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Hepatitis Monthly

Official Journal of Research Center for Gastroenterology and Liver Diseases

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https://doi.org/10.5812/hepatmon.6023

Hepatocellular Carcinoma in Pakistan: Where do We Stand?

Author(s):
Amna Subhan ButtAmna Subhan Butt1,*, Zaigham AbbasZaigham Abbas1, Wasim JafriWasim Jafri1
1Section of Gastroenterology, Department of Medicine, The Aga Khan University Hospital, [email protected], 74800, Pakistan
Hepatitis Monthly:Vol. 12, issue 10; 6023
Published online:Oct 10, 2012
Article type:Review Article
Received:Nov 29, 2011
Accepted:Apr 05, 2012
How to Cite:Butt A, Abbas Z, Jafri W. Hepatocellular Carcinoma in Pakistan: Where do We Stand?. Hepat Mon. 2012;12(10):6023. doi: https://doi.org/10.5812/hepatmon.6023

Abstract

Context:

From the 1970s till the mid 1990s, hepatitis B was the most common etiological factor for hepatocellular carcinoma (HCC) in Pakistan. Afterwards, a shift in HCC etiology was observed with a steady rise in hepatitis C virus (HCV) related HCC cases. HCV-3a, which is the most prevalent genotype, is also most frequent in HCV related HCC. There was an increase in the proportion of non-B non-C (NBNC) HCC cases as well, which might be attributed to an increase in non-alcoholic fatty liver disease.

Evidence Acquisition:

The age-standardized rate for HCC is 7.64/100 000 in males and 2.8/100 000 in females. Male to female ratio is 3.6:1. Usual age of presentation is in the fifth and sixth decade. Most patients present with advanced disease, as they are not in a regular surveillance program. This is more so for patients with NBNC chronic liver disease. As many sonologists in Pakistan are practicing without sufficient training to pick up early lesions, alpha-fetoprotein is still recommended to compliment ultrasound in the surveillance of HCC.

Results:

Majority of HCC patients present with nonresectable disease. Interventions such as transarterial chemoembolization, radiofrequency ablation, resection and chemotherapy including sorafenib are available in selected centers. Pakistan appears to be in an area of intermediate endemicity for HCC. There is a need for population based epidemiological studies to estimate the exact disease burden.

Conclusions:

Measures to prevent the spread of hepatitis C and B can slow down the epidemic rise in the incidence of HCC in the coming decades. There is a need to implement a proper surveillance program to identify HCC cases at an early stage.

Keywords
Carcinoma
Hepatocellular
Pakistan
Hepatitis C

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