See Chapter 7.8 page 277 in WCRF/AICR Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective.
626,000 new cases in 2002
In general more common in developing countries, over half of all cases occur in China.
Large geographic variation, perhaps the greatest variation among the major tumour sites.
Incidence rates about twice as high among men as among women.
Almost always fatal.
Includes hepatocellular carcinoma (90%), angiosarcoma, cholangiocarcinoma and hepatoblastoma.
Infection with hepatitis B virus is the predominant cause (80% of cases).
Hepatitis C virus also important
- Hepatitis B established cause for liver cirrhosis and liver cancer.
- Chronic HBV infection can act as both initiator and promoter of liver cancer.
- Effect can be augmented by other carcinogens; aflatoxins, specific industrial exposure, and tobacco smoke.
- Tobacco weakly or modestly associated, possibly more important etiologic factor among cancer cases that do not carry HBsAg (hep B surface antigen).
- Chronic viral infection which results in widespread cell death and thus compensatory cell proliferation. This can lead to cirrhosis, and possibly to environment where cells with a specific growth advantage such as loss of P53 or of other tumour suppressor genes have a growth advantage...
- Note that only 10-30% of those with cirrhosis develop liver cancer.
CONVINCING EVIDENCE - decreases risk:
CONVINCING EVIDENCE - increases risk:
PROBABLE EVIDENCE - decreases risk:
PROBABLE EVIDENCE - increases risk:
- Alcoholic drinks
LIMITED/SUGGESTIVE EVIDENCE - decreases risk:
LIMITED/SUGGESTIVE EVIDENCE - increases risk:
Most effective means of preventing:
- Avoidance of exposure to hepatitis B and C virus
- Not use tobacco
Most effective dietary means of preventing:
- Limit alcohol consumption
- Avoid food that is likely to be contaminated with aflatoxin