Liver cancer: Risk factors for rise in Hepatocellular Carcinoma cases

• With 841,080 new instances of liver cancer in 2018.
• Liver cancer is the sixth most common cancer overall.
• Although HCC incidence and mortality are rising in various parts of Europe and the USA.

With 841,080 new instances of liver cancer in 2018 and being the fourth most common cause of cancer-related mortality globally, liver cancer is the sixth most common cancer overall. Although HCC incidence and mortality are rising in various parts of Europe and the USA, East Asia and Africa still have the highest rates of hepatocellular carcinoma (HCC) incidence and mortality.

Indeed, since the early 2000s, HCC has had the greatest rate of growth among cancer-related causes of death in the USA, and if current trends continue, HCC is expected to overtake other cancer-related causes of death by 2030 to rank third. The age at presentation for HCC in India spans from 40 to 70 years, and the age adjusted incidence rate for males is 4 to 7.5 and 1.2 to 2.2 per 100,000 people per year, respectively, according to the data that are currently available.

The following risk factors for HCC were highlighted in an interview with HT Lifestyle by Dr. Vikram Raut, Director of Liver Transplantation and HPB Surgery at Medicover Hospitals in Navi Mumbai:

1. Infection with the Hepatitis B virus

When parking, always place a plastic bottle on your tyres. Here’s why. Parents | In Asia and Africa, sponsored HBV infection causes 60% of instances of HCC. Although the majority of patients with HBV-induced HCC have cirrhosis at presentation, HBV raises the risk of HCC even in the absence of cirrhosis. Patients in early 30s or 40s in Africa present with HCC, most likely as a result of exposure to aflatoxin B1, which increases the risk of HCC by working in concert with HBV. In some regions of Asia, HCC incidence has decreased as a result of HBV vaccination programmes, while many countries have not yet started universal immunisation campaigns.

2. Infection with the hepatitis C virus

In North America, Europe, and Japan, chronic HCV infection is the most prevalent underlying liver disease among individuals with HCC. An increasing number of HCV-infected patients are being successfully treated with direct-acting antiviral (DAA) therapy to achieve an SVR, which lowers the risk of HCC by 50–80%. However, many patients, particularly those who are members of racial or ethnic minorities or who come from underdeveloped socioeconomic areas, have not yet had their HCV status tested and are still unaware that they are infected. Additionally, even after SVR, patients with HCV-induced cirrhosis continue to have a high risk of developing HCC (>2% per year) and should be closely monitored.

3. Liquor

Cirrhosis, HCC, and alcoholic liver disease are all results of excessive alcohol consumption. Currently, cirrhosis from persistent alcohol use or NASH affects a growing number of people. Depending on the location, alcohol-related cirrhosis accounts for between 15% and 30% of HCC cases each year, with yearly incidence ranging from 1% in population-based studies to 2-3% in tertiary care referral centres. Chronic alcohol use can also raise the risk of HCC from other causes. For instance, multiple studies show that HBV carriers who drink more than those who don’t have a higher chance of developing HCC. Despite the fact that drinking alcohol and other forms of cirrhosis, particularly NASH, share many pathophysiological processes, there is evidence to support separate alcohol-specific pro-tumorigenic mechanisms in individuals.

4. NASH

NASH, which serves as the precursor stage in the development of HCC in patients with diabetes mellitus or obesity, is another common aetiological reason for cirrhosis in humans. NASH is now the most frequent cause of cirrhosis in most parts of the world due to the rising incidence of obesity. Since 2010, the percentage of HCC attributable to NASH has grown quickly, accounting for 15–20% of cases in the West today. Although the annual incidence of HCC is lower in NASH-related cirrhosis (1-2% per year) than in viral-mediated cirrhosis (3-5% per year), it is still >1.1 per 100 person-years, demonstrating the cost-effectiveness of surveillance and the need for its implementation.

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