Though there is dearth of robust epidemiological data on Liver cancer in India, unpublished data from leading centers point towards the fact that HCC has become a significant public health problem and is on the rise! Age adjusted incidence rate for HCC in India for men ranges from 4-7.5 and for women 1.2-2.2 per 100,000 population per year while male: female ratio of HCC is 4:1 and age of presentation varies from 40-70 years. Cancer at younger age, cancer occurring in less/non fibro progressed disease, especially the Stetatohepatitic HCC (SH-HCC) are being increasingly being reported. Regional variability prevail, the highest incidence is reported from North Eastern states, particularly Sikkim & Arunachal Pradesh.

It is prudent to figure out what fuels this upsurge?

Yesteryears, the causation was mostly centered round viral factors (HBV/HCV), followed by alcohol. Those infected with HBV have 100 fold increased risk of developing HCC. Now, with aberrant lifestyle factors the smoldering epidemic of metabolic syndrome- diabetes and obesity have become major contributors. There are real life and projected data pointing towards MAFLD turning aggressive globally, with south Asia and India being “capital of diabetes” dysmetabolism is going to be the HCC promoter in the years to come. MetS promotes HCC in a multipronged manner- insulin resistance, role of activated platelets, HCC associated hub gene expression, inflammation and signaling pathways, altered gut microbiota and immunomodulation.
HCC is projected as the third leading cause of cancer related mortality by 2030, needless to say curbing the epidemic of metabolic syndrome is the way to go.