Primary hepatocellular carcinoma

Article Abstract:

Primary hepatocellular carcinoma (liver cancer) is especially common in Asia and subSaharan Africa, where as many as one in 200 people develop the disease each year, usually as a consequence of chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). Alcohol and aflatoxins (a toxin produced by molds found in peanuts) are common toxins that may play a role in the development of hepatocellular carcinoma. Aflatoxins are consumed in foods in Africa and southern China. In Western countries, alcohol is the most common cause of cirrhosis (chronic degenerative live disease), which leads to liver cancer. Fewer than five percent of patients are alive five years after being diagnosed with hepatocellular carcinoma, and most survive only a few months. Screening programs have been successful in Japan, China and Alaska, and one follow-up study from Shanghai reported a five-year survival rate of 70 percent, and a 10-year survival rate approaching 50 percent. However, unlike patients in Western countries, these patients have little or no liver disease, and are excellent surgical risks. Unlike the fast-growing and aggressive tumors found in African patients, Asian patients have small, localized and encapsulated tumors. Massimo Colombo and his colleagues reported in the September 5, 1991 issue of The New England Journal of Medicine that alpha-fetoprotein (a protein found in the fetus and in adults with certain illnesses) and ultrasonography did not meet expectations in detecting surgically treatable disease in a high-risk population. Screening may not be effective in improving diagnosis or in prolonging survival. The best hope at this time seems to lie in preventing liver cancer by controlling hepatitis infection and modifying high-risk behavior, such as excessive alcohol intake and using high doses of androgens and other anabolic steroids. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hepatitis, editorial

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Hepatocellular carcinoma in Italian patients with cirrhosis

Article Abstract:

Cirrhosis of the liver is a degenerative disease of the liver. Hepatocellular carcinoma (liver cancer) is common among patients with cirrhosis, although why the cancer develops is unknown. In Japan and Taiwan, careful follow-up of patients with cirrhosis has led to early diagnosis and surgical treatment of liver cancer, and improved outcomes have been reported. Although patients with small liver tumors do better after surgery than those with large tumors, it is not clear whether these tumors should be surgically removed or only observed. To clarify this and other issues, 447 Italian men and women with cirrhosis were assessed. At the beginning of the study, almost seven percent of the patients had liver cancer (prevalence), and cancer developed at a yearly rate of about three percent (incidence); the incidence fell to two percent when patients who had high initial serum alpha-fetoprotein levels, indicating probable cancer, were excluded. (Alpha-fetoprotein is a protein found in the fetus and in adults with certain illnesses.) These statistics indicate that liver cancer is part of the natural progression of cirrhosis, and not necessarily related to end-stage disease. Patients were screened, using alpha-fetoprotein assays and ultrasonography. Alpha-fetoprotein levels did predict development of liver cancer, and rapidly increasing levels indicated fast-growing tumors. However, 59 percent of patients who developed cancer had normal or variable alpha-fetoprotein levels, indicating that screening patients did not improve the detection of small, potentially operable tumors. Survival of patients after surgery was not encouraging in this study. Poor detection and lack of improvement in survival argue against implementation of aggressive alpha-fetoprotein screening in Western countries. (Consumer Summary produced by Reliance Medical Information, Inc.)

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The increasing incidence of hepatocellular carcinoma

Article Abstract:

A vaccine against hepatitis B and C viruses might lower the rate of hepatocellular carcinoma. Hepatocellular carcinoma is a common type of liver cancer and a 1999 study reported an increase in the number of cases since 1980. Both viruses can cause chronic inflammation of the liver, and cell damage leading to cirrhosis. Cirrhosis in turn is a risk factor for liver cancer. The viral genes might become part of the cell's genes, which could disrupt chromosomes and lead to cancer. However, the exact mechanism is not known. Treatment of hepatitis B and hepatitis C may also lower the risk of liver cancer.

Editorial, Prevention, Hepatitis C, Hepatitis B

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