Primary Liver Cancer Epidemiology

Epidemiology

• Primary liver cancer (PLC) is the 6th most common cancer worldwide and the 2nd leading cause of cancer-related deaths.
• Incidence rates vary globally, with highest rates in East Asia and Africa.
• In the US, PLC is relatively rare, accounting for approximately 2% of cancer diagnoses.

Risk Factors

• Chronic hepatitis B and C infections: major risk factors, especially in developing countries.
• Liver cirrhosis: increases risk of PLC.
• Non-alcoholic fatty liver disease (NAFLD): growing concern as a risk factor.
• Exposure to aflatoxins (found in contaminated foods): increases risk.
• Family history of PLC: possible genetic component.

Pathology

• Hepatocellular carcinoma (HCC): most common type of PLC (70-90% of cases).
• Cholangiocarcinoma (CCA): 10-20% of PLC cases, originating from bile ducts.
• Other rare types: fibrolamellar carcinoma, sarcoma, and lymphoma.

Clinical Features

• Symptoms often non-specific and occurring late in disease progression:
  • Abdominal pain, weight loss, fatigue, and loss of appetite.
  • Jaundice, ascites, and bleeding in advanced cases.
• Laboratory tests: elevated alpha-fetoprotein (AFP) levels, abnormal liver function tests.

Diagnosis

• Imaging: ultrasound, CT, MRI, and PET scans to detect tumors and assess liver function.
• Biopsy: often necessary for diagnosis, especially for CCA.
• Staging: TNM system or Okuda staging system used to determine prognosis and treatment.

Treatment

• Curative options:
  • Surgical resection (partial hepatectomy).
  • Liver transplantation.
• Palliative options:
  • Transcatheter arterial chemoembolization (TACE).
  • Radiofrequency ablation (RFA).
  • Systemic chemotherapy.
• Surveillance: regular imaging and AFP monitoring essential for early detection of recurrence.

Prognosis

• 5-year survival rate: approximately 20-30% for HCC, 10-20% for CCA.
• Early detection and treatment improve outcomes, highlighting importance of surveillance and awareness.

Epidemiology

• Primary liver cancer (PLC) is the 6th most common cancer worldwide and the 2nd leading cause of cancer-related deaths.
• PLC incidence rates vary globally, with the highest rates found in East Asia and Africa.
• In the US, PLC is relatively rare, accounting for approximately 2% of cancer diagnoses.

Risk Factors

• Chronic hepatitis B and C infections are major risk factors for PLC, especially in developing countries.
• Liver cirrhosis increases the risk of PLC.
• Non-alcoholic fatty liver disease (NAFLD) is a growing concern as a risk factor for PLC.
• Exposure to aflatoxins, found in contaminated foods, increases the risk of PLC.
• A family history of PLC may indicate a possible genetic component.

Pathology

• Hepatocellular carcinoma (HCC) is the most common type of PLC, accounting for 70-90% of cases.
• Cholangiocarcinoma (CCA) accounts for 10-20% of PLC cases and originates from bile ducts.
• Other rare types of PLC include fibrolamellar carcinoma, sarcoma, and lymphoma.

Clinical Features

• Symptoms of PLC are often non-specific and occur late in disease progression.
• Abdominal pain, weight loss, fatigue, and loss of appetite are common symptoms of PLC.
• Jaundice, ascites, and bleeding may occur in advanced cases of PLC.
• Laboratory tests often reveal elevated alpha-fetoprotein (AFP) levels and abnormal liver function tests.

Diagnosis

• Imaging tests such as ultrasound, CT, MRI, and PET scans are used to detect tumors and assess liver function.
• Biopsy is often necessary for diagnosis, especially for CCA.
• The TNM system or Okuda staging system is used to determine prognosis and treatment.

Treatment

• Curative treatment options for PLC include surgical resection (partial hepatectomy) and liver transplantation.
• Palliative treatment options for PLC include transcatheter arterial chemoembolization (TACE), radiofrequency ablation (RFA), and systemic chemotherapy.
• Surveillance with regular imaging and AFP monitoring is essential for early detection of recurrence.

Prognosis

• The 5-year survival rate for HCC is approximately 20-30%, while it is 10-20% for CCA.
• Early detection and treatment improve outcomes, highlighting the importance of surveillance and awareness.