Hepatocellular Carcinoma (Hcc)


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Epidemiology of HCC for George Washington University Cancer Epidemiology Class

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Hepatocellular Carcinoma (Hcc)

  1. 1. Hepatocellular Carcinoma (HCC): Examining Hepatitis C Virus (HCV) as a Risk Factor Ms. Jamie D. Ritchey Public Health 238 Cancer Epidemiology May 2002
  2. 2. Differing forms of malignant, benign, and tumor-like neoplasms of the liver <ul><li>Malignant: </li></ul><ul><li>1) Hepatocellular Carcinoma </li></ul><ul><li>2) Hepatoblastoma </li></ul><ul><li>3) Bile duct (cholangio-) carcinoma </li></ul><ul><li>4) Angiosarcoma </li></ul><ul><li>Benign/tumor-like neoplasms: </li></ul><ul><li>1) Hemangioma </li></ul><ul><li>2) Hepatocellular adenoma </li></ul><ul><li>3) Infintile Hermangioendothelimoa </li></ul><ul><li>4) Mixed hamartema </li></ul><ul><li>5) Mesenchymal hamaratoma </li></ul><ul><li>6) Focal nodular hyperplasia </li></ul><ul><li>7) Nodular regenerative hyperplasic </li></ul>1.        U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. What you Need to Know About Liver Cancer. NIH publication No. 01-5009. September 2001.   2.        Fraumeni JF Jr, Hoover RN, Devesa SS, Kinlen LJ. Epidemiology of Cancer. In:DeVita VT, Hellman S, Rosenberg SA, eds. Cancer principles and practices of oncolgy, 4 th edition. Philadelphia: Lippincott, 1993; 150-81.   3.        Schottenfeld, David and Fraumeni, Joseph F., eds. London, Thomas W. McGlynn, Katherine A Cancer Epidemiology and Prevention: Liver Cancer. Oxford University Press, 2 nd ed., 1996. Pp 772-521.
  3. 3. Descriptive Epidemiology of HCC <ul><li>4 th most common cancer in the world </li></ul><ul><li>HCC Accounts for approx. 75% of liver cancers </li></ul><ul><li>Estimated to kill 14,100 Americans in 2002 </li></ul><ul><li>Most common cancer in some countries: Asia and Africa </li></ul><ul><li>China, Thailand, and Egypt reporting the highest rates internationally </li></ul>
  4. 4. Analytical Epidemiology of HCC: Risk Factors <ul><li>Hepatitis Viruses </li></ul><ul><li>Alcohol Consumption </li></ul><ul><li>Aflatoxin </li></ul><ul><li>Anabolic Steroids and Birth Control pills </li></ul><ul><li>Vinyl Chloride </li></ul><ul><li>Clonorchis siensis </li></ul><ul><li>Arsenic </li></ul><ul><li>Patenteral antischistosomal therapy (PAT)-Egypt </li></ul><ul><li>Gender </li></ul><ul><li>Race </li></ul><ul><li>Hemochromatosis and Tyrosinemia </li></ul>
  5. 5. Hepatitis Viruses <ul><li>Hepatitis A: not a risk factor for HCC </li></ul><ul><li>Hepatitis B </li></ul><ul><li>Hepatitis C </li></ul><ul><li>Hepatitis D: requires co-infection with HBV </li></ul><ul><li>Hepatitis E </li></ul><ul><li>Hepatitis F: unknown virology and clinical outcome </li></ul><ul><li>Hepatitis G: does not seem to progress </li></ul>
  6. 6. Basics of HCV <ul><li>In the Flaviviridae virus family, genus Hepaivirus </li></ul><ul><li>9.6 kilobase pairs in length </li></ul><ul><li>At least six major genotypes, more than 30 subtypes </li></ul><ul><li>Difficult to culture in vitro -life cycle is poorly understood </li></ul><ul><li>Discovered in 1989, Michael Houghton and Chiron Corp. </li></ul>
