**Liver Cancer and Hepatocellular Carcinoma: A Detailed Guide** **간암: 원인·증상·진단·치…
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**Liver Cancer and Hepatocellular Carcinoma: A Detailed Guide**
**간암: 원인·증상·진단·치료·예방까지 자세히**
---
## English
### 1) What “liver cancer” means
“Liver cancer” can mean:
* **Primary liver cancer** (starts in the liver)
* **Hepatocellular carcinoma (HCC)**: the most common type.
* **Intrahepatic cholangiocarcinoma**: bile-duct cancer within the liver.
* **Metastatic cancer to the liver** (spread from colon, pancreas, breast, etc.) — far more common overall, but managed differently.
Most “간암” discussions in medicine and public health focus on **HCC**, because it is strongly tied to chronic liver disease and is often preventable and screen-detectable. ([PMC][1])
---
### 2) Why HCC happens
HCC most often develops on a background of **chronic liver injury → inflammation → fibrosis → cirrhosis → cancer**. The risk rises because:
* chronically injured liver cells undergo repeated cycles of damage and regeneration,
* fibrosis changes the tissue microenvironment,
* viral and metabolic factors can directly promote carcinogenic pathways.
Important nuance: **metabolic fatty liver–related HCC can occur even without cirrhosis**, which makes surveillance strategy harder. ([Journal of Liver Cancer][2])
---
### 3) Major risk factors
The biggest global drivers are well-established:
* **Chronic hepatitis B (HBV)** (can cause HCC even without cirrhosis)
* **Chronic hepatitis C (HCV)** (risk strongly rises with cirrhosis)
* **Alcohol-related liver disease**
* **Metabolic fatty liver disease** (often discussed as NAFLD/NASH; newer terminology includes MASLD/MASH)
* **Cirrhosis of any cause** (the single strongest common “risk container”)
* Additional factors: aflatoxin exposure, hereditary hemochromatosis, Wilson disease, smoking, diabetes/obesity. ([암 정보 센터][3])
---
### 4) Symptoms and why early HCC is often “silent”
Early HCC frequently causes **no specific symptoms**. Symptoms often appear when:
* tumor burden becomes large,
* there is bile duct obstruction,
* or cirrhosis decompensates.
Common symptoms/signs:
* right upper abdominal discomfort, early satiety
* unexplained weight loss, fatigue, loss of appetite
* **jaundice**, dark urine, itching (bile obstruction or liver failure)
* abdominal swelling (ascites), leg edema
* easy bruising/bleeding (low clotting factors), worsening encephalopathy (confusion)
Urgent red flags (medical evaluation should be prompt):
* vomiting blood / black tarry stools (variceal bleeding in cirrhosis),
* new confusion or severe drowsiness,
* rapidly enlarging abdomen with fever or severe pain,
* rapidly worsening jaundice.
---
### 5) Who should be screened and how
Because early-stage HCC can be treated more effectively, guidelines consistently recommend **surveillance for high-risk groups**, most classically:
* cirrhosis from HBV/HCV/alcohol/metabolic disease,
* certain chronic HBV patients even without cirrhosis (risk varies by age, family history, ethnicity, viral activity).
A widely cited standard approach is:
* **liver ultrasound every 6 months**, often **with AFP blood testing** (AFP may improve sensitivity when combined with ultrasound, but is imperfect). ([PMC][1])
When ultrasound quality is limited (obesity, nodular cirrhosis), many recommendations support **contrast-enhanced MRI or CT** as alternative surveillance/diagnostic imaging. ([PMC][4])
---
### 6) Diagnosis workflow
Typical steps (simplified, but clinically faithful):
1. **Risk context**: cirrhosis/HBV history changes how confidently imaging can diagnose HCC.
2. **Imaging**: multiphasic CT or MRI looks for hallmark vascular behavior:
* arterial phase hyperenhancement + washout in portal/delayed phase (classic pattern).
3. **AFP and other labs**: supportive, not definitive alone.
4. **Biopsy**: used when imaging is not definitive or when diagnosis will change management. Modern practice guidance describes imaging-based diagnosis pathways and when biopsy is appropriate. ([PMC][1])
---
### 7) Staging and why liver function matters as much as tumor size
HCC management is unusual because outcomes depend on **two diseases at once**:
* the cancer,
* and the underlying liver function (often cirrhosis).
