Etiology, screening and early diagnosis of hepatocellular carcinoma: successes and new challenges related to the epidemic of obesity

Hepatocellular carcinoma (HCC) is a global public health problem, with morbidity and mortality continuing to increase.
The extremely high mortality rate (mortality/ morbidity – 0,95) is explained by the asymptomatic course of HCC at the
curable stages and the complete resistance of the tumor to chemoradiotherapy. Organization of effective surveillance and
screening – is the only possible way for improving the results of treatment of HCC in the foreseeable future. It is known
that HCC is almost always develops in the long-existing chronic liver disease, the etiologic factors of these diseases are
well known – it is viral hepatitis, alcohol and non-alcoholic fatty liver disease (NAFLD). In this regard, regular screening
in high-risk groups (all patients with cirrhosis and some patients with hepatitis B without cirrhosis) makes it possible to
detect HCC with a diameter of 1–2 cm, that is, at a very early stage of the disease. Timely treatment in this group of patients
allows achieving five-year survival at the level of 80–90%. In recent years, significant successes have been achieved in the
primary and secondary prevention of virus-associated HCC. The expected decrease in the incidence of this type of tumor
and an increase in the incidence of liver cancer caused by NAFLD may require a review of existing screening programs and
early diagnosis of HCC, as well as significantly increase their cost.