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Hepatocellular carcinoma, also called malignant hepatoma, is the most common form of primary malignant liver cancer and originates in the hepatocyte cells of the liver. Unless otherwise specified, the term "liver cancer" is used throughout this Guidebook to refer specifically to hepatocellular carcinoma which represents the most common type of primary liver cancer.

Hepatocellular carcinoma (liver cancer) is the fifth most common type of cancer worldwide with nearly 500,000 new cases diagnosed each year. Although the incidence of liver cancer is highest in parts of Africa and Asia, increasing numbers of cases are being diagnosed in the United States, Western Europe, and Japan. Approximately 19,000 cases of primary liver cancer are diagnosed each year in the United States with an overall incidence of 2.4 to 3.2 cases per 100,000 people. Hepatocellular carcinoma is the most common type of primary liver cancer in adults and represents about 75% of all primary liver tumors. This type of liver cancer occurs much more frequently in men than in women.

Although the exact cause of hepatocellular carcinoma is not currently known, this is one of the few types of cancers with well-defined risk factors. A risk factor is any characteristic or activity that increases a person's chances of developing a particular disease or disorder. The major risk factors for hepatocellular carcinoma include:

• Cirrhosis of the liver - Approximately 80% of cases of liver cancer are diagnosed in patients with liver cirrhosis. Since chronic alcohol abuse is a major cause of liver cirrhosis, it is also recognized as a major risk factor for liver cancer.

• Hepatitis - Chronic infection with the Hepatitis B virus or the Hepatitis C virus increases a person's risk for developing cirrhosis of the liver and, therefore, also increases the risk for developing liver cancer. In the United States, infection with the Hepatitis C virus is about 3 times more common than infection with the Hepatitis B virus and, consequently, about 50% of cases of liver cancer in the U.S. occur in patients infected with Hepatitis C.

• Exposure to aflatoxins - Aflatoxins are toxic substances produced by certain fungi (molds) under warm humid, conditions that can contaminate crops. In some parts of the world, but not the United States, aflatoxin crop contamination is a major problem and has been linked to the development of liver cancer.

• Hemochromatosis - Hereditary hemochromatosis is a genetic disorder that results in the excessive accumulation of iron in various organs of the body, including the liver, that can result in liver cirrhosis. It has been estimated that liver cancer occurs in about 7% to 22% of patients with hereditary hemochromatosis who also have liver cirrhosis.

• Primary biliary cirrhosis - Primary biliary cirrhosis is a disease characterized by inflammatory destruction of the small bile ducts within the liver. Primary biliary cirrhosis eventually leads to cirrhosis of the liver and is, therefore, a risk factor for developing liver cancer.

• Anabolic steroids - Athletes who use anabolic steroids (e.g., testosterone) for a long period of time to increase muscle mass are at increased risk for developing primary liver cancer.