Clinicians commonly use:
* **Child–Pugh class** (A/B/C) and MELD for liver reserve,
* and integrated staging systems (e.g., BCLC in many settings) that link stage to treatment pathways.
---
### 8) Treatment options by clinical situation
Real-world care is multidisciplinary (hepatology, oncology, surgery, interventional radiology). Core modalities:
**Curative-intent options (best chance for long-term control)**
* **Surgical resection**: best for solitary tumors with good liver reserve and no severe portal hypertension.
* **Liver transplantation**: treats both tumor and cirrhosis; eligibility often follows size/number criteria.
* **Local ablation** (radiofrequency/microwave): effective for small tumors when surgery isn’t ideal.
**Locoregional therapies (control tumor within the liver)**
* **TACE** (transarterial chemoembolization): commonly for intermediate-stage disease.
* **TARE/Y-90 radioembolization**: selected cases, increasingly used in certain centers.
* External beam radiation in specific scenarios.
**Systemic therapy (advanced or unresectable disease, or when locoregional therapy is unsuitable)**
Modern guidelines and oncology references list **immune-based combinations** as preferred first-line systemic options for many patients, including:
* **atezolizumab + bevacizumab**
* **tremelimumab + durvalumab**
Patient-facing NCCN guidance (2025) presents these as preferred first-line systemic choices. ([NCCN][5])
Choice depends heavily on bleeding risk (varices), autoimmune conditions, liver function, and prior therapy.
---
### 9) Prevention and risk reduction
The highest-impact levers are consistent across major cancer and liver organizations:
* **HBV vaccination** and **HBV antiviral treatment** when indicated
* **HCV cure** with direct-acting antivirals (reduces risk, though surveillance may continue if cirrhosis remains)
* reduce or eliminate **harmful alcohol use**
* manage **metabolic risk**: weight, diabetes, lipids, blood pressure; treat fatty liver disease
* avoid aflatoxin-contaminated foods where relevant
* stop smoking
Because liver cancer burden is increasingly influenced by metabolic disease, major reviews emphasize shifting epidemiology toward fatty-liver drivers. ([Journal of Liver Cancer][2])
---
## 한국어
### 1) 간암이란 무엇인가
간암은 크게 두 범주가 있습니다.
* **원발성 간암**: 간에서 시작
* **간세포암(HCC)**: 가장 흔한 형태(일반적으로 “간암”이라 하면 HCC를 의미하는 경우가 많음)
* **간내 담관암**: 간 안의 담관에서 발생
* **전이성 간암**: 다른 장기 암이 간으로 전이
임상·보건 관점에서 “간암”의 핵심은 **만성 간질환과 강하게 연결되고, 선별검사(감시)로 조기 발견이 가능하며, 예방 여지가 큰 HCC**입니다. ([PMC][1])
---
### 2) 왜 생기나
HCC는 대개
**만성 손상(바이러스/알코올/대사질환) → 염증 → 섬유화 → 간경변 → 암**
의 흐름 속에서 발생합니다.
중요한 포인트:
* **지방간(NAFLD/NASH, 최근엔 MASLD/MASH로도 표현) 관련 간암은 간경변이 없어도 발생할 수 있다**는 보고가 있어, “누구를 어떻게 감시할 것인가”가 더 어려워집니다. ([Journal of Liver Cancer][2])
---
### 3) 주요 위험요인
대표 위험요인은 다음이 확립되어 있습니다.
* **B형간염(HBV)**: 간경변이 없어도 간암 위험이 증가할 수 있음
* **C형간염(HCV)**: 특히 간경변에서 위험이 큼
* **과음/알코올성 간질환**
* **대사성 지방간 질환(비만·당뇨·지질이상과 연관)**
* **원인 불문 간경변**(가장 강력한 “위험 기반”)
* 기타: 아플라톡신 노출, 유전대사질환(혈색소증·윌슨병 등), 흡연, 당뇨/비만 등 ([암 정보 센터][3])
---
### 4) 증상
초기 간암은 **증상이 거의 없는 경우가 많아** 선별검사가 중요합니다.
