Hepatocellular carcinoma

Causes and risk

Risk factor liver cirrhosis, chronic hepatitis B, haemochromatosis. Those three are the roads, and each is given its own weight:

• Chronic HBV infection: lifetime risk HCC around 20%, and risk of HCC varies with viral
• Chronic HCV infection can cause cirrhosis and is a risk factor for HCC, but HCV rarely causes HCC in the absence of cirrhosis
• Hereditary hemochromatosis is a genetic disorder of iron regulation and subsequent iron overload; possible end-organ damage includes cardiomyopathy, cirrhosis of the liver, and hepatocellular carcinoma

Who is put under surveillance, and how often

It is looked for before the patient has any symptom. The characteristics associated with an increased risk for HCC in patients with HBV, and which are indications for surveillance with US every 6 months, are cirrhosis, Asian men over 40 years and Asian women over 50 years, Black patients over 20 years, an elevated ALT level with HBV DNA levels >10,000 U/mL, and family history of HCC.

After hepatitis C the rule is the cirrhosis one: patients with cirrhosis should undergo sonography surveillance for HCC every 6 months.

What the screen is made of: US abdomen for lesion, serum AFP, 6 monthly.