CURRENT CONCEPTS Hepatocellular Carcinoma

Each year, hepatocellular carcinoma is diagnosed in more than half a million people worldwide, including approximately 20,000 new cases in the United States.(1,2) Liver cancer is the fifth most common cancer in men and the seventh in women. Most of the burden of disease (85%) is borne in developing countries, with the highest incidence rates reported in regions where infection with hepatitis B virus (HBV) is endemic: Southeast Asia and sub-Saharan Africa (Fig. 1).(3) Hepatocellular carcinoma rarely occurs before the age of 40 years and reaches a peak at approximately 70 years of age. Rates of liver cancer among men are two to four times as high as the rates among women. Hepatocellular carcinoma related to infection with hepatitis C virus (HCV) has become the fastest-rising cause of cancer-related death in the United States, and during the past two decades, the incidence of hepatocellular carcinoma in the United States has tripled while the 5-year survival rate has remained below 12%(2) (Fig. 2). The greatest proportional increase in cases of hepatocellular carcinoma has been seen among Hispanics and whites between 45 and 60 years of age.(4)