가능한 증상/징후:
* 우상복부 불편감, 쉽게 배부름
* 체중감소, 피로, 식욕부진
* **황달**, 소변색 진해짐, 가려움
* 복수(배가 붓는 느낌), 다리부종
* 쉽게 멍/출혈, 의식저하·혼동(간성뇌증)
빠른 평가가 필요한 신호:
* 토혈/흑변(식도정맥류 출혈 가능),
* 갑작스런 의식 변화,
* 급격히 심해지는 황달,
* 급격한 복부팽만 + 발열/심한 통증.
---
### 5) 선별검사와 감시
고위험군(특히 간경변, 고위험 B형간염 등)을 대상으로, 다수 가이드라인이 공통으로 제시하는 표준은:
* **6개월마다 간 초음파 검사**, 경우에 따라 **AFP 혈액검사**를 병행하는 방식입니다. ([PMC][1])
초음파 질이 떨어질 때(비만, 결절성 간경변 등)에는 **조영 MRI/CT** 같은 대체 영상이 고려될 수 있다는 내용이 정리되어 있습니다. ([PMC][4])
---
### 6) 진단
일반적인 흐름:
1. **위험 배경**(간경변/HBV)이 진단 신뢰도에 크게 영향
2. **다상(동맥기·문맥기·지연기) CT/MRI**로 특징적 조영 패턴 확인
3. **AFP 등 혈액검사**는 보조
4. 영상이 애매하거나 치료 전략에 중요하면 **조직검사**를 시행
영상 기반 진단의 원칙과 조직검사의 역할은 최신 진료 지침에서 체계적으로 설명됩니다. ([PMC][1])
---
### 7) 병기와 간기능
간암은 **암 자체**와 **간기능(간경변 정도)** 두 축이 동시에 예후를 좌우합니다.
* Child–Pugh(A/B/C), MELD 등으로 간기능을 평가하고,
* 병기 체계(예: BCLC 등)로 치료 경로를 결정하는 방식이 흔합니다.
---
### 8) 치료
**근치적 치료(완치를 목표)**
* **간절제**: 간기능이 좋고 종양이 제한적일 때
* **간이식**: 암과 간경변을 동시에 해결(적합 기준 필요)
* **고주파/마이크로파 소작술**: 작은 종양에서 효과적
**국소·혈관중재 치료**
* **TACE**
* **방사선색전술(Y-90)**
* 특정 상황에서 방사선치료
**전신치료**
진행성/절제불가/국소치료 부적합 시 전신치료가 핵심이 됩니다. 2025년 NCCN 환자 가이드에서도 1차 전신치료로
* **아테졸리주맙+베바시주맙**
* **트레멜리무맙+더발루맙**
을 선호 옵션으로 제시합니다. ([NCCN][5])
실제 선택은 정맥류 출혈 위험, 자가면역질환, 간기능(Child–Pugh), 동반질환 등에 따라 달라집니다.
---
### 9) 예방과 위험 감소
가장 영향이 큰 축은 명확합니다.
