LIVER CANCER

1. HEPATITIS B VIRUS AND LIVER CANCER Biju Pottakkat MS,MCh (GI Surgery), DNB, MNAMS,FICS, PDF (Hepato-biliary Surgery) Department of Surgical Gastroenterology, JIPMER, Puducherry

4. Liver cancer

5. 10% of chronic hepatitis to cirrhosis in 5 years 6.5% Cancer in 5 years 130 million carriers 30 million chronic infection

6. 42 million chronic hepatitis B 60% of liver cancers- HBV related 5.9 liver cancers per 100000 population

8. HEPATOCELLULAR CANCER 620000 CASES/YEAR 595000 DEATHS /YEAR

9. International agency for research on cancer (IARC) Hepatitis B vaccine – first anticancer vaccine

10. Hepatocellular cancer- Risk factors HBV,HCV

13. Pathogenesis

14. Phenotypically altered precursor nodules Dysplastic hepatocytes HBsAg laden ground glass hepatocytes

15. Minimal symptoms

16. Symptoms related to cirrhosis Portal vein thrombosis

18. Diagnosis

21. Screening = early detection? Randomised screening- Haimen, China, 1993-1997, Chronic HBV infected Size of tumor Screened (%) Case group (%) <2 cm 8 3 2-5 cm 26 18 >5 cm or multifocal 66 79

25. Therapies

27. Cirrhosis Normal Intra-operative problems

28. Modified techniques

29. Interferon and HCC Did not decrease the incidence in HBV Did not improve one year over all survival

30. Antiviral as adjuvant therapy

31. 65% are not aware that they have HBV infection……….(and can develop cancer)