Chapter 088. Hepatocellular Carcinoma (Part 1)

Harrisons Internal Medicine Chapter 88. Tumors of the Liver and Biliary Tree Hepatocellular CarcinomaIncidence Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. The annual global incidence is about 1 million cases, with a male to female ratio of about 4:1. The incidence rate equals the death rate. In the United States, 19,160 new cases and 16,780 deaths were noted in 2007. The death rate in males in low-incidence countries such as the United States is 1.9 per 100,000 per year; in intermediate-incidence areas such as Austria and South Africa, annualdeath rates range from 5.1–20.0...
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Chapter 088. Hepatocellular Carcinoma (Part 1) Chapter 088. Hepatocellular Carcinoma (Part 1) Harrisons Internal Medicine > Chapter 88. Tumors of the Liver andBiliary Tree > Hepatocellular Carcinoma Incidence Hepatocellular carcinoma (HCC) is one of the most common malignanciesworldwide. The annual global incidence is about 1 million cases, with a male tofemale ratio of about 4:1. The incidence rate equals the death rate. In the UnitedStates, 19,160 new cases and 16,780 deaths were noted in 2007. The death rate inmales in low-incidence countries such as the United States is 1.9 per 100,000 peryear; in intermediate-incidence areas such as Austria and South Africa, annualdeath rates range from 5.1–20.0 per 100,000; and in high-incidence areas such asin Asia (China and Korea), death rates are as high as 23.1–150 per 100,000 peryear (Table 88-1). The incidence of HCC in the United States is around 3 per100,000 persons, with significant sex, ethnic, and geographic variations. Thesenumbers are rapidly increasing and may be an underestimate. Around 4 millionpersons in the United States are chronic carriers of hepatitis C virus (HCV). About10% of them, or 400,000, are likely to develop cirrhosis. Around 5% or 20,000 ofthese may develop HCC annually. Add to this the two other common predisposingfactors—hepatitis B virus (HBV) and chronic alcohol consumption—and 60,000new HCC cases annually seem possible. Future advances in HCC survival willlikely depend on immunization strategies for HBV and HCV and earlier diagnosisby screening of patients at risk of HCC development. Table 88-1 Age-Adjusted Incidence Rates for HepatocellularCarcinoma Persons per 100,000 per YearCountry Male FemaleArgentina 6.0 2.5Brazil, Recife 9.2 8.3Brazil, Sao Paulo 3.8 2.6Mozambique 112.9 30.8South Africa, Cape: Black 26.3 8.4South Africa, Cape: White 1.2 0.6Senegal 25.6 9.0Nigeria 15.4 3.2Gambia 33.1 12.6Burma 25.5 8.8Japan 7.2 2.2Korea 13.8 3.2China, Shanghai 34.4 11.6India, Bombay 4.9 2.5India, Madras 2.1 0.7Great Britain 1.6 0.8France 6.9 1.2Italy, Varese 7.1 2.7Norway 1.8 1.1Spain, Navarra 7.9 4.7