~ 80% of hepatocellular carcinoma cases arise in cirrhosis ( Hepatology 2018 68:723).In the United States, chronic hepatitis C is a critical risk factor for hepatocellular carcinoma ( Hepatology 2018 68:723).Chronic viral hepatitis is the leading cause of hepatocellular carcinoma worldwide ( Philos Trans R Soc Lond B Biol Sci 2017 372:20160274).Chronic liver disease leading to cirrhosis most common etiologies leading to this include chronic viral hepatitides (HBV and HCV), heavy alcohol consumption, nonalcoholic fatty liver disease ( Nat Rev Gastroenterol Hepatol 2019 16:589, Hepatology 2018 68:723).M:F = 3:1 ( Global Cancer Observatory: Liver Fact Sheet ).Median age of onset is older than sixth decade in North America and Europe median age of onset in Asia and Africa is between third and sixth decades ( Nat Rev Gastroenterol Hepatol 2019 16:589).Asia (72.5%) has the highest incidence worldwide, followed by Europe (9.8%), Africa (7.7%), North America (5%), Latin America and the Caribbean (4.6%) and Oceania (0.4%) ( Global Cancer Observatory: Liver Fact Sheet ).Incidence and age of onset vary geographically.Sixth most common malignancy and fourth most common cause of cancer mortality worldwide ( Global Cancer Observatory: Liver Fact Sheet ).Most common (> 80%) primary liver malignancy worldwide ( Nat Rev Gastroenterol Hepatol 2019 16:589).

Ish mass effect 2