Hepatocellular Carcinoma: Epidemiology and Molecular Carcinogenesis

The pathophysiology of hepatocarcinogenesis is linked tightly to the evolution of cirrhosis. Several mechanisms at the cirrhosis stage appear to accelerate cancer formation including the following: (1) telomere dysfunction inducing chromosomal instability, (2) a growth-inhibitory environment selecting for proliferative cells, (3) alterations of the microenvironment and macroenvironment stimulating cellular proliferation (Figure 10). A detailed understanding of how these alterations select for distinct molecular pathways during the development of HCC could improve the screening, prevention, and treatment of HCC in patients with chronic liver disease and cirrhosis.