Steven M. Zangan, MD, and Jay Patel, MD
Liver cancer is the fourth-leading cause of cancer-related death in the world and comprises as many as 1 million deaths per year worldwide.1-4 Hepatocellular carcinoma (HCC) has unique geographic, gender, and age distributions determined by specific etiologic factors. HCC is an aggressive disease, with the number of deaths per year caused approx¬imating the incidence throughout the world.
A variety of important risk factors for the development of HCC has been identified, including hepatitis B carrier state, chronic hepatitis C virus infection, hereditary hemochroma-tosis, and cirrhosis of almost any cause.6 However, HCC can also occur in patients with no known risk factors.7 The inci-dence of HCC varies by geographic location and among eth¬nic groups within the same country, likely because of re¬gional variations in hepatic viruses and environmental pathogens.1 Most hepatomas occur in patients with chronic liver disease or cirrhosis.
Patients diagnosed at an early stage may benefit from surgical resection, transplantation, or percutaneous therapy. Although the mainstay of therapy is surgical resection, most patients are not eligible because of tumor extent or underlying liver dysfunction. Because HCC is typically clinically silent during early stages, disease is typically advanced at the time of presentation and only approximately 30%-40% of patients who are evaluated benefit from these treatment options.8 The median survival after late-stage diagnosis ranges between 6 and 20 months.9 Many treatment options have been developed to improve the quality and duration of life for patients with unresectable disease. Although no standard therapy exists, the most commonly used palliative therapies in the United States include systemic therapies and image-guided interventions, such as thermal ablation, transarterial chemoembolization, and selective internal radiation therapy.