Hepatocellular Carcinoma in Pakistan: An Insight into Future

Abstract

Carcinoma (HCC) is one of the most prevalent type of cancer across the world and constitutes around 7% of all cancers. Approximately 750,000 new cases of liver cancer are reported per year globally [1,2]. The incidence of HCC increases with age and is highest in people aged around 70 years [2]. The distribution and onset of HCC varies significantly in different geographical regions of the world, might be due to causative factors and genetic makeup of the inhabitants. Among the risk factors for HCC, Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are well-known and their role is well established. Majority of HCC are viral borne and HBV/HCV are the main culprits behind 80% HCC globally [1]. Infection with HBV and HCV is one of the prominent source of chronic liver infections worldwide. It is estimated that approximately 350 million individuals are HBV and 200 million individuals are HCV carriers globally [3,4].Although the knowledge about the molecular virology of these viruses is well established, the molecular mechanism from acute infection to HCC development are still not well known. The research data showed that HCC is a typical inflammation-related cancer but the exact mechanism is still not clear. Viral induced liver injury is mainly due to human immune response against viruses and there is no evidence that viral replication plays any role in liver injury directly [5]. T cells are recruited to liver during the acute stage of HBV and HCV infection. These cells are the key players in anti-viral immune response and help for resolution of infection as well as prevents development of chronic infection. However, there are studies supporting the role of these T cells in liver injury during HBV and HCV infection [6,7]. In liver injury the pathological process resulted into hostile environment which leads to survival of intrahepatic stem cells, also known as hepatic progenitor cells (in humans) rather than the regenerated hepatocytes. Abnormal dedifferentiation of hepatic progenitor cells during HBV/HCV infection under the influence of immune cells and certain cytokines, may lead to the tumorigenesis of human hepatocellular carcinoma [8,9].Pakistan is a country with very high burden of viral hepatitis. Available data showed that there are around nine million HBV [10] and 11 million HCV carriers in Pakistan [11,12]. It is difficult to study the natural history of these diseases. The asymptomatic infection, difficulty to ascertain exact time of infection onset, data collection from general population, different risk groups and persons with multiple risk factors make it more difficult to generalize the natural history of the disease to whole country or whole population. However, it can be estimated that around 5% to 10% of chronic virally infected individuals develop HCC [13]. In recent years HBV infection goes down probably due to massive vaccination campaign by Government but the burden of HCV is on raise. Although the country is endemic for these infections but data regarding the prevalence of HBV and ...

Platelets’ RNA as biomarker trove for differentiation of early-stage hepatocellular carcinoma from underlying cirrhotic nodules

“…Among the HCC cases, 17 were HCV-mediated while only 3 were HBV-mediated, and 14 cases of cirrhosis were mediated by HCV infection, 2 were HBV-mediated and 4 had cryptogenic cirrhosis. This correlates to the fact that most common etiology of cirrhosis and HCC in Pakistan is HCV [ 23 ].…”