HBV and HCC : should we treat both or leave ?

1. Gastroenterologist , Hepatologist
Qabbary Specialized Hospital

2. Case 1
Female patient 30 years old presented to HBV Clinic with the following inv.
HBV PCR 1500
ALT 33
AST 40
HBeAg negative
Pelvi abd u/s unremarkable
Fibro scan F1
no past history of other disease or drug intake
Family Hx. Reveals HCC (in the father ) IDDM (mother)
What will be your recommendation to the patient about the treatment?
1- treatment of HBV is indicated
2- treatment is not indicated now and only followup is recommended

4. Case 2
male patient 55 years old presented to HBV Clinic with the following inv.
HBV PCR 700
ALT 50
AST 66
HBeAg negative
Pelvi abd u/s reveals HFL
Triphasic CT reveals HCC
After consultation to the HCC council in HCC clinic , the patient treated with surgical
resection
3 months later the patient visit HBV clinic
What will be your recommendation to the patient about the treatment?
1- treatment of HBV is indicated
2- treatment is not indicated now and only followup is recommended
3- assessment of the degree of cirrhosis is indicated by fibro scan or liver biopsy

6. Epidemiology
Global maps showing the
close similarity between the
geographical distributions of
chronic hepatitis B virus
infection and
hepatocellular carcinoma

15. The Necessity of Antiviral Treatment on
HBV-Related HCC
1. The Impact of Antiviral Therapy on HBV Load for HBV Related HCC.
Antiviral treatment may render patients with HBV-related HCC better
able to tolerate HCC treatments and may improve prognosis.
2. The Impact of Antiviral Therapy on Perioperative Liver
Function for HBV-Related HCC
Recent reports found that an effective preoperative anti-HBV therapy
could contribute to improve liver function ,
resulting in improving the cumulative survival rate.

16. 3. The Impact of Antiviral Therapy on Postoperative
Recurrences for HBV-Related HCC.
to confirm the efficacy of nucleotide analogs against the
recurrence of HCC, further studies with a larger number of
patients and longer follow-up period are needed to address
this question.
4. The Antiviral Therapy on the Overall Survival for HBV
Related HCC.
the overall survival was improved for those patients with
postoperative antiviraltherapy.
antiviral therapy may serve as a cost-effective and
favorable alternative to improve the prognosis of patients

17. Liver cancer is the fifth most common cancer
and the second most frequent cause of cancer-related death
globally
(EASL ,AASLD 2018)

18. Prevention of HCC

22. EASL 2018
Diagnosis
A- Non-invasive
1- tumor markers
2- Imaging
B- invasive (Biopsy)

24. tumor markers

25. AFP
is principally the result of production by the tumor or by
regenerating hepatocytes. Therefore, AFP levels are also
frequently elevated in
1-chronic active hepatitis C (levels of 200-300 ng/mL are not
uncommon), but they tend to fluctuate and do not progressively
increase
2-following liver resection (transient until regeneration complete)
3-recovery following toxic injury
4-seroconversion following hepatitis B infection (typically inducing
transient exacerbation of inflammation)
AFP is 75-91% specific, and values greater than 400 ng/mL are
generally considered diagnostic of HCC in the proper clinical
context, including appropriate radiologic findings.

27. AFP-L3
 is an isoform of (AFP)
 AFP can be fractionated by affinity electrophoresis into 3 glycoforms: L1, L2, and L3
 its shows little diagnostic value in HCC patients with a total serum AFP concentration
below 20ng/mL
Des-γ-carboxyprothrombin (DCP)
 also known as protein induced by vitamin K absence/antagonist-II (PIVKA-II)
 is an abnormalform of prothrombin which promotes the malignant proliferation of
HCC cells
Squamous cell carcinoma antigen (SCCA)
Hepa-IC is ELISA Kit for the detection of Squamous Cell Carcinoma Antigen variants
Immune Complexes (SCCA-IgM)

31. Clinical Staging
 Numerous staging systems
TNM
Okuda
CLIP
BCLC
 Incorporate 4 determinats of survival
1-Sererity of underlying liver disease
2-Size of tumor
3-extension of tumor in to adjacent structure
4-Presence of metastasis