INTRODUCTION
Liver cancer is one of the commonest cancers worldwide which occupies
fifth and seventh ranks in terms of incidence among males and females
respectively, and fourth position in overall
mortality.1 The higher age-standardized rates (ASR) of
incidence of liver cancer i.e. 22.2 and 7.2 per 100,000 population among
males and females respectively in South East Asia suggest that this
tumor is more prevalent in the developing world where the prevalence of
viral hepatitis B and hepatitis C is higher. As per the same report, the
estimated mortality of liver cancer in this region is 21.4 and 6.8 per
100,000 for males and females respectively.2 According
to the National Cancer Registry of Nepal (2013), the incidence of liver
cancer in Nepal in men and women is 0.8 and 0.9 per 100,000 population
respectively. However, the mortality rates of cancer are not recorded in
the registry.3
Hepatocellular carcinoma (HCC) is the most common primary liver cancer,
the other less common types being intrahepatic cholangiocarcinoma (ICC),
angiosarcoma, hemangiosarcoma, and hepatoblastoma in the descending
order of their occurrence.4, 5
Liver cirrhosis is the most common cause of HCC accounting for 80% of
cases.6 The commonest risk factors for HCC are viral
hepatitis (hepatitis B and hepatitis C infection), excessive alcohol
use, occupational exposure, nonalcoholic fatty liver disease (NAFLD),
and autoimmune hepatitis (AIH).6 These factors lead to
liver cirrhosis which is also considered as a premalignant state. The
cirrhotic cells are more likely to undergo dysplasia and may lead to HCC
development.6 The patients with hepatic cirrhosis and
those with suspected HCC are investigated with noninvasive modalities
like multiphasic contrast-enhanced computed tomography (CECT),
contrast-enhanced magnetic resonance imaging (CE-MRI) of the abdomen to
verify the presence of HCC (diagnosis) and to determine its extent
(radiological staging).7
The Barcelona Clinic Liver Cancer (BCLC) algorithm is the most widely
used staging system. Patients with a single liver tumor or as many as
three nodules of less than 3 cm diameter are classified as having very
early-stage (BCLC stage 0) or early-stage (BCLC stage A) cancer. These
patients benefit from curative treatment modalities like resection,
transplantation, or ablation. Those with a greater tumor burden,
confined to the liver, but are free of symptoms are considered to have
intermediate-stage (BCLC stage B) cancer. If their liver function is
intact, they can be benefitted from chemoembolization. Those with
symptoms of HCC and/or vascular invasion and/or extrahepatic cancer are
considered to have advanced-stage (BCLC stage C) and terminal-stage
(BCLC stage D) cancer. These patients could benefit from treatment with
the kinase inhibitor, sorafenib.8
Though the cancer registry began in Nepal in 2003, the registry is not
comprehensive, and there are very limited studies conducted on liver
cancers in Nepal.9 In this single center-based study,
we have analyzed clinical, etiological, and radiological data and
treatment patterns of patients with liver cancer visiting the outpatient
department (OPD) or admitted to the Department of Gastroenterology in
Tribhuvan University Teaching Hospital (TUTH).