Minsig Choi, MD: What are the etiology risk factors in the development of hepatocellular cancer? We all know that hepatocellular cancer or liver cancer is caused by a chronic irritation or inflammations. Usually the most common causes of this irritation or inflammations are viral hepatitis, like hepatitis B and C, because these are the viral infections that can cause chronic infection. Other etiologies could be alcohol irritation—people who drink a lot of alcohol—and recently there’s the incidence of NASH, which is nonalcoholic steatohepatitis, which is also associated with obesity.

There are some rare causes that can cause liver damage, and these are altered immune problems, genetic problems like alpha-1 antitrypsin deficiency, hemochromatosis, and some aflatoxin exposures, but the most common reasons are viral hepatitis, alcohol, and NASH.

Peter Galle, MD: Concerning the global trends in incidence and prevalence of hepatocellular carcinoma, we see in most countries a rise in incidence and in prevalence. There are some countries—for example, Japan would be 1—where there has been a decline. This is related to successful treatment of hepatitis C virus and the resulting cirrhotic complications in these countries. But for most countries, we indeed see a rising incidence. This is, for the most part, explained by the increasing incidence in NASH and nonalcoholic fatty liver disease, and in the resulting complications from NASH cirrhosis. Problem here is that we increasingly see noncirrhotic patients with NASH developing hepatocellular carcinoma.

We still see most patients with the viral hepatitis C, followed by hepatitis B patients. In many European countries, alcoholic liver disease is a main contributor as well. Recently as we saw an increase in what has been, in the past, considered to be cryptogenic cirrhosis. We had no explanation, and then we learned that this is basically a fatty liver disease and NASHs in these days, increasingly contributing to hepatocellular carcinoma.

Transcript Edited for Clarity