Hepatocellular carcinoma (HCC) is the most common type of
liver cancer worldwide. The incidence of HCC is on the rise in Thailand, where it has become the most common
malignancy in males and the third most common in females. Here, we review some of the risk factors that have contributed to this increase in HCC incidence in the Thai population. Hepatitis B virus (HBV) is the main etiologic risk factor for HCC, followed by hepatitis C virus (HCV). Patients with HBV genotype C have a higher positive rate of
hepatitis B early
antigen (
HBeAg) and progress to
cirrhosis and HCC earlier than genotype B. For HCV patients, 16% developed HCC associated
cirrhosis by year 5 after diagnosis, and the cumulative risk for death from HCC at year 10 was 60%. Dietary exposure to the fungal hepatocarcinogen
aflatoxin B1 has been shown to interact synergistically with HBV
infection to increase the risk of early onset HCC. Chronic
alcohol abuse remains an important risk factor for malignant transformation of hepatocytes, frequently in association with alcohol-induced
cirrhosis. In recent years,
obesity and
metabolic syndrome have markedly increased the incidence of HCC and are important causes of HCC in some resource-rich regions.