Aetiology

Causes include:

• in 80% of cases there is some existing liver cirrhosis: major cause in developed world is pre-existing alcoholic liver cirrhosis.
• other causes of primary liver cancer include:
  • chronic HBV or HCV carriage
  • cirrhosis of any cause but especially alpha-1 antitrypsin deficiency, haemochromatosis, primary biliary cirrhosis
• drugs such as anabolic steroids and the contraceptive pill
• toxins such as aflatoxin - a toxin produced by species of Aspergillus which grows on stored grains and peanuts
• parasitic infestations for example, schistosomiasis, echinococcus, clonorchis sinensis

10 to 15% of all types of cirrhosis develop hepatocellular carcinoma in 20 years; 35% if the cirrhosis is caused by haemochromatosis or alcohol.