Hepatocellular carcinoma is the most common form of liver cancer, and one of the most prevalent malignancies in the world. The international yearly incidence is approximately one million cases. The American Cancer Society (Cancer Facts & Figures 2008) estimated that in the United States there will be 21,370 new cases diagnosed and 18,410 deaths due to this disease in 2008. This makes the incidence and mortality rates almost equal. In contrast, there were approximately 12,000 deaths in 1999 and correspondingly fewer in previous years; thus, the incidence of this disease is increasing very rapidly.
Although the reasons for this epidemic are not yet fully understood, the increased prevalence of hepatitis C has been implicated as an important etiologic factor in the United States. Hepatocellular carcinoma also is extensively associated with high endemic hepatitis B carrier rates and mycotoxin contamination of food, water and soil. Approximately 60% to 80% of patients have underlying cirrhosis, due to hepatitis B, hepatitis C, alcohol, autoimmune chronic active hepatitis or mycotoxin exposure. Metabolic disorders such as hemochromatosis and tyrosinemia also increase the risk. Ethnic factors are also important, as both native and non-native Asians have a higher incidence.
Current therapy for HCC is dismal. Only approximately 5% to 10% of patients are surgical candidates and less than one percent undergo attempted complete radical resection. Systemic chemotherapy, either as single agent or combination, has not resulted in prolonged survival. Intrahepatic artery chemotherapy has yielded some increased response, but this therapy as well as radiotherapy and embolization have limited palliative benefit. Furthermore, liver transplantation only helps to prolong survival in selected patients. Despite all forms of current treatment, life expectancy for most patients is only one year post-diagnosis.