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Hepatocellular Carcinoma (Hcc)

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Epidemiology of HCC for George Washington University Cancer Epidemiology Class

Epidemiology of HCC for George Washington University Cancer Epidemiology Class


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