Hepatocellular carcinoma (HCC) is a major public health problem. Although initially thought of as a disease of the developing world, particularly sub-Saharan Africa and the Far East, it is now recognized to be of growing importance in the United States, Europe, Russia and Japan, mainly in relation to the increasing prevalence of chronic hepatitis C virus infection.

EPIDEMIOLOGY, RISK FACTORS AND PREVENTION

HCC is said to be the fifth most common cancer worldwide, and the third most common cause of cancer-related mortality (1), but these are likely to be underestimates because of underreporting in developing countries. The highest annual incidence rates, of around 100 per 100,000, occur in parts of southern Africa and the Far East (1), and as such, these areas account of at least 75% of all cases. In contrast, HCC is less common in northern Europe, the United States and Australia, although there is evidence that the frequency may be increasing, most likely in relation to the spread of chronic hepatitis C virus infection (2). HCC usually arises in a diseased liver, usually at the stage of cirrhosis, and in this setting it is predominately a disease of men. The cirrhosis is not always symptomatic, and the development of HCC may be the first indication of the underlying cirrhosis (3, 4). HCC is now one of the leading causes of death in patients with cirrhosis. In most populations, the incidence increases with age, but the mean age tends to be lower in high-incidence areas.