Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

Hepatocellular carcinoma (HCC) is the fifth most common cancer in men and eighth most common cancer in women worldwide, resulting in at least 500 000 deaths per year. It accounts for 90% of all liver cancers. Its crude incidence in the European Union is 8.29/100 000. Areas such as Asia and subSaharan Africa with high rates of infectious hepatitis have incidences as high as 120 cases per 100 000. It is four to eight times more common in men and usually associated with chronic liver injury [hepatitis B (HBV), hepatitis C (HCV) and alcoholic cirrhosis]. Chronic infection with HBV in the setting of cirrhosis increases the risk of HCC 100-fold. Some 5%–30% of individuals with HCV infection develop chronic liver disease, 30% progress to cirrhosis, and in these, 1%–2% per year develop HCC. Co-infection with HBV further increases the risk. Alcohol abuse in the setting of chronic HCV infection doubles the risk of HCC compared with HCV infection alone. Median age at diagnosis is between 50 and 60 years. In Africa and Asia, age at diagnosis is substantially younger, the cancer occurring in the fourth and fifth decades of life, respectively.