Gastrointestinal tumor

Gastrointestinal Cancers:
Hepatocellular Carcinoma
and
Colorectal Cancer

Hepatocellular Carcinoma | Colorectal Cancer

The most common types of liver cancer are the following:

Hepatocellular carcinoma (HCC). HCC makes up 72% of liver cancer cases.1 HCCs may be classified further based on the main molecular pathways and immune status of the tumor.2 Thus, HCCs can be categorized into the proliferation and nonproliferation classes or the immune-active, immune-exhausted, immune-intermediate, and immune-excluded classes.2

Intrahepatic bile duct cancer (cholangiocarcinoma). Intrahepatic bile duct cancer exhibits different clinical features from HCC and comprises 19% of liver cancer cases.1

Incidence in the United States

The incidence of liver cancer rates tripled over the past 4 decades and has 3 times higher incidence in men than in women.1 Based on cases reported from 2015 through 2019, the age-adjusted incidence rate of liver and intrahepatic bile duct cancers was 9.5 per 100,000 men and women per year.3 In 2023, it was estimated that 41,210 individuals would be diagnosed with liver cancer in the United States and that 29,380 individuals would die from the disease.1

Epidemiology in the United States

In 2023, liver cancer was estimated to be the fifth leading cause of cancer death among men and the seventh leading cause of cancer death among women in the United States.1 The stage of diagnosis influences survival rates, but fewer than half of patients with liver cancer are diagnosed at an early stage.3 In the United States, 5-year survival rates for patients diagnosed with localized, regional, and metastasized liver cancer are 36%, 13%, and 3%, respectively.3

Risk Factors
 

Cirrhosis is the greatest risk factor for HCC development and is present in 70% to 90% of those who have primary liver cancer.2,4,5 Common causes of cirrhosis include hepatitis B virus infection, hepatitis C virus infection, heavy alcohol consumption, non-alcoholic steatohepatitis (NASH), α1- antitrypsin deficiency, and hemochromatosis.1,2,5 In patients with chronic hepatitis C infection, antiviral therapies reduce—but do not eliminate—the risk of HCC.2 Other factors associated with increased risk of HCC include tobacco use, intake of aflatoxin b1 (fungal carcinogen present in food supplies), male sex, older age, persistent increase in alanine aminotransferase level, increased α-fetoprotein level, and progressive impairment of liver function.2,4

Unmet Need
 

Although survival rates have increased in recent years, liver cancer remains a highly lethal cancer, with a 5-year survival of only 21% (data from 2012-2018).3 To date, treatment options for patients with HCC are largely limited.6 Resection, transplantation, or ablative strategies are among the treatment options for certain patients with HCC.1,7 However, considering that only 44% are diagnosed at the early stage, treatment options are limited.3 Locoregional therapy such as ablation, arterially directed therapies, and external beam radiotherapy are also among the treatment options for certain patients.7

References: 1. American Cancer Society. Cancer Facts and Figures 2023. 2. Llovet et al. Nat Rev Dis Primers. 2021;7:6. 3. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Liver and Intrahepatic Bile Duct Cancer. https://seer.cancer.gov/statfacts/html/livibd.html. Accessed September 1, 2022. 4. Bruix et al. Gastroenterology. 2016;150:835-853. 5. Herbst et al. Clin Liver Dis. 2013;1:180-182. 6. Rahib et al. Cancer Res. 2014;74:2913-2921. 7. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Hepatobiliary Cancers V.3.2022. © National Comprehensive Cancer Network, Inc. 2022. All rights reserved. Accessed November 16, 2022. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use, or application, and disclaims any responsibility for their application or use in any way.

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Hepatocellular Carcinoma | Colorectal Cancer

Colorectal cancer (CRC) was expected to be the third most common cancer diagnosis and third leading cause of cancer death in the United States in 2023.1 CRCs are classified into right- and left-sided on the basis of tumor origin. Right- vs left-sided tumors differ in histology, size, and genomic makeup, informing disease prognosis and response to treatment.2,3

Right-sided tumors originate from the ascending colon and proximal two-thirds of the transverse colon.2

Left-sided tumors originate from the descending and sigmoid colon, as well as the distal one-third of the transverse colon.2

Incidence in the United States

In the United States in 2023, CRC was estimated to represent ~8% of all new cancer cases,1 with an estimated 153,020 individuals expected to be diagnosed with CRC.1 CRC is more common in men, with an age-adjusted incidence rate of 43.4 per 100,000 men and 32.8 per 100,000 women (data from 2015-2019).4 An estimated 52,550 individuals were anticipated to die from CRC in 2023.1

Epidemiology in the United States

The median age at diagnosis is 66 years.4 Approximately 37% of patients have localized cancers, whereas the remaining patients present with regional (36%) or distant (22%) metastasis at diagnosis. The 5-year relative survival rate of patients with CRC is 65%; those with localized disease have a higher 5-year survival rate (91%) than do those with regional (73%) or distant (15%) metastasis (data from 2012-2018).4

Risk Factors
 

The greatest risk factor associated with CRC incidence is advanced age.5 Ninety percent of CRCs are diagnosed after age 50 years. Other potential risk factors include African American race, history of CRC in a first-degree relative (especially if before the age of 55 years), and inflammatory bowel disease.5

Unmet Need
 

The incidence of CRC is increasing in younger patients, but the disease is often not diagnosed until advanced stages.1 Because early-stage CRC does not typically cause symptoms, it is recommended that screening begin at age 45 years for patients at average risk of CRC.1

References: 1. American Cancer Society. Cancer Facts and Figures 2023. 2. Baran et al. Gastroenterology Res. 2018;11:264-273. 3. Mangone et al. BMC Public Health. 2021;21:906. 4. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Colorectal Cancer. https://seer.cancer.gov/statfacts/html/colorect.html. Accessed September 1, 2022. 5. National Cancer Institute. Colorectal Cancer Prevention (PDQ®)–Health Professional Version. https://www.cancer.gov/types/colorectal/hp/colorectal-prevention-pdq. Accessed September 1, 2022.

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