* **B형간염 예방접종**, 필요 시 **항바이러스 치료**
* **C형간염 치료(완치)** 후에도 간경변이 있으면 감시는 지속될 수 있음
* 과음 줄이기/중단
* 비만·당뇨·지질이상 등 **대사 위험 관리**(지방간 악화 방지)
* 아플라톡신 노출 최소화
* 금연
지방간·대사질환이 간암의 중요한 원인으로 커지는 “역학 변화”가 여러 최신 리뷰에서 강조됩니다. ([Journal of Liver Cancer][2])
---
## 日本語
### 1) 肝がんとは
肝がんは「原発性（肝臓で発生）」と「転移性（他臓器から転移）」に大別されます。一般に“肝がん”で中心となるのは **肝細胞がん（HCC）** で、慢性肝疾患と強く結びつき、サーベイランスで早期発見が狙えます。 ([PMC][1])
### 2) 主因とリスク
主要因は **HBV/HCV、アルコール、脂肪肝（NAFLD/NASH、近年はMASLD/MASH）**、そして **肝硬変** です。脂肪肝関連HCCは肝硬変なしでも起こり得る点が難しさです。 ([Journal of Liver Cancer][2])
### 3) サーベイランス
高リスク群では **6か月ごとの腹部超音波**（AFP併用を含む運用も多い）が推奨の中心です。 ([PMC][1])
超音波が不十分な場合、造影MRI/CTが検討されます。 ([PMC][4])
### 4) 治療
根治（切除・移植・局所焼灼）、肝内制御（TACE、Y-90等）、進行例の全身治療に大別されます。全身治療の一次選択として免疫療法を含む併用（例：アテゾリズマブ＋ベバシズマブ、トレメリムマブ＋デュルバルマブ）が患者向けNCCN資料でも主要選択肢として示されています。 ([NCCN][5])
---
## Español
### 1) Qué es el “cáncer de hígado”
Puede ser **primario** (nace en el hígado) o **metastásico** (llega desde otro órgano). En la práctica clínica, gran parte de “cáncer de hígado” se refiere al **carcinoma hepatocelular (HCC)**, muy ligado a hepatitis crónica, cirrosis y enfermedad metabólica. ([PMC][1])
### 2) Factores de riesgo principales
HBV, HCV, alcohol, hígado graso (NAFLD/NASH; también MASLD/MASH) y cirrosis. Se reconoce que el HCC asociado a hígado graso puede aparecer incluso sin cirrosis. ([Journal of Liver Cancer][2])
### 3) Detección en alto riesgo
La vigilancia estándar para grupos de alto riesgo se centra en **ecografía hepática cada 6 meses**, con o sin AFP según el contexto. ([PMC][1])
Si la ecografía es limitada, se puede considerar imagen con contraste (MRI/CT). ([PMC][4])
### 4) Tratamiento
Curativo (resección, trasplante, ablación), locorregional (TACE, radioembolización), y sistémico (en avanzado/no resecable). Guías para pacientes del NCCN (2025) describen como opciones preferidas de primera línea combinaciones como **atezolizumab + bevacizumab** o **tremelimumab + durvalumab** en escenarios apropiados. ([NCCN][5])
---
## Français
### 1) Définition
Le “cancer du foie” peut être **primaire** (débutant dans le foie) ou **métastatique**. Le plus discuté en hépatologie est le **carcinome hépatocellulaire (CHC/HCC)**, fortement associé aux hépatites chroniques, à la cirrhose, à l’alcool et aux maladies métaboliques. ([PMC][1])
### 2) Facteurs de risque
HBV, HCV, alcool, stéatose hépatique (NAFLD/NASH; MASLD/MASH) et cirrhose. On souligne aussi que le CHC lié aux troubles métaboliques peut survenir sans cirrhose, ce qui complique la surveillance. ([Journal of Liver Cancer][2])
### 3) Surveillance
Chez les personnes à haut risque, la recommandation centrale est **une échographie hépatique tous les 6 mois**, parfois associée à l’AFP selon les pratiques. ([PMC][1])
En cas d’échographie insuffisante, une imagerie de contraste (IRM/CT) peut être utilisée. ([PMC][4])
### 4) Traitements
Options curatives (résection, transplantation, ablation), locorégionales (TACE, Y-90), et systémiques (formes avancées/non résécables). Les documents patients du NCCN (2025) mettent en avant, en première ligne chez des patients appropriés, des associations incluant **atezolizumab + bevacizumab** ou **tremelimumab + durvalumab**. ([NCCN][5])
---
[1]: https://pmc.ncbi.nlm.nih.gov/articles/PMC10663390/?utm_source=chatgpt.com "AASLD Practice Guidance on prevention, diagnosis, and ..."
[2]: https://www.e-jlc.org/journal/view.php?number=557&utm_source=chatgpt.com "Changing etiology and epidemiology of hepatocellular ..."
[3]: https://www.cancer.gov/types/liver/what-is-liver-cancer/causes-risk-factors?utm_source=chatgpt.com "Liver Cancer Causes, Risk Factors, and Prevention - NCI"
[4]: https://pmc.ncbi.nlm.nih.gov/articles/PMC10854554/?utm_source=chatgpt.com "Management of Hepatocellular Carcinoma in 2024"
[5]: https://www.nccn.org/patients/guidelines/content/PDF/liver-hp-patient.pdf?utm_source=chatgpt.com "Liver Cancer"
**간암: 원인·증상·진단·치료·예방까지 자세히**
---
## English
### 1) What “liver cancer” means
“Liver cancer” can mean:
* **Primary liver cancer** (starts in the liver)
* **Hepatocellular carcinoma (HCC)**: the most common type.
