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The Geographical Pathology of Primary Liver Cancer

( Department of Pathology and Oncology, University of Kansas Medical Center, Kansas City, Kansas)

Recent epidemiological data on primary liver carcinoma are reviewed. The highest incidence is reported in African males, in whom the frequency rises rapidly until the 3d decade, after which it remains constant or may even decrease. There is evidence that the increase in liver cancer in African and Asia is dependent on an increase in the proportion of cirrhotic livers which become malignant rather than on increased incidence of cirrhosis. The pathogenesis of liver cancer in man is unknown, but there is circumstantial evidence that it may represent a two-stage process in which liver damage in childhood, possibly due to malnutrition, may predispose the organ to a carcinogenic stimulus in later life. Pathological evidence suggests that this stimulus may be viral hepatitis. The significance of this hypothesis is discussed in relation to pertinent experimental observations.