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Hepatocellular carcinoma
Causes and risk factors

Hepatitis B virus

High titres of HBsAg and HBcAb are frequently found in patients with hepatocellular carcinoma. The close geographic relationship between hepatitis B incidence and hepatocellular carcinoma rates is well recognized. In endemic areas of HCC is increased 140 fold in HBsAg carriers. Anti-HBcAb was found in the serum of up to 90% of cases in the Far East.

Cirrhosis

Hepatocellular carcinoma is associated with cirrhosis in 50% to 80% of patients, alcoholism being the most common cause of hepatic cirrhosis. While 5% of cirrhotic patients eventually develop hepatocellular cancer, which is often multifocal.

Aflatoxin

Aflatoxin has also been implicated as a factor in the etiology of primary liver cancer in parts of the world where this mycotoxin occurs in high levels in ingested food.

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Other factors

• Oral contraceptive use for 8 or more years is associated with increased risk of HCC.
• Cigarette smoking, alcohol intake, diabetes and insulin intake appear to be significant risk factors.
• Mutations of p53 tumor suppressor gene have been reported in 50% of the cases.
• Workers who were exposed to vinyl chloride before controls on vinyl chloride dust were instituted developed sarcomas in the liver, most commonly angiosarcomas.

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