Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INCIDENCE ++ Hepatocellular carcinoma (HCC) incidence varies from 3 per 100,000 in Western countries to as high as 15 per 100,000 in countries with high hepatitis B virus (HBV) and hepatitis C virus (HCV) incidence. HCC incidence is steadily increasing. HCC is the sixth most common cancer and third cause of cancer-related death worldwide. +++ EPIDEMIOLOGY ++ Strong male preponderance (∼4:1). Most common in aging populations and in areas with high hepatitis incidence. Related to limited resources. Heavy alcohol drinking, consumption of aflatoxin, and tobacco smoking are associated with HCC. Familial aggregation of liver cancer has been reported. +++ SURVEILLANCE ++ Surveillance aims for a reduction in mortality of this patient population and involves the repeated application of screening tools in patients at risk for HCC. The availability of efficient diagnostic tests and treatment options results in successful surveillance. Surveillance is necessary in the following patient groups: Cirrhotic patients HBV carriers with serum viral load >10,000 copies/mL or family history of HCC Asian HBV carriers (>40 years old for males, >50 years old for females) Africans or African Americans with HBV Genetic hemochromatosis and cirrhosis Alpha 1-antitrypsin deficiency and cirrhosis HCV-infected patients with fibrosis, even after achieving sustained virologic response following treatment Surveillance by abdominal ultrasound resulted in an average size of the detected tumors of 1.6 ± 0.6 cm, with <2% of the cases exceeding 3 cm. In the Western world and in less experienced centers, sensitivity of finding early-stage HCC by ultrasound is considerably less effective. No data exist to support the use of contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) for surveillance. Some centers utilize the determination of serum alpha-fetoprotein (AFP) along with ultrasound to gain 6% to 8% in the tumor detection rate, but at the price of false-positive results. Surveillance of patients at risk for HCC should be carried out every 6 months, and ultrasound is considered the modality of choice. +++ MOLECULAR INFORMATION ++ HCV genotype 1b is claimed to increase the risk of HCC development. Several chromosomal aberrations have been reported, for example, amplification of 1q, 8q, 6p, and 17q or loss of 8p, 16q, 4q, 17p, and 13q. Loss of 4q has been correlated with more aggressive HCC phenotype. Some evidence suggests that the Wnt developmental pathway plays a role in HCC pathogenesis. Aberrant expression of several microRNAs has been implicated in HCC carcinogenesis. Single nucleotide polymorphisms (SNPs) and haplotypes located in the SCBY14, CRHR2, and GFRA1 genes are identified in patients with HCV infection; further revalidation is required, though. GSTM1 and GSTT1 null genotype carriers show slightly higher HCC incidence; further revalidation is required, though. Cirrhotic patients with a G/G genotype for the EGF gene have a 4-fold chance of developing HCC; therefore, EGF signaling might be a potential target for chemoprevention. No validated biomarker can be used as a prognostic method ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.