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.
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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
- 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.