* **Intrahepatic cholangiocarcinoma**: bile-duct cancer within the liver.
* **Metastatic cancer to the liver** (spread from colon, pancreas, breast, etc.) — far more common overall, but managed differently.
Most “간암” discussions in medicine and public health focus on **HCC**, because it is strongly tied to chronic liver disease and is often preventable and screen-detectable. ([PMC][1])
---
### 2) Why HCC happens
HCC most often develops on a background of **chronic liver injury → inflammation → fibrosis → cirrhosis → cancer**. The risk rises because:
* chronically injured liver cells undergo repeated cycles of damage and regeneration,
* fibrosis changes the tissue microenvironment,
* viral and metabolic factors can directly promote carcinogenic pathways.
Important nuance: **metabolic fatty liver–related HCC can occur even without cirrhosis**, which makes surveillance strategy harder. ([Journal of Liver Cancer][2])
---
### 3) Major risk factors
The biggest global drivers are well-established:
* **Chronic hepatitis B (HBV)** (can cause HCC even without cirrhosis)
* **Chronic hepatitis C (HCV)** (risk strongly rises with cirrhosis)
* **Alcohol-related liver disease**
* **Metabolic fatty liver disease** (often discussed as NAFLD/NASH; newer terminology includes MASLD/MASH)
* **Cirrhosis of any cause** (the single strongest common “risk container”)
* Additional factors: aflatoxin exposure, hereditary hemochromatosis, Wilson disease, smoking, diabetes/obesity. ([암 정보 센터][3])
---
### 4) Symptoms and why early HCC is often “silent”
Early HCC frequently causes **no specific symptoms**. Symptoms often appear when:
* tumor burden becomes large,
* there is bile duct obstruction,
* or cirrhosis decompensates.
Common symptoms/signs:
* right upper abdominal discomfort, early satiety
* unexplained weight loss, fatigue, loss of appetite
* **jaundice**, dark urine, itching (bile obstruction or liver failure)
* abdominal swelling (ascites), leg edema
* easy bruising/bleeding (low clotting factors), worsening encephalopathy (confusion)
Urgent red flags (medical evaluation should be prompt):
* vomiting blood / black tarry stools (variceal bleeding in cirrhosis),
* new confusion or severe drowsiness,
* rapidly enlarging abdomen with fever or severe pain,
* rapidly worsening jaundice.
---
### 5) Who should be screened and how
Because early-stage HCC can be treated more effectively, guidelines consistently recommend **surveillance for high-risk groups**, most classically:
* cirrhosis from HBV/HCV/alcohol/metabolic disease,
* certain chronic HBV patients even without cirrhosis (risk varies by age, family history, ethnicity, viral activity).
A widely cited standard approach is:
* **liver ultrasound every 6 months**, often **with AFP blood testing** (AFP may improve sensitivity when combined with ultrasound, but is imperfect). ([PMC][1])
When ultrasound quality is limited (obesity, nodular cirrhosis), many recommendations support **contrast-enhanced MRI or CT** as alternative surveillance/diagnostic imaging. ([PMC][4])
---
### 6) Diagnosis workflow
Typical steps (simplified, but clinically faithful):
1. **Risk context**: cirrhosis/HBV history changes how confidently imaging can diagnose HCC.
2. **Imaging**: multiphasic CT or MRI looks for hallmark vascular behavior:
* arterial phase hyperenhancement + washout in portal/delayed phase (classic pattern).
3. **AFP and other labs**: supportive, not definitive alone.
4. **Biopsy**: used when imaging is not definitive or when diagnosis will change management. Modern practice guidance describes imaging-based diagnosis pathways and when biopsy is appropriate. ([PMC][1])
---
### 7) Staging and why liver function matters as much as tumor size
HCC management is unusual because outcomes depend on **two diseases at once**:
* the cancer,
* and the underlying liver function (often cirrhosis).
