New Insights in Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third most common cause of cancer mortality. HCC is one of the few cancers with well-defined major risk factors. Worldwide, in 80% of the cases HCC develops in cirrhotic livers, and cirrhosis is the strongest predisposing factor. The incidence is high in Asia and parts of Africa. Geographical differences in incidence reflect variations of the main causal factors such as hepatitis B virus infection (HBV) which is common in Asia and Africa. HBV infection leads to the development of HCC through direct and indirect pathways. Being an oncogenic virus, it can cause HCC in the absence of cirrhosis, as it has the ability to integrate into the host genome affecting cellular signalling and growth control. Another unique feature of HCC is that it is a vaccine preventable disease. Implementation of a nationwide HBV vaccination programme for newborns in Taiwan has convincingly demonstrated a drop in the incidence of HCC in the years thereafter. In Japan, Europe, and the United States about 60% of the patients with HCC are attributed to chronic hepatitis C virus (HCV) infection, 20% are attributed to chronic HBV infection and about 20% are equally divided between cryptogenic and alcoholic liver disease. Hepatitis C as an infection transmitted by blood or plasma products before 1990 and is an important factor in the development of HCC in western countries. HCV causes HCC mainly through indirect pathways: chronic inflammation, cell deaths, and regeneration. In the pathogenesis the concurrent presence of the use of alcohol, the presence of diabetes and overweight play also an important role as a co-factor in HCV infection.

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