Liver cancer
Globally, , liver cancer resulted in 754,000 deaths, up from 460,000 in 1990, making it the third leading cause of cancer death after lung and stomach. In 2012, it represented 7% of cancer diagnoses in men, the 5th most diagnosed cancer that year. Of these deaths 340,000 were secondary to hepatitis B, 196,000 were secondary to hepatitis C, and 150,000 were secondary to alcohol. HCC, the most common form of liver cancer, shows a striking geographical distribution. China has 50% of HCC cases globally, and more than 80% of total cases occur in sub-Saharan Africa or in East-Asia due to hepatitis B virus. Cholangiocarcinoma also has a significant geographical distribution, with Thailand showing the highest rates worldwide due to the presence of liver fluke.
LI-RADS
Liver transplantation has significant risks, including the risk of recurrent cancer. The outcomes and survival benefits of transplantation as treatment of HCC are highest when transplant is reserved for the "best" candidates which meet strict criteria. In addition to undergoing a complete medical and psychological evaluation, imaging assessment for extent of the cancer is an important component of eligibility for transplant. A landmark study in 1996 showed that both overall and recurrence-free survival following liver transplantation for cirrhosis and unresectable HCC was improved by limiting this treatment to disease that met certain strict criteria, now known as the Milan criteria. The criteria include assessment of size and number of active liver tumors, as well as the absence of invasion of large blood vessels. In the U.S., these Milan criteria are currently used by the Organ Procurement and Transplantation Network (OPTN) committee to evaluate transplant candidacy. Only persons with limited disease, as defined by the criteria, are considered for transplantation.