Clinicians commonly use:
* **Child–Pugh class** (A/B/C) and MELD for liver reserve,
* and integrated staging systems (e.g., BCLC in many settings) that link stage to treatment pathways.
---
### 8) Treatment options by clinical situation
Real-world care is multidisciplinary (hepatology, oncology, surgery, interventional radiology). Core modalities:
**Curative-intent options (best chance for long-term control)**
* **Surgical resection**: best for solitary tumors with good liver reserve and no severe portal hypertension.
* **Liver transplantation**: treats both tumor and cirrhosis; eligibility often follows size/number criteria.
* **Local ablation** (radiofrequency/microwave): effective for small tumors when surgery isn’t ideal.
**Locoregional therapies (control tumor within the liver)**
* **TACE** (transarterial chemoembolization): commonly for intermediate-stage disease.
* **TARE/Y-90 radioembolization**: selected cases, increasingly used in certain centers.
* External beam radiation in specific scenarios.
**Systemic therapy (advanced or unresectable disease, or when locoregional therapy is unsuitable)**
Modern guidelines and oncology references list **immune-based combinations** as preferred first-line systemic options for many patients, including:
* **atezolizumab + bevacizumab**
* **tremelimumab + durvalumab**
Patient-facing NCCN guidance (2025) presents these as preferred first-line systemic choices. ([NCCN][5])
Choice depends heavily on bleeding risk (varices), autoimmune conditions, liver function, and prior therapy.
---
### 9) Prevention and risk reduction
The highest-impact levers are consistent across major cancer and liver organizations:
* **HBV vaccination** and **HBV antiviral treatment** when indicated
* **HCV cure** with direct-acting antivirals (reduces risk, though surveillance may continue if cirrhosis remains)
* reduce or eliminate **harmful alcohol use**
* manage **metabolic risk**: weight, diabetes, lipids, blood pressure; treat fatty liver disease
* avoid aflatoxin-contaminated foods where relevant
* stop smoking
Because liver cancer burden is increasingly influenced by metabolic disease, major reviews emphasize shifting epidemiology toward fatty-liver drivers. ([Journal of Liver Cancer][2])
---
## 한국어
### 1) 간암이란 무엇인가
간암은 크게 두 범주가 있습니다.
* **원발성 간암**: 간에서 시작
* **간세포암(HCC)**: 가장 흔한 형태(일반적으로 “간암”이라 하면 HCC를 의미하는 경우가 많음)
* **간내 담관암**: 간 안의 담관에서 발생
* **전이성 간암**: 다른 장기 암이 간으로 전이
임상·보건 관점에서 “간암”의 핵심은 **만성 간질환과 강하게 연결되고, 선별검사(감시)로 조기 발견이 가능하며, 예방 여지가 큰 HCC**입니다. ([PMC][1])
---
### 2) 왜 생기나
HCC는 대개
**만성 손상(바이러스/알코올/대사질환) → 염증 → 섬유화 → 간경변 → 암**
의 흐름 속에서 발생합니다.
중요한 포인트:
* **지방간(NAFLD/NASH, 최근엔 MASLD/MASH로도 표현) 관련 간암은 간경변이 없어도 발생할 수 있다**는 보고가 있어, “누구를 어떻게 감시할 것인가”가 더 어려워집니다. ([Journal of Liver Cancer][2])
---
### 3) 주요 위험요인
대표 위험요인은 다음이 확립되어 있습니다.
* **B형간염(HBV)**: 간경변이 없어도 간암 위험이 증가할 수 있음
* **C형간염(HCV)**: 특히 간경변에서 위험이 큼
* **과음/알코올성 간질환**
* **대사성 지방간 질환(비만·당뇨·지질이상과 연관)**
* **원인 불문 간경변**(가장 강력한 “위험 기반”)
* 기타: 아플라톡신 노출, 유전대사질환(혈색소증·윌슨병 등), 흡연, 당뇨/비만 등 ([암 정보 센터][3])
---
### 4) 증상
초기 간암은 **증상이 거의 없는 경우가 많아** 선별검사가 중요합니다.
