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Patients with liver cirrhosis secondary to hepatitis C have a 3-5% annual incidence of hepatocellular carcinoma.

third most common cause of cancer worldwide.
Chronic hepatitis B - most common cause worldwide
chronic hepatitis C - most common cause in Europe.

main risk factor for developing HCC is ''liver cirrhosis'' eg. 2ndary to hepatitis B & C (3-5% annual incidence), alcohol, haemochromatosis and primary biliary cirrhosis. (NOT Wilsons) Also ....
    alpha-1 antitrypsin deficiency
    hereditary tyrosinosis
    glycogen storage disease
    aflatoxin
    drugs: oral contraceptive pill, anabolic steroids
    porphyria cutanea tarda
    male sex
    diabetes mellitus, metabolic syndrome

''Features''
    tends to present late
    features of liver cirrhosis or failure may be seen: jaundice, ascites, RUQ pain, hepatomegaly, pruritus, splenomegaly
    possible presentation is decompensation in a patient with chronic liver disease

''Screening with ultrasound (+/- alpha-fetoprotein)'' should be considered for high risk groups such as:
    patients liver cirrhosis secondary to hepatitis B & C or haemochromatosis
    men with liver cirrhosis secondary to alcohol

''Management options''
    early disease: surgical resection
    liver transplantation
    radiofrequency ablation
    transarterial chemoembolisation
    sorafenib: a multikinase inhibitor