  7. 7. HCV Epidemiology <ul><li>Risk Groups/Factors: </li></ul><ul><li>Injection drug users </li></ul><ul><li>Hemodialysis patients </li></ul><ul><li>Health care workers </li></ul><ul><li>Multiple Sex partners </li></ul><ul><li>Tattooing </li></ul><ul><li>Recipients of blood transfusions before 1992 </li></ul><ul><li>Recipients of clotting factors prior to 1987 </li></ul><ul><li>CDC est. 3.9 million Americans are infected, 1.8% pop. </li></ul><ul><li>WHO est. HCV 3% world pop., 170 million chronic carriers </li></ul><ul><li>HCV is leading indicator for transplantation </li></ul><ul><li>No vaccine </li></ul><ul><li>Blood supply screening for HCV began in early 1990’s </li></ul>
  8. 8. http://www.brown.edu/Courses/Bio_160/Projects2000/HepatitisC/hcvepidemiology.html
  9. 9. HCV <ul><li>“ There are currently no prospective studies comparing the incidence of HCC in a population with HCV induced cirrhosis versus non-infected individuals, so no calculation of a RR is possible.” </li></ul>Sherman M. Surveillance of Hepatocellular Carcinoma. Semin Oncol 2001; 28 (5) 450-459.
  10. 10. HCV Clinical Stages (points for intervention) <ul><li>Acute Infection </li></ul><ul><li>Chronic Infection: 75-80% do not clear the virus with in a 6 month period </li></ul><ul><li>Cirrhosis: 20-50% of individuals progress </li></ul><ul><li>HCC: 1-5% of individuals infected with HCV </li></ul>
  11. 11. Hepatitis Infected liver http://www.brown.edu/Courses/Bio_160/Projects2000/HepatitisC/hcvepidemiology.html                                         
  12. 12. Clinical Epidemiology HCV Diagnosis and screening methods <ul><li>Alanine aminotransferase levels (ALT) </li></ul><ul><li>Enzyme immunoassay (EIAs) (EIA-3) </li></ul><ul><li>Detects for core proteins: NS3, NS4, NS5 </li></ul><ul><li>Recombinant immunoblot assays (RIBAs) </li></ul><ul><li>PCR </li></ul>
  13. 13. Treatments HCV infection <ul><li>No cure </li></ul><ul><li>Interferon-alpha 2b </li></ul><ul><li>Ribavirin </li></ul><ul><li>Combination therapy </li></ul><ul><li>Pegylated interferon </li></ul>
  14. 14. HCV leading to HCC <ul><li>HCC really is two-fold: a virulent cancer, and, a chronic disease. </li></ul><ul><li>HCV not found to be directly carcinogenic </li></ul><ul><li>Poorly understood lifecycle is a challenge for researchers-proposed life cycle is in existance </li></ul>
  15. 15. HCC
  16. 16. Clinical Epidemiology HCC diagnosis screening tests <ul><li>Alpha-fetoprotein test (AFP) </li></ul><ul><li>Ultrasonography </li></ul><ul><li>Computed tomography (CT) and Magnetic resonance imaging (MRI) </li></ul><ul><li>Liver Biopsy </li></ul>
  17. 17. Tertiary Prevention: treatment options for HCC <ul><li>Surgical Resection </li></ul><ul><li>Tumor Ablation or Embolization </li></ul><ul><li>Brachytherapy </li></ul><ul><li>Chemotherapy </li></ul><ul><li>Liver transplantation </li></ul>
  18. 18. Recommendations for primary prevention <ul><li>National HBV vaccination programs need to be implemented in all countries with high rates of HBV </li></ul><ul><li>Aflatoxin infection incorporated into nutrition programs </li></ul><ul><li>Screening the blood supply and all blood products from HBV and HCV </li></ul>
  19. 19. Research continuation <ul><li>Vaccine for HCV </li></ul><ul><li>Role of sexual transmission of HCV investigated further in case-control and cohort studies </li></ul><ul><li>Role of arsenic further investigated in prospective study </li></ul>
  20. 20. Thank You for your attention Questions?