Hepatobiliary malignancies comprise a diverse group of tumors including hepatocellular carcinoma (HCC), variants such as fibrolamellar HCC and cholangiocellular carcinoma, cholangiocarcinoma, carcinoma of the gallbladder, and rare cancers such as sarcoma, angiosarcoma, and hepatoblastoma. The relative frequency of these tumors is shown in Table 19-1. The estimated new cases and deaths from liver and intrahepatic bile duct cancer in the United States in 2009 total 22,620 and 18,160, respectively (1).
Table 19–1. Relative Frequency of Hepatobiliary Tumors Diagnosed in the United States |Favorite Table|Download (.pdf)
Table 19–1. Relative Frequency of Hepatobiliary Tumors Diagnosed in the United States
|Subtype of Hepatobiliary Cancer||Frequency%|
|Cholangiocellular and fibrolamellar||2|
|Angiosarcoma, sarcoma, hepatoblastoma||1|
The majority of primary liver tumors are HCC or cholangiocarcinoma. These tumor types have different etiologies, epidemiologies, clinical presentations, and treatment options; thus, they are discussed separately.
Hepatocellular carcinoma (HCC) is a malignancy of worldwide significance and has become increasingly important in the United States. HCC is the most common primary liver malignancy, the sixth most common cancer, and the third most common cause of cancer-related deaths worldwide (2). Eighty percent of new cases occur in developing countries, but the incidence is rising in economically developed regions, including Japan, western Europe, and the United States (3–6). The worldwide distribution of HCC and its associated etiologies are summarized in Table 19-2. Liver cirrhosis is the seventh leading cause of death in the world, the tenth most common cause of death in the United States, and acknowledged as a premalignant condition for developing HCC (7–9). In the United States, hepatitis C virus (HCV), alcohol use, and nonalcoholic fatty liver disease (NAFLD) are the most common causes of cirrhosis (9). The incidence of HCC doubled during the period 1975 to 1995 and continued to rise through 1998 (10,11). This trend is expected to continue due to the estimated 4 million hepatitis C–seropositive individuals in the United States and the known latency of HCC development from the initial HCV infection, which may take two to three decades (11). It is also known that NAFLD-associated cirrhosis is on the rise in the United States (12–14). A majority of patients present with advanced disease that is not amenable to curative procedures. Overall, HCC has a very poor prognosis, with a 5-year survival rate of 5%.
Table 19–2. Incidence of Hepatocellular Carcinoma (HCC) Worldwide |Favorite Table|Download (.pdf)
Table 19–2. Incidence of Hepatocellular Carcinoma (HCC) Worldwide
|Region||Males||Females||Number of Cases||Principal Associations|
|Asia, sub-Saharan Africa||30-120||9-30||>500,000 cases per year||HBV, aflatoxin exposure|
|Southern Europe, Argentina, Switzerland||5-10||2-5||HCV|
|United States||<5||<3||19,000 predicted for 2004||HCV, ...|