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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

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  • 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


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  • 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


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  • Vaccination have high HBV infection rates

    • 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


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  • Transmitted by parenteral route prevalence

    • Intravenous drug use

    • Hemodialysis

    • Blood transfusion

    • Exposure to blood of infected patient

  • Other routes probably exist but have not been identified


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  • Aflatoxins areas with low HBV and HCV incidence

  • Thorotrast (X-ray contrast material)

  • Vinyl Chloride

  • Steroid Hormones

  • Schistosomiasis

  • Liver flukes

  • Iron

  • Tobacco

  • Diet


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  • Cirrhosis areas with low HBV and HCV incidence

  • Immune Function

  • Genetic Susceptibility

  • Hemochromatosis

  • Other Inherited Metabolic Disease

  • Diabetes Mellitus

  • Non-alcoholic Steatohepatitis

  • Primary Sclerosing Cholangitis


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  • Serum alpha-fetoprotein (AFP) certain industries to hepatocarcinogens

    • Limitations:

      • Senstitivity and specificity

  • Ultrasonography of the liver

    • Limitations

      • Quality of equipment

      • Skill of operator in identifying small tumors

      • Cost


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  • Vaccine for HCV certain industries to hepatocarcinogens

  • Understand molecular pathogenesis of HCC

  • New targets for chemoprevention of HCC and therapies for established HCC


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  • 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


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  • Cancer Epidemiology, 3 Hepatitis B or Crd ed. 2006. Oxford University Press

  • Centers for Disease Control

  • American Cancer Society


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