Sei sulla pagina 1di 24

Primary liver cancer is the fifth most

common cancer in the world and the


third most common cause of cancer
mortality
Hepatocellular carcinomas (HCCs) are
malignant tumors of liver parenchymal
cells
1.3% of estimated incident cancer cases
are in the liver and intrahepatic bile duct
Incidence rates are higher for males
than females (2-4:1)
Higher incidence for African Americans
and Asians than whites
5 year survival rate is approximately 6.9%
One of the most common malignancies
in eastern Asia and sub-Saharan Africa
Incidence up to 90.0/100,000 in some
parts of the world
More than 600,000 deaths in 2002
44% of the worlds cases occur in China
Incidence increases with age then
plateaus when the peak is reached,
around 55 to 65 in the United States

Ethnic and familial clustering have been


reported
Possible interaction between Hepatitis
infection and a major gene
Implicated as the probable cause of HCC
in at least 80% of cases worldwide
About 5% of the worlds population(350
million people) is chronically infected with
HBV
Lifetime risk of HCC for these individuals is
estimated at 10-25%
In low prevalence areas (such as the U.S.), is
spread mainly by exposure to contaminated
blood through IV drug use or sexual contact
with an HBV carrier
In highly endemic areas of Asia, about half of
chronic infections result from perinatal
transmission
Can also be transmitted through household
contacts, contaminated blood or blood
products, organ transplantation, or needle-stick
Areas of the world with high mortality rates for
HCC also have high HBV infection rates
Cirrhosis is closely related with chronic HBV
infection, at least 80% of liver cancers occur in
cirrhotic livers
Case control studies in all regions of the world
have shown that chronic HBV infection is much
more common in HCC cases than controls
OR ranged from 5:1 to 65:1
Prospective studies of chronic HBV carriers have
shown very high relative risks for HCC
400 and 500 /100,000 compared with 5/100,000
Prevention of HBV reduces risk of subsequent HCC
Viral DNA is integrated into host cell
genome
HBV sequences are present in HCCs

One gene may have important


promotional role in
hepatocarcinogenesis, but the
mechanism is not yet known
Vaccination
90% preventable with proper use of hepatitis
B vaccine
Universal immunization of newborns in
Taiwan is associated with at least a 50%
reduction in incidence of HCC among
adolescents
Part of WHO universal childhood vaccination
Cost reduced from $100 to $1 per pediatric
dose
Major viral cause of liver cancer in areas
with low HBV prevalence
About 3% of the worlds population (170
million people) is chronically infected
with HCV
3-4 million new infections each year
2-4% with chronic HCV develop HCC
Transmitted by parenteral route
Intravenous drug use
Hemodialysis
Blood transfusion
Exposure to blood of infected patient
Other routes probably exist but have not
been identified
Many epidemiological studies have
indicated association
Detection of HCV RNA in tumor and
nontumor cirrhotic liver tissue of patients
with HCC
Alcohol is a significant risk factor for liver
cancer in areas with low HBV and HCV
incidence
Evidence indicates that alcohol causes
cirrhosis which in turn increases risk of HCC

In high incidence areas, alcohol may


exacerbate viral liver damage and
promote tumor development
Aflatoxins Schistosomiasis
Thorotrast (X-ray Liver flukes
contrast material) Iron
Vinyl Chloride Tobacco
Steroid Hormones Diet
Cirrhosis
Immune Function
Genetic Susceptibility
Hemochromatosis
Other Inherited Metabolic Disease
Diabetes Mellitus
Non-alcoholic Steatohepatitis
Primary Sclerosing Cholangitis
Limit exposure of the general populations
and workers in certain industries to
hepatocarcinogens
Reduce transmission of hepatitis by IV drug
use through counseling about risks
Prevent HBV infection (vaccination)
Serum alpha-fetoprotein (AFP)
Limitations:
Senstitivity and specificity
Ultrasonography of the liver
Limitations
Quality of equipment
Skill of operator in identifying small tumors
Cost
Vaccine for HCV
Understand molecular pathogenesis of
HCC
New targets for chemoprevention of
HCC and therapies for established HCC
80-95% of HCCs are associated with
chronic infection with Hepatitis B or C
HBV infection is preventable by
immunization and HCV is preventable
through public health measures
If opportunities for intervention are acted
upon, HCC could become a minor
cause for cancer mortality in the future
Cancer Epidemiology, 3rd ed. 2006.
Oxford University Press
Centers for Disease Control
American Cancer Society

Potrebbero piacerti anche