

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EPIDEMIOLOGY

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Risk factors for the development of HCC include hepatitis B virus (HBV), as the most common worldwide cause, hepatitis C virus (HCV), as the most common cause in the United States and other Western countries, alcoholic liver disease, and nonalcoholic fatty liver disease (NAFLD); less common causes include hemochromatosis, alpha-1-antitrypsin deficiency, ...

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