Epidemiology
Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, but is less common in the UK with approximately 2800 cases per year (1% of all cancer diagnoses and 40% of hepatobiliary cancers). The distribution of HCC closely aligns with that of chronic HBV infection, with most cases in East Asia and Sub-Saharan Africa. HCC is four to eight times more common in men than in women and most diagnoses are made during the fifth or sixth decade of life, corresponding with time taken for liver cirrhosis to develop.
Secondary metastases to the liver, rather than primary liver tumours, are more common in the UK, particularly from primaries in the colon, pancreas, stomach, breast and lung.
Cholangiocarcinoma (usually adenocarcinoma) accounts for more than 50% of hepatobiliary cancer in the UK, affecting the bile ducts inside or outside the liver. It is a relatively rare cancer with around 1000 cases per year in the UK. Other rarer types of hepatobiliary cancer include angiosarcoma and hepatoblastoma, a cancer affecting children under 3 years.
Aetiology
More than 70% of HCC cases worldwide are associated with chronic infection with hepatitis B or C viruses. The lifetime risk of developing HCC is 40% in HBV-infected individuals and is thought to be higher for HCV infection. Other risk factors include alcoholic cirrhosis, aflatoxin (a fungal contaminant of crops in tropical regions), primary biliary cirrhosis and inherited metabolic disorders such as haemochromatosis and tyrosinaemia.
Individuals with primary sclerosing cholangitis have a lifetime risk of developing cholangiocarcinoma of 10–20%. Infection with liver flukes has been implicated and accounts for the higher prevalence of cholangiocarcinoma in Southeast Asia.
Clinical presentation
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
