The annual incidence of Hepatocellular carcinoma in the United States is approximately 2.4/100,000. The incidence is rising rapidly due in large part to the hepatitis C epidemic. There is a 2 to 3:1 male-to-female predominance. The incidence in African American men is almost twice that in white men. HCC is diagnosed mainly in the fifth and sixth decades.
1 Major risk factors for cirrhosis
In the United States include hepatitis C, alcohol, autoimmune phenomena such as primary biliary cirrhosis and autoimmune hepatitis, and hereditary metabolic disorders. From 70% to 85% of HCC arises in the setting of cirrhosis. Malignant tumors of the liver occur in 4.5% of cirrhotic patients and in up to 10% when hemochromatosis is the inciting factor.
2 Clinical manifestations.
Eighty percent of patients experience weight loss and weakness. Approximately 50% have abdominal pain that is dull, persistent, and occurs in the epigastrium or right upper quadrant. Acute severe abdominal pain infrequently has been associated with intraperitoneal hemorrhage due to rupture of a necrotic nodule or erosion of a blood vessel.