Direct risk factors
- Cirrhosis of liver
- Chronic Hepatitis B virus (HBV) infection
- Chronic Hepatitis C virus (HCV) infection
- Alcohol consumption
- Aflatoxin exposure
Associated risk factors
- Diabetes mellitus
- Non-alcoholic fatty liver disease (NAFLD)
Possible risk factors
Currently data is insufficient to implicate any genetic risk factor for HCC in India.
Prevention of HCC
- Hepatitis B vaccination is recommended to all newborns and high risk groups
- Universal precautions to avoid transmission of blood borne viruses in healthcare settings should be adopted.
- Testing of blood and blood products for HBV and HCV is mandatory and must be followed.
- Healthy life-style should be encouraged including prevention of obesity and alcohol abuse.
- Encourage control of metabolic conditions, such as diabetes and NAFLD.
- Antiviral therapies aimed at maintaining HBV suppression in patients with chronic hepatitis B and achieving sustained viral response in patients with chronic hepatitis C should be recommended to all those who are candidates for antiviral therapy, because these measures have succeeded in preventing progression to cirrhosis, and HCC development.
- In patients with HBV cirrhosis with high viral load there is evidence that antiviral therapy helps in preventing HCC development and is recommended.
In patients with HBV cirrhosis with low viral load antiviral therapy can be given, however, currently data is not strong in its role in HCC prevention.
- HCC surveillance can detect early tumors that are potentially amenable to treatment; hence, all patients at risk of developing HCC and who are eligible for HCC therapy are candidates for regular HCC surveillance.
- Level of awareness and attitude of physicians managing patients of chronic liver disease (CLD) is a major factor in surveillance of HCC; there is a need for greater healthcare provider awareness and utilization of nurse coordinators to improve delivery of HCC surveillance.
- Following patients should be subjected to surveillance forHCC:
- Child's A and B cirrhotic patients of any etiology
- Child's C cirrhotic patients of any etiology who are listed for liver transplantation
- Patients without cirrhosis:
- Patients with chronic hepatitis B: males >40 years and females >50 years
- Patients with chronic HBV infection of any age with family history of HCC
- Chronic HCV with advanced fibrosis.
- Six-monthly ultrasound abdomen by experienced personnel is the recommended surveillance test.
- Serum alfa-fetoprotein has no additive role in surveillance.