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. 2012 Oct;12(10 HCC):e6023.
doi: 10.5812/hepatmon.6023. Epub 2012 Oct 10.

Hepatocellular carcinoma in pakistan: where do we stand?

Amna Subhan Butt  1 , Zaigham Abbas, Wasim Jafri
Affiliations

Hepatocellular carcinoma in pakistan: where do we stand?

Amna Subhan Butt et al. Hepat Mon. 2012 Oct.

Abstract

Context: From the 1970s till the mid 1990s, hepatitis B was the most common etiological factor for hepatocellular carcinoma (HCC) in Pakistan. Afterwards, a shift in HCC etiology was observed with a steady rise in hepatitis C virus (HCV) related HCC cases. HCV-3a, which is the most prevalent genotype, is also most frequent in HCV related HCC. There was an increase in the proportion of non-B non-C (NBNC) HCC cases as well, which might be attributed to an increase in non-alcoholic fatty liver disease.

Evidence acquisition: The age-standardized rate for HCC is 7.64/100 000 in males and 2.8/100 000 in females. Male to female ratio is 3.6:1. Usual age of presentation is in the fifth and sixth decade. Most patients present with advanced disease, as they are not in a regular surveillance program. This is more so for patients with NBNC chronic liver disease. As many sonologists in Pakistan are practicing without sufficient training to pick up early lesions, alpha-fetoprotein is still recommended to compliment ultrasound in the surveillance of HCC.

Results: Majority of HCC patients present with nonresectable disease. Interventions such as transarterial chemoembolization, radiofrequency ablation, resection and chemotherapy including sorafenib are available in selected centers. Pakistan appears to be in an area of intermediate endemicity for HCC. There is a need for population based epidemiological studies to estimate the exact disease burden.

Conclusions: Measures to prevent the spread of hepatitis C and B can slow down the epidemic rise in the incidence of HCC in the coming decades. There is a need to implement a proper surveillance program to identify HCC cases at an early stage.

Keywords: Carcinoma, Hepatocellular; Hepatitis C; Pakistan.

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Figures

Figure 1.
Figure 1.. Distribution of HCC Cases, 1970-2011
Figure 2.
Figure 2.. Comparison of Hepatitis B and C Related HCC and NBNC-HCC During 1970-2011
Figure 3.
Figure 3.. Comparison of Various Etiological Factors for HCC, 1970-2011
Figure 4.
Figure 4.. Comparison of Hepatitis B and C related HCC and NBNC-HCC during Different Time Intervals
See this image and copyright information in PMC

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References

    1. Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer. 2006;118(12):3030–44. doi: 10.1002/ijc.21731. - DOI - PubMed
    1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55(2):74–108. doi: 10.3322/canjclin.55.2.74. - DOI - PubMed
    1. Raza SA, Clifford GM, Franceschi S. Worldwide variation in the relative importance of hepatitis B and hepatitis C viruses in hepatocellular carcinoma: a systematic review. Br J Cancer. 2007;96(7):1127–34. doi: 10.1038/sj.bjc.6603649. - DOI - PMC - PubMed
    1. Ogunbiyi JO. Hepatocellular carcinoma in the developing world. Semin Oncol. 2001;28(2):179–87. doi: 10.1016/S0093-7754(01)90090-9. - DOI - PubMed
    1. Donato F, Boffetta P, MA P. Metaanalysis of epidemiological studies on the combined effect of Hepatitis B and C virus infections in causing hepatocellular carcinoma. Int J Cancer. 1998;75:347–54. - PubMed

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