Natural history of hepatocellular carcinoma in cirrhotics.

Raja, S (2011) Natural history of hepatocellular carcinoma in cirrhotics. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION : Hepatocellular carcinoma (HCC) is a major health problem worldwide, due to its high incidence (approximately 600 000 new cases in 2008), and high rates of Mortality. It results in 598 000 deaths per year worldwide.(1) The incidence of HCC is increasing in almost all geographical areas and this neoplasm currently represents the third cause of cancer related death. In >90% of the cases, cirrhosis of any aetiology underlies HCC and the development of HCC constitutes their most frequent cause of death. Overall, 75–80% of global HCC cases are due to hepatitis B virus (HBV) (50–55%) or hepatitis C virus (HCV) (25–30%). The identification that chronic liver disease is the relevant risk factor for this tumor, has made surveillance campaigns aimed at early detection of HCC possible and surveillance is now universally recognized to be the practical approach for improving treatment of HCC patients. From a global perspective, the two most important risk factors for HCC are chronic hepatitis B and C infection. The geographic distribution patterns of HCC and HBV almost coincide with each other. Recent studies demonstrated that the Taiwanese mass vaccination program against HBV has significantly reduced the carrier rate of HBsAg in children and adolescents and, as anticipated, the incidence of childhood HCC. A substantial decrease in HCC incidence in adults may be observed in 3–4 decades. In contrast, the incidence of HCC has risen in the past 10–20 years in several developed countries such as the United States, Japan, England, and France where HBV is not endemic. Recent review suggested that a cohort effect related to HCV infection may likely contribute to the increasing disease burden in these countries. In India, the mean incidence of HCC in four population-based registries is 2.77% for males and 1.38% for females. The prevalence of HCC in India varies from 0.2% to 1.6%. The characteristics of patients with HCC are influenced by the etiology and the status of the underlying liver disease. The understanding of its natural history may influence the prognosis and choice of treatment. Most of the published literatures were retrospective studies and moreover limited number of studies available for South Indian population. AIMS & OBJECTIVE OF THE STUDY To prospectively study the natural history of Hepatocellular Carcinoma in patients with cirrhotic background in a tertiary care hospital. CONCLUSION : 1) Age above 59 years, male sex, longer duration and more advanced stage of cirrhosis were significant risk factors for HCC in anti-HCV positive cirrhotic patients, while none of these variables were significant risk factors for HCC in HBsAg positive patients. 2)high AFP fetoprotein predicts early development of HCC in cirrhotics. 3)higher risk for infiltrative / diffuse but not for nodular HCC is seen in patients with HBV infection and with HBV/HCV coinfection. 4) mean duration of survival after the diagnosis is <9 months. 5) The paraneoplastic manifestations are distinctly rare. 6) HCC is diagnosed very late and presents with vascular invasion or metastases in most of the cases. 7) Since HBV is one of most common etiologic agent, the universal vaccination against hepatitis B would prove an effective preventive strategy.

Item Type: Thesis (Masters)
Uncontrolled Keywords: hepatocellular carcinoma ; cirrhotics ; Natural history.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:18
Last Modified: 13 Jul 2017 04:18

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