The etiology of hepatocellular carcinoma and consequences for treatment.
Most patients with hepatocellular carcinoma (HCC) have liver cirrhosis, which develops following long periods of chronic liver disease. Cirrhosis is characterized by a decrease in hepatocyte proliferation, indicating an exhaustion of the regenerative capacity of the liver, and results in an increase in fibrous tissue and a destruction of liver cells, which may ultimately lead to the development of cancerous nodules. Half of all cases of HCC are associated with hepatitis B virus infection, with a further 25% associated with hepatitis C virus. Other risk factors for developing HCC include alcoholic liver disease, nonalcoholic steatohepatitis, intake of aflatoxin-contaminated food, diabetes, and obesity. There are multiple factors involved in the etiology of HCC, all of which have a direct impact on patient characteristics and disease course, and although a causative agent can often be identified, HCC remains an extremely complex condition associated with a poor prognosis. Additionally, the geographic variation in etiology means that information from different countries is needed in order to optimize surveillance methods and develop effective chemoprevention strategies. Unfortunately, there are still many gaps in our current understanding, and further research efforts are needed to fully elucidate the diverse mechanisms involved in the pathogenesis of HCC and offer optimal prevention strategies for those at risk.
Virginia Commonwealth University Medical Center, Richmond, Virginia, USA. asanyal@mcvh-vcu.edu
Arun J
AJ
Sanyal
Seung Kew
SK
Yoon
Riccardo
R
Lencioni
D000348:Aflatoxins / Q000633:toxicity; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000401:mortality* / Q000517:prevention & control / Q000628:therapy*; D005234:Fatty Liver / Q000150:complications; D016174:Hepacivirus / Q000472:pathogenicity; D006509:Hepatitis B / Q000150:complications; D006515:Hepatitis B virus / Q000472:pathogenicity; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008108:Liver Diseases, Alcoholic / Q000150:complications; D008113:Liver Neoplasms / Q000209:etiology* / Q000401:mortality* / Q000517:prevention & control / Q000628:therapy*; D065626:Non-alcoholic Fatty Liver Disease; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
D000348:Aflatoxins