Commentary
Hepatocellular carcinoma is the fifth and ninth most commonly diagnosed cancer in men and women, respectively, and the fourth leading cause of cancer mortality worldwide. Risk factors for HCC include chronic hepatitis B and hepatitis C, alcohol addiction, metabolic liver disease (particularly non-alcoholic fatty liver disease) and exposure to dietary toxins such as aflatoxins and aristolochic acid.
In developing countries hepatocellular carcinoma is largely attributed to underlying hepatitis B virus infection, with more than 70% of hepatocellular carcinoma cases attributable to hepatitis B virus. Until recently, cirrhosis secondary to hepatitis C virus was the most common underlying aetiology of hepatocellular carcinoma, accounting for 60% of hepatocellular carcinoma cases.
More recently, the landscape of HCV and in turn hepatocellular carcinoma is changing owing to direct acting antiviral therapy and the opioid epidemic. Owing to the current epidemic of metabolic syndrome, more recent data show that the population affected by NAFLD and NASH continues to increase and now comprises a significant portion with hepatocellular carcinoma.