가능한 증상/징후:
* 우상복부 불편감, 쉽게 배부름
* 체중감소, 피로, 식욕부진
* **황달**, 소변색 진해짐, 가려움
* 복수(배가 붓는 느낌), 다리부종
* 쉽게 멍/출혈, 의식저하·혼동(간성뇌증)
빠른 평가가 필요한 신호:
* 토혈/흑변(식도정맥류 출혈 가능),
* 갑작스런 의식 변화,
* 급격히 심해지는 황달,
* 급격한 복부팽만 + 발열/심한 통증.
---
### 5) 선별검사와 감시
고위험군(특히 간경변, 고위험 B형간염 등)을 대상으로, 다수 가이드라인이 공통으로 제시하는 표준은:
* **6개월마다 간 초음파 검사**, 경우에 따라 **AFP 혈액검사**를 병행하는 방식입니다. ([PMC][1])
초음파 질이 떨어질 때(비만, 결절성 간경변 등)에는 **조영 MRI/CT** 같은 대체 영상이 고려될 수 있다는 내용이 정리되어 있습니다. ([PMC][4])
---
### 6) 진단
일반적인 흐름:
1. **위험 배경**(간경변/HBV)이 진단 신뢰도에 크게 영향
2. **다상(동맥기·문맥기·지연기) CT/MRI**로 특징적 조영 패턴 확인
3. **AFP 등 혈액검사**는 보조
4. 영상이 애매하거나 치료 전략에 중요하면 **조직검사**를 시행
영상 기반 진단의 원칙과 조직검사의 역할은 최신 진료 지침에서 체계적으로 설명됩니다. ([PMC][1])
---
### 7) 병기와 간기능
간암은 **암 자체**와 **간기능(간경변 정도)** 두 축이 동시에 예후를 좌우합니다.
* Child–Pugh(A/B/C), MELD 등으로 간기능을 평가하고,
* 병기 체계(예: BCLC 등)로 치료 경로를 결정하는 방식이 흔합니다.
---
### 8) 치료
**근치적 치료(완치를 목표)**
* **간절제**: 간기능이 좋고 종양이 제한적일 때
* **간이식**: 암과 간경변을 동시에 해결(적합 기준 필요)
* **고주파/마이크로파 소작술**: 작은 종양에서 효과적
**국소·혈관중재 치료**
* **TACE**
* **방사선색전술(Y-90)**
* 특정 상황에서 방사선치료
**전신치료**
진행성/절제불가/국소치료 부적합 시 전신치료가 핵심이 됩니다. 2025년 NCCN 환자 가이드에서도 1차 전신치료로
* **아테졸리주맙+베바시주맙**
* **트레멜리무맙+더발루맙**
을 선호 옵션으로 제시합니다. ([NCCN][5])
실제 선택은 정맥류 출혈 위험, 자가면역질환, 간기능(Child–Pugh), 동반질환 등에 따라 달라집니다.
---
### 9) 예방과 위험 감소
가장 영향이 큰 축은 명확합니다.
