Hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most frequent form of primary liver cancer found in adults. Among people with cirrhosis, it is the leading cause of death, and globally it ranks as the third most common cause of cancer-related fatalities. The highest concentration of HCC cases—and the poorest survival rates after treatment—are seen in Asia and sub-Saharan Africa, regions where hepatitis B infection is widespread and often acquired at birth. In the United States and other high-income countries, the incidence of HCC is rising, driven largely by an increase in hepatitis C infections. Over the past two decades, cases linked to non-alcoholic steatohepatitis (NASH) have also grown sharply, making NASH the fastest-growing cause of HCC. This trend is thought to reflect the rising prevalence of NASH and its risk factors—diabetes and obesity—in wealthier nations. For reasons not yet understood, HCC is more than three times as common in males as in females. The overall five-year survival rate for people with HCC is 18%.

Most people diagnosed with HCC already have signs and symptoms of chronic liver disease. The cancer may be detected when these symptoms worsen, or it may be found incidentally in someone without symptoms. When symptoms do appear, they can be nonspecific—such as abdominal pain, nausea, vomiting, or fatigue. Other signs more closely tied to liver disease include jaundice, abdominal swelling from fluid buildup, easy bruising due to blood clotting problems, loss of appetite, and unintentional weight loss.

Because HCC overwhelmingly develops in people with cirrhosis, its risk factors are largely those that cause chronic liver disease and can lead to cirrhosis. However, some risk factors are more strongly linked to HCC than others. For instance, while heavy alcohol use is estimated to cause 60–70% of cirrhosis cases, most HCC occurs in cirrhosis caused by viral hepatitis (though the two can overlap).