V Primary liver cancer is the fifth most

common cancer in the world and the

third most common cause of cancer
mortality
V Hepatocellular carcinomas (HCCs) are
malignant tumors of liver parenchymal
cells
V O
 of estimated incident cancer cases
are in the liver and intrahepatic bile duct
V Incidence rates are higher for males
than females (2-4:O)
V Higher incidence for African Americans
and Asians than whites
V 5 year survival rate is approximately 6 
V rne of the most common malignancies
in eastern Asia and sub-Saharan Africa
V Incidence up to  O in some
parts of the world
V More than 6 deaths in 22
V 44 of the world·s cases occur in China
V Incidence increases with age then
plateaus when the peak is reached
around 55 to 65 in the United States

V Ethnic and familial clustering have been

reported
 Possible interaction between Hepatitis
infection and a major gene
V Implicated as the probable cause of HCC
in at least 8 of cases worldwide
V About 5 of the world·s population(
5
million people) is chronically infected with
HBV
V Lifetime risk of HCC for these individuals is
estimated at O-25
V 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
V In highly endemic areas of Asia about half of
chronic infections result from perinatal
transmission
V Can also be transmitted through household
contacts contaminated blood or blood
products organ transplantation or needle-stick
V Areas of the world with high mortality rates for
HCC also have high HBV infection rates
V Cirrhosis is closely related with chronic HBV
infection at least 8 of liver cancers occur in
cirrhotic livers
V Case control studies in all regions of the world
have shown that chronic HBV infection is much
more common in HCC cases than controls
 r ranged from 5:O to 65:O
V Prospective studies of chronic HBV carriers have
shown very high relative risks for HCC
 4 and 5 O compared with 5O
 Prevention of HBV reduces risk of subsequent HCC
V Viral DNA is integrated into host cell
genome
 HBV sequences are present in HCCs

V rne gene may have important

promotional role in
hepatocarcinogenesis but the
mechanism is not yet known
V Vaccination
  preventable with proper use of hepatitis
B vaccine
 Universal immunization of newborns in
Taiwan is associated with at least a 5
reduction in incidence of HCC among
adolescents
 Part of WHr universal childhood vaccination
 Cost reduced from $O to $O per pediatric
dose
V Major viral cause of liver cancer in areas
with low HBV prevalence
V About
 of the world·s population (O
million people) is chronically infected
with HCV

-4 million new infections each year

 2-4 with chronic HCV develop HCC

V Transmitted by parenteral route
 Intravenous drug use
 Hemodialysis
 Blood transfusion
 Exposure to blood of infected patient
V rther routes probably exist but have not
been identified
V Many epidemiological studies have
indicated association
V Detection of HCV NA in tumor and
nontumor cirrhotic liver tissue of patients
with HCC
V 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

V In high incidence areas alcohol may

exacerbate viral liver damage and
promote tumor development
V Aflatoxins V Schistosomiasis
V Thorotrast (X-ray V Liver flukes
contrast material) V Iron
V Vinyl Chloride V Tobacco
V Steroid Hormones V Diet
V Cirrhosis
V Immune Function
V Genetic Susceptibility
V Hemochromatosis
V rther Inherited Metabolic Disease
V Diabetes Mellitus
V Non-alcoholic Steatohepatitis
V Primary Sclerosing Cholangitis
V Limit exposure of the general populations
and workers in certain industries to
hepatocarcinogens
V educe transmission of hepatitis by IV drug
use through counseling about risks
V Prevent HBV infection (vaccination)
V Serum alpha-fetoprotein (AFP)
 Limitations:
˜ Senstitivity and specificity
V Ultrasonography of the liver
 Limitations
˜  uality of equipment
˜ Skill of operator in identifying small tumors
˜ Cost
V Vaccine for HCV
V Understand molecular pathogenesis of
HCC
V New targets for chemoprevention of
HCC and therapies for established HCC
V 8-5 of HCCs are associated with
chronic infection with Hepatitis B or C
V HBV infection is preventable by
immunization and HCV is preventable
through public health measures
V If opportunities for intervention are acted
upon HCC could become a minor
cause for cancer mortality in the future
V Cancer Epidemiology
rd ed 26
rxford University Press
V Centers for Disease Control
V American Cancer Society