* **B형간염 예방접종**, 필요 시 **항바이러스 치료**
* **C형간염 치료(완치)** 후에도 간경변이 있으면 감시는 지속될 수 있음
* 과음 줄이기/중단
* 비만·당뇨·지질이상 등 **대사 위험 관리**(지방간 악화 방지)
* 아플라톡신 노출 최소화
* 금연
지방간·대사질환이 간암의 중요한 원인으로 커지는 “역학 변화”가 여러 최신 리뷰에서 강조됩니다. ([Journal of Liver Cancer][2])
---
## 日本語
### 1) 肝がんとは
肝がんは「原発性（肝臓で発生）」と「転移性（他臓器から転移）」に大別されます。一般に“肝がん”で中心となるのは **肝細胞がん（HCC）** で、慢性肝疾患と強く結びつき、サーベイランスで早期発見が狙えます。 ([PMC][1])
### 2) 主因とリスク
主要因は **HBV/HCV、アルコール、脂肪肝（NAFLD/NASH、近年はMASLD/MASH）**、そして **肝硬変** です。脂肪肝関連HCCは肝硬変なしでも起こり得る点が難しさです。 ([Journal of Liver Cancer][2])
### 3) サーベイランス
高リスク群では **6か月ごとの腹部超音波**（AFP併用を含む運用も多い）が推奨の中心です。 ([PMC][1])
超音波が不十分な場合、造影MRI/CTが検討されます。 ([PMC][4])
### 4) 治療
根治（切除・移植・局所焼灼）、肝内制御（TACE、Y-90等）、進行例の全身治療に大別されます。全身治療の一次選択として免疫療法を含む併用（例：アテゾリズマブ＋ベバシズマブ、トレメリムマブ＋デュルバルマブ）が患者向けNCCN資料でも主要選択肢として示されています。 ([NCCN][5])
---
## Español
### 1) Qué es el “cáncer de hígado”
Puede ser **primario** (nace en el hígado) o **metastásico** (llega desde otro órgano). En la práctica clínica, gran parte de “cáncer de hígado” se refiere al **carcinoma hepatocelular (HCC)**, muy ligado a hepatitis crónica, cirrosis y enfermedad metabólica. ([PMC][1])
### 2) Factores de riesgo principales
HBV, HCV, alcohol, hígado graso (NAFLD/NASH; también MASLD/MASH) y cirrosis. Se reconoce que el HCC asociado a hígado graso puede aparecer incluso sin cirrosis. ([Journal of Liver Cancer][2])
### 3) Detección en alto riesgo
La vigilancia estándar para grupos de alto riesgo se centra en **ecografía hepática cada 6 meses**, con o sin AFP según el contexto. ([PMC][1])
Si la ecografía es limitada, se puede considerar imagen con contraste (MRI/CT). ([PMC][4])
### 4) Tratamiento
Curativo (resección, trasplante, ablación), locorregional (TACE, radioembolización), y sistémico (en avanzado/no resecable). Guías para pacientes del NCCN (2025) describen como opciones preferidas de primera línea combinaciones como **atezolizumab + bevacizumab** o **tremelimumab + durvalumab** en escenarios apropiados. ([NCCN][5])
---
## Français
### 1) Définition
Le “cancer du foie” peut être **primaire** (débutant dans le foie) ou **métastatique**. Le plus discuté en hépatologie est le **carcinome hépatocellulaire (CHC/HCC)**, fortement associé aux hépatites chroniques, à la cirrhose, à l’alcool et aux maladies métaboliques. ([PMC][1])
### 2) Facteurs de risque
HBV, HCV, alcool, stéatose hépatique (NAFLD/NASH; MASLD/MASH) et cirrhose. On souligne aussi que le CHC lié aux troubles métaboliques peut survenir sans cirrhose, ce qui complique la surveillance. ([Journal of Liver Cancer][2])
### 3) Surveillance
Chez les personnes à haut risque, la recommandation centrale est **une échographie hépatique tous les 6 mois**, parfois associée à l’AFP selon les pratiques. ([PMC][1])
En cas d’échographie insuffisante, une imagerie de contraste (IRM/CT) peut être utilisée. ([PMC][4])
### 4) Traitements
Options curatives (résection, transplantation, ablation), locorégionales (TACE, Y-90), et systémiques (formes avancées/non résécables). Les documents patients du NCCN (2025) mettent en avant, en première ligne chez des patients appropriés, des associations incluant **atezolizumab + bevacizumab** ou **tremelimumab + durvalumab**. ([NCCN][5])
---
[1]: https://pmc.ncbi.nlm.nih.gov/articles/PMC10663390/?utm_source=chatgpt.com "AASLD Practice Guidance on prevention, diagnosis, and ..."
[2]: https://www.e-jlc.org/journal/view.php?number=557&utm_source=chatgpt.com "Changing etiology and epidemiology of hepatocellular ..."
[3]: https://www.cancer.gov/types/liver/what-is-liver-cancer/causes-risk-factors?utm_source=chatgpt.com "Liver Cancer Causes, Risk Factors, and Prevention - NCI"
[4]: https://pmc.ncbi.nlm.nih.gov/articles/PMC10854554/?utm_source=chatgpt.com "Management of Hepatocellular Carcinoma in 2024"
[5]: https://www.nccn.org/patients/guidelines/content/PDF/liver-hp-patient.pdf?utm_source=chatgpt.com "Liver Cancer"