Hepatocellular carcinoma associated with chronic hepatitis B and C: pathogenesis, treatment and prevention

Primary liver cancer, of which hepatocellular carcinoma (HCC) is the domina nt histological subtype, is the third most common cancer in males and the s ixth most common cancer in females world-wide. The differing geographical p revalence of HCC in high and low incidence areas of the world reflects the varying prevalence of HBV and HCV infection. Chronic infection with the hep atitis virus (types B and C) is an important cause of HCC accounting for ap proximately 77% of cases. HCC is difficult to treat and has a poor prognosi s with most tumours diagnosed at an advanced stage. The pathogenesis of bot h HBV- and HCV-related HCC is poorly understood, restricting the identifica tion of targets for treatment. Primary or secondary prevention of HBV throu gh vaccination should dramatically reduce the number of cases of HBV-associ ated liver disease and HCC. Unfortunately no vaccine exists for the prevent ion of HCV. Treatment of individuals already chronically infected with hepa titis B or C is important from the perspective of public health to limit sp read, and to the individual to prevent progression to cirrhosis or carcinog enesis. However, because of the high cost of the currently available agents , the restrictive eligibility criteria usually used for their use and the e xtensive adverse effects associated with them, this will remain a challenge to the medical and allied professions. (C) 2000 Lippincott Williams & Wilk ins.