Elsevier

The Lancet

Volume 353, Issue 9160, 10 April 1999, Pages 1253-1257
The Lancet

Seminar
Hepatocellular carcinoma

https://doi.org/10.1016/S0140-6736(98)09148-XGet rights and content

Summary

Hepatocellular carcinoma (HCC) for most patients is a terminal complication of chronic inflammatory and fibrotic liver disease. With regrettably few exceptions, treatment is largely palliative, and long-term survival is rare. However, the major causes of HCC worldwide are known and preventable. Hepatitis B and C exist only in man; the viruses have no known non-human reservoirs. Transmission of the viruses can be interrupted by vaccination against hepatitis B virus infection and improvements in medical techniques for hepatitis C, for which no vaccine has yet been developed.

Section snippets

Incidence

The burden of HCC is irregularly distributed in the world, for the most part following the prevalence of the hepatitis B virus. Of the estimated 350 000 new cases per year, one-third occur in China and another third elsewhere in Asia. There are about 30 000 cases per year in Europe and 23 000 in Japan; the USA has about 7000 cases per year and there are at least six times that number in Africa. Men are afflicted at least twice as often as women. Although HCC ranks eighth in frequency among

Presymptomatic trauma

Small HCCs (<2 cm) are histologically well-differentiated and arranged in a thin trabecular pattern without a capsule.18 These tumours are distinct from both the large cell and small cell dysplasias which at one time were thought to be the preneoplastic lesions of HCC.19, 20 The stepwise development of HCC is now thought to proceed from adenomatous hyperplasia through atypical hyperplasia to early hepatocellular carcinoma.21 However, because no consistent diagnostic criteria have been

Surgical resection

When HCC is diagnosed the first question faced by the patient and the clinician is—Can it be resected? A simple history and physical examination will exclude many patients from consideration for resection. Because most HCCs occur in cirrhotic liver, patients are in danger of decompensation or liver failure if an overaggressive resection is attempted. Most surgeons will attempt resection only if the patient has cirrhosis of Child-Pugh class A and a single definable tumour.34 Despite progress in

Screening

Because HCC tends to occur in a definable population (those with chronic hepatitis or cirrhosis) and because the outlook with advanced disease is so poor, it is tempting to postulate that screening of cirrhotic patients might yield individuals who could receive early and successful therapy. Patients with cirrhosis screened for HCC have an annual conversion rate of about 3% in western patients and 6% in Japanese patients.51, 52 Suggested strategies for screening have included periodic ultrasound

Prevention

The best news in HCC research is that the disease can be prevented. The strongest data come from Taiwan where, in 1984, neonatal vaccination began. For the first two years, only the children of HBsAg-positive mothers were vaccinated against HBV but after 1986 vaccination was universal. The rate of HCC in children aged 6–9 years decreased from 5·2 million before the programme to 1·3 per million in the first vaccinated cohort.54 Mass vaccination programmes in Hong Kong, Thailand, Indonesia, and

References (56)

  • AJG Hanley et al.

    Cancer mortality among Chinese migrants: a review

    Int J Epidemiol

    (1995)
  • S Fargion et al.

    Survival and prognostic factors in 212 Italian patients with genetic hemochromatosis

    Hepatology

    (1992)
  • GW Beebe et al.

    Study of the likelihood of hepatocellular carcinoma following the 1942 US Army epidemic of hepatitis B

  • J Summers

    Three recently described animal virus models for human hepatitis B virus

    Hepatology

    (1981)
  • P Marion et al.

    Hepatocellular carcinoma in ground squirrels persistently infected with ground squirrel hepatitis virus

    Proc Natl Acad Sci USA

    (1986)
  • V Lambert et al.

    Natural and experimental infection of wild ducks with DHBV

    J Gen Virol

    (1991)
  • C Goulliat et al.

    Woodchuck hepatitis virusinduced carcinoma as a relevant natural model for therapy of human hepatoma

    J Hepatol

    (1997)
  • K Okuda et al.

    Changing incidence of hepatocellular carcinoma in Japan

    Cancer Res

    (1987)
  • K Okuda

    Hepatitis B virus and hepatocellular carcinoma

  • I Imai et al.

    Relation of interferon therapy and hepatocellular carcinoma in patients with chronic hepatitis C

    Ann Intern Med

    (1998)
  • H Austin

    The role of tobacco use and alcohol consumption in the etiology of hepatocellular carcinoma

  • B Nalpas et al.

    Alcohol, hepatotrophic viruses and hepatocellular carcinoma

    Alcohol Clin Exp Res

    (1995)
  • A Takada et al.

    Characteristic features of alcoholic liver disease in Japan: a review

    Gastroenterol Jap

    (1993)
  • T Lasky et al.

    Hepatocellular carcinoma p53 GT transversions at codon 249: the fingerprint of aflatoxin exposure?

    Environ Health Perspect

    (1997)
  • The general rule for the clinical and pathological study of primary liver cancer

    (1992)
  • PP Anthony et al.

    Liver cell dysplasia: a premalignant condition

    J Clin Pathol

    (1973)
  • S Watanabe et al.

    Morphologic studies of the liver cell dysplasia

    Cancer

    (1983)
  • Y Kondo

    Pathology of early hepatocellular carcinoma and preneoplastic lesions in the liver

  • Cited by (0)

    View full text