Hepatocellular Carcinoma in Malaysia and Its Changing Trend

carcinoma causes 670,000 deaths globally per annum, with up to 1,837 people every day or 76 people every hour. High prevalence of the main etiologies, HBV and HCV, are among the top three causes of cancer in Asia. Older persons are at higher risk and there is male predominance observed. Despite various clinical treatment options, such as potentially curative surgical resection, liver transplantation, supportive symptomatic care, including percutaneous ethanol injection and RFA, and noncurative TACE, 5 the survival rate of HCC is very poor as the majority of patients present with advanced disease. 2 Hepatocellular carcinoma is commonly diagnosed after the symptoms have presented or usually in intermediate or end stage of HCC. 6 If early diagnosis was done and treatment was received, the survival rate could increase up to 50%. Management of advanced disease may include systemic therapy for palliation of symptoms, 5 with one example of a systemic pharmacotherapeutic agent being ABSTRACT Hepatocellular carcinoma (HCC) is one of the leading causes of death globally. In Malaysia liver cancer is the eighth most common cause of cancer for both gender and fifth most common cause of cancer for males. Liver cancer is a cause of premature death in Malaysia: The trend from 1990 to 2010 was observed upward. Since 1990, the annual years of life lost (YLLs) from liver cancer have increased by 31.5%. Older persons are at higher risk and there is male predominance observed. Curative surgical resection, liver transplantation, and supportive symptomatic care, including percutaneous ethanol injection and radiofrequency ablation (RFA), and noncurative transarterial chemoembolization (TACE) are among available treatment facilities. Yet the survival rate is very poor as majority of patients present at very advanced stage. Hepatitis B virus (HBV) remained the leading cause of HCC in Malaysia. Several studies showed cryptogenic causes, which are mainly nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) among the predominant causes of HCC in Malaysia than hepatitis C virus (HCV), alcohol, or any other reason. This mainly correlates with the increasing incidence of diabetes and obesity in Malaysia.