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Hepatocellular carcinoma: a global view

Abstract

Hepatocellular carcinoma (HCC) is a global health problem, although developing countries are disproportionally affected: over 80% of HCCs occur in such regions. About three-quarters of HCCs are attributed to chronic HBV and HCV infections. In areas endemic for HCV and HBV, viral transmission occurs at an early age, and infected individuals develop HCC in mid-adulthood. As these are their most productive years of life, HCC accounts for a substantial burden on the health-care system and drain of productive capacity in the low-income and middle-income countries most affected by HCV and HBV infections. Environments with disparate resource levels require different strategies for the optimal management of HCC. In high-resource environments, guidelines from the American Association for the Study of Liver Diseases or European Association for the Study of the Liver should be applied. In intermediate-resource or low-resource environments, the fundamental focus should be on primary prevention of HCC, through universal HBV vaccination, taking appropriate precautions and antiviral treatments. In intermediate-resource and low-resource environments, the infrastructure and capacity for abdominal ultrasonography, percutaneous ethanol injection, radiofrequency ablation and surgical resection should be established. Programs to provide targeted therapy at low cost, similar to the approach used for HIV therapy in the developing world, should be pursued.

Key Points

  • Hepatocellular carcinoma (HCC) is the seventh most common cancer and the third leading cause of cancer-related deaths in the world

  • Over 80% of HCCs occur in developing countries, which lack infrastructure for the management of this disease

  • High-resource environments should utilize American Association for the Study of Liver Diseases or European Association for the Study of the Liver guidelines for HCC prevention, surveillance, diagnosis and treatment

  • In intermediate-resource or low-resource environments, primary prevention of HCC through universal HBV vaccination, appropriate precautions and antiviral treatment should be the primary focus

  • The infrastructure and capacity for high-quality ultrasonography, percutaneous ethanol injection, radiofrequency ablation and surgical resection are crucial

  • Programs to provide targeted therapy at low cost, similar to those used for HIV therapy, should be pursued in resource-poor environments

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Figure 1: Global variations in age-adjusted incidence rates of liver cancer, prevalence of chronic HCV infection and chronic HBV infection.
Figure 2: Age-specific incidence rates of hepatocellular carcinoma among men in China and Gambia (West Africa).
Figure 3: Estimated attributable fractions of primary hepatocellular cancers with a viral etiology in countries with different levels of medical resources (data from Bosch et al. [2004]).13
Figure 4: Change in the incidence rates of hepatocellular carcinoma between 1983 and 2004.

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Acknowledgements

This work was supported by NIH grants CA100882 and CA128633 (awarded to L. R. Roberts). We apologize to the many excellent contributors to this field whose work is not acknowledged in the reference list owing to space limitations.

Désirée Lie, University of California, Irvine, CA is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Yang, J., Roberts, L. Hepatocellular carcinoma: a global view. Nat Rev Gastroenterol Hepatol 7, 448–458 (2010). https://doi.org/10.1038/nrgastro.2010.100

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