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Liver Cancer Hepatocellular carcinoma

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The high incidence of primary liver cancer in East Asia and South-East Asia is largely attributable to the high prevalence of chronic HBV infection in these regions. – PowerPoint PPT presentation

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Title: Liver Cancer Hepatocellular carcinoma


1
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2
  • 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

3
  • 1.3 of estimated incident cancer cases are in
    the liver and intrahepatic bile duct
  • Incidence rates are higher for males than females
    (2-41)
  • Higher incidence for African Americans and Asians
    than whites
  • 5 year survival rate is approximately 6.9

4
  • 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

5
  • 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

6
  • 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

7
  • 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

8
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9
  • 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 51 to 651
  • 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

10
  • 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

11
  • 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

12
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13
  • 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

14
  • 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

15
  • Many epidemiological studies have indicated
    association
  • Detection of HCV RNA in tumor and nontumor
    cirrhotic liver tissue of patients with HCC

16
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17
  • 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

18
  • Aflatoxins
  • Thorotrast (X-ray contrast material)
  • Vinyl Chloride
  • Steroid Hormones
  • Schistosomiasis
  • Liver flukes
  • Iron
  • Tobacco
  • Diet

19
  • Cirrhosis
  • Immune Function
  • Genetic Susceptibility
  • Hemochromatosis
  • Other Inherited Metabolic Disease
  • Diabetes Mellitus
  • Non-alcoholic Steatohepatitis
  • Primary Sclerosing Cholangitis

20
  • 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)

21
  • Serum alpha-fetoprotein (AFP)
  • Limitations
  • Senstitivity and specificity
  • Ultrasonography of the liver
  • Limitations
  • Quality of equipment
  • Skill of operator in identifying small tumors
  • Cost

22
  • Vaccine for HCV
  • Understand molecular pathogenesis of HCC
  • New targets for chemoprevention of HCC and
    therapies for established HCC

23
  • 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

24
  • Cancer Epidemiology, 3rd ed. 2006. Oxford
    University Press
  • Centers for Disease Control
  • American Cancer Society
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