JGH Open: A Summary of Risk Factors for Hepatocellular Carcinoma

Liver cell carcinoma (HCC), !---- a primary liver cancer, is the third leading cause of cancer-related deaths worldwide in 2019, with approximately 841,000 new cases and 782,000 deaths each yearthe global incidence of HCC is about 10.1 cases / 100,000 people - yearsglobally, 80 per cent of HCC cases occur in sub-Saharan Africa and East Asiathe main risk factors for HCC vary by regionit is worth noting that the incidence of HCC depends not only on race/ethnicity, gender, age and geographical/demographic factors, but also on several risk factors, such as cirrhosis, hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, excessive alcohol consumption, non-alcoholic fatty liver disease (NAFLD), obesity, diabetes, metabolic syndrome and environmental toxicitybased on the current research progress, HCC risk factors are summarized belowcirrhosis is the main risk factor for HCC, about 80% of hCC occurs on the basis of cirrhosispatients with cirrhosis had a 30-fold increased risk of Developing HCC compared to patients without cirrhosisAge-standardized cirrhosis-related mortality rose from 19.77 cases per 100,000 in 2007 to 23.67 per 100,000 in 2016, an annual growth rate of 2.3% (95% confidence interval 2.0-2.7), according to a study using the U.SCensus and the National Mortality Databasein order to reduce the incidence and fatality of liver cancer, patients with cirrhosis should strengthen early prevention, early diagnosis and early treatmentHBV infection with hepatitis B virus (HBV) infection is the leading cause of HCC in Endemic Asiapeople infected with chronic HBV may have a 5-100-fold increased risk of HCCin the early stages, HBV infection is asymptomatic, and 15%-40% of patients with chronic hepatitis B will progress throughout their lives with complications related to cirrhosis or cirrhosis, of which older men are at the highest riskdeath rate from HBV-related cirrhosis decreased by an average of 1.1% between 2007 and 2016Globally,, a total of 44 per cent of HCC cases can be attributed to chronic HBV infection, with the majority occurring in East Asia worldwide, the most common risk factor for liver cancer is chronic (long-term) infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) these infections can lead to cirrhosis and liver cancer, which is the most common cancer in many parts of the world hepatitis C infection is a common cause of HCC in the United States, while hepatitis B is more common in Asia and developing countries People infected with both viruses are at high risk of chronic hepatitis, cirrhosis and liver cancer if they are heavy drinkers, the risk is higher HCV infection increased the risk of HCC by 15-20 times compared to HBV the incidence of HCV-related HCC in was 1%-3% after 30 years of infection, mainly in patients with hepatic fibrosis or cirrhosis in the advanced period, and the annual incidence of HCC was 2%-4% once developed into cirrhosis lifestyle factors (alcohol and smoking) alcohol consumption as a major risk factor or in combination with HBV, HCV or diabetes, leading to an increased risk of HCC a five-fold increase in the risk of Developing HCC in those who drank more than 80g of alcohol per day for 10 consecutive years mortality from alcohol-related liver disease (ALD) cirrhosis increased by an average of 4.5 per cent per year between 2007 and 2016 worldwide, about 26% of HCC cases can be attributed to alcohol consumption men drink more alcohol than women alcohol abuse is the main cause of cirrhosis, which in turn is associated with an increased risk of liver cancer cigarettes contain more than 4,000 chemicals that can be toxic, mutated and carcinogenic several epidemiological studies have shown that smoking is a mild risk factor in HCC progression some of the chemicals in tobacco, such as 4-amino biphenyls and polycyclic aromatic hydrocarbons, produce active substances that cause HCC non-alcoholic fatty liver disease (NAFLD) is currently the most common liver disease, with a global prevalence rate of 25% NAFLD is often considered a non-progressive liver fat degeneration, rarely associated with liver complications However, at least 20%-30% of NAFLD patients are associated with necrotizing inflammation and fibrosis, 10%-20% of cases can progress towards cirrhosis, and some patients can progress further towards HCC in addition, 20 per cent of NAFLD-related HCC has no evidence of cirrhosis however, NAFLD patients face significantly lower risk of HCC than those with hepatitis C, hepatitis B and alcoholic cirrhosis 9% of hCC cases worldwide or are caused by obesity obesity is a metabolic disorder that increases the risk of HCC through chronic inflammation obesity is associated with higher fat decomposition