ABSTRACT
Primary liver cancer is the third leading cause of cancer deaths worldwide with mortality estimated at 598,000 in 2002 (Parkin et al. 2005). Recent statistics from the American Cancer Society estimated that approximately 22,620 new cases of liver and intrahepatic bile duct cancers will be diagnosed in the United States in 2009 (ACS 2009). Ÿe majority of primary liver cancers in North America are hepatocellular carcinoma (HCC) with many of the remaining being cholangiocarcinoma. Ÿe incidence rates of primary liver cancer have historically been lower in the United States than in Asian countries. However, the disease rates are increasing as a result of increasing incidence of the hepatitis B and C infections. HCC has tripled in the United States from 1975 to 2005 (Altekruse, McGlynn, and Reichman 2009). In addition, liver metastases from solid malignancies are a large source of morbidity. Colorectal cancer, which accounted for about 1 million new cases in 2002 (Parkin et al. 2005) and 146,970 new cases in the United States in 2009 (ACS 2009), o«en metastasizes to the liver, sometimes as the only metastatic disease site.
