Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. In Germany, there are currently around 9,000 new HCC diagnoses per year, and almost 8,000 people affected do not survive the disease. Before the tumor develops in the liver, the organ is often already damaged by chronic inflammation.

The traditional causes of chronic liver damage include, in particular, infections with hepatitis viruses or excessive alcohol consumption. In the meantime, however, obesity and metabolic diseases, which include diabetes mellitus and lead to a so-called fatty liver, are becoming increasingly important.

These epidemiological developments have been traced by an international research team led by Professor Dr. Arndt Vogel and Private Lecturer (PD) Dr. Anna Saborowski from the Clinic for Gastroenterology, Hepatology and Endocrinology at the Hannover Medical School (MHH). They reviewed around 200 international studies and compiled an up-to-date overview of risk factors, diagnosis and treatment of hepatocellular carcinoma. The work has been published in The Lancet.

Proportion of virally caused HCC cases decreases

"Non-alcoholic fatty liver disease is increasing significantly and is becoming a major cause of hepatocellular carcinoma," notes Professor Vogel. Due to poor nutrition and lack of exercise, the number of extremely overweight people who develop a fatty liver is increasing.

It is true that the risk for individuals to develop cancer later on is relatively low. But the widespread disease of obesity and the resulting increase in the number of people with fatty liver increases the absolute number of cancer cases. "The proportion of viral liver cancers, on the other hand, has decreased thanks to vaccinations against hepatitis B and successful treatment of hepatitis C," explains the gastroenterologist.

However, not only the epidemiology of liver cancer has changed. The treatment options for HCC have also evolved since the last Lancet review four years ago. "For a long time, there were only a few therapeutic options for patients with advanced tumor stages," explains PD Dr. Saborowski.

In the meantime, however, a whole range of options is available for systemic therapy. On the one hand, special drugs are used that intervene in the signaling pathways for tumor growth. On the other hand, the big breakthrough was achieved with the introduction of the so-called immune checkpoint inhibitors. These active substances activate the immune system so that cancer cells are recognized and fought. With the staggered use of the different drugs, the prognosis of patients with HCC can be significantly improved.

Treatment in specialized centers recommended

One problem remains that liver cancer is often diagnosed late because of its non-specific symptoms. "There is a lack of biomarkers with which we can not only identify patients at risk, but also make precise treatment decisions for all stages of hepatocellular carcinoma," says Professor Vogel.

However, it is crucial for the success of the therapy that HCC patients are treated where the entire spectrum of diagnostic and therapeutic options, including liver transplantation, interventional local procedures and systemic therapies, are offered. And this is only offered by specialized facilities such as the Visceral Oncology Center of the MHH, emphasizes the liver cancer expert.

"In our tumor conferences, doctors from different disciplines work together and draw up a joint therapy plan, review it regularly and decide what is best for the patient in each situation."

--Stefan Zorn, Medizinische Hochschule Hannover