rates, plasma free fatty acids and triglycerides obesity not only induces chronic inflammation that causes cancer, but also leads to changes in the endocrine system, which may increase the risk of NAFLD and HCC rising prevalence of NASH has in part contributed to the progression of obesity and obesity-related diseases, which in turn increases the risk of HCC The exact link between obesity and HCC risk is unclear However, recent studies have shown that obesity-related HCC has several molecular pathways these factors include insulin resistance, adipose tissue reconstruction, inflammatory cytokines and fat factor secretion, chronic inflammation, and changes in the gut microbiome that lead to elevated levels of insulin and insulin-like growth factors Diabetes and Metabolic Syndrome Diabetes and Metabolic Syndrome are associated with increased incidence of NAFLD and NASH, which ultimately increase the risk of cirrhosis and HCC about 7% of HCC cases worldwide can be attributed to diabetes A recent study estimated that people with a history of diabetes had a 2-3-fold increased risk of developing liver cancer According to U.S studies, type 2 diabetes is associated with an increased risk of HCC (HR, 4.59; 95% CI, 2.98-7.07), which increases with the duration of diabetes and combined metabolic diseases, which increases in older age and women with hepatitis C studies have shown that the use of metformin (1000 mg/d) reduces the risk of HCC, suggesting that metformin can be used as a preventive agent to improve The risk of HCC in patients with type 2 diabetes a better understanding of genetic and epigenetic changes in obesity may provide new targets for the treatment of HCC type 2 diabetes is associated with an increased risk of liver cancer, usually in patients with other risk factors, such as severe alcohol use and/or chronic toxic hepatitis this risk may increase because people with type 2 diabetes tend to be overweight or obese, which in turn can cause liver problems environmental toxin aflatoxin (AF) is a secondary metabolite produced by toxic strains such as aflatoxin and parasitic clostridium, and is a highly toxic substance these carcinogens are made from a fungus that contaminates peanuts, wheat, soybeans, peanuts, corn and rice stored in a humid, warm environment can lead to the growth of the fungus although this can occur almost anywhere in the world, it is more common in warm and tropical countries naturally contaminated foods, aflatoxin B1 (AFB1) is the most common and is one of the strongest known chemical carcinogens aflatoxin B1 exposure is an important factor in HCC developed countries such as the United States and Europe testtor the amount of aflatoxin in food Mutations in the tumor suppressor gene p53 can be detected exposure to high levels of AFB1 contamination of groundwater by chemicals such as trichloroethylene (TCE), cadmium, lead, nickel, radon and arsenic, as well as human exposure to organic solvents such as toluene, benzene and xylene, have all shown an increased risk of HCC Occupational exposure to chemicals such as dIchloroethylene (DDT) and nitrosamines is another risk factor for HCC these substances play a carcinogenic role by regulating the CYP3A1 gene and shortening the telomeres (by capping the end of each DNA chain to maintain chromosomal integrity) thorotrast, a chemical that has been injected into certain patients in the past as part of certain X-ray tests take steps to eliminate these chemicals or minimize their exposure when they are identified Thorotrast is no longer used and workers' exposure to vinyl chloride should be strictly regulated other factors of primary bile cirrhosis Certain types of autoimmune diseases affecting the liver can also cause cirrhosis , for example, a disease called primary bile cirrhosis (PBC) in PBC, the bile ducts in the liver are damaged or even damaged, leading to cirrhosis of the liver people with advanced Stage PBC are at high risk hereditary metabolic diseases certain hereditary metabolic diseases can lead to cirrhosis of the liver people with hereditary hemoglobinal disorder absorb too much iron from their food iron precipitates throughout the body's tissues, including the liver if enough iron accumulates in the liver, it can lead to cirrhosis and liver cancer diseases that increase the risk of liver cancer include tyrosine, Alpha1-antitryplastin deficiency, Porphyria cutanea tarda, glycogen storage disease, Wilson Disease References: 1 Thylur RP, Roy SK, Shrivastava A, LaVeist TA, Shankar S, Srivastava RK Assessment of the risk factors, and racial and ethnic serifs inocellular carcinoma JGH Open 2020;4(3):351-359 Published 2020 Apr 15 doi:10.1002/jgh3.12336 Source: MedSci Original !-- Content Presentation Ends - !-- Determine Whether login ends