Figure 3.

Etiology and risk factors promoting HCC carcinogenesis. Continuous chronic exposure to hepatic injuries caused by environmental factors (viral hepatitis, alcohol abuse, NASH, exposure to toxins, etc.) repeatedly damage the hepatocytes and induce inflammation eventually leading to liver cirrhosis. In this stage, the liver is susceptible to genomic instabilities. That is why it is more likely for the hepatocytes to accumulate somatic mutations, epigenetic changes, and gene rearrangements which can lead to metabolic changes and molecular pathway alterations. These dysregulations drive tumor progression and metastasis.