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Screening for hepatocellular carcinoma
1Department of Medicine, Hospital Kuala Lumpur.
Insights
Early screening for hepatocellular carcinoma (HCC) in high-risk Asian males, particularly those with hepatitis B or C, improves detection and survival rates. Regular screening with ultrasound and AFP testing is recommended for at-risk individuals.
Area of Science:
- Hepatology
- Oncology
- Public Health
Background:
- Hepatocellular carcinoma (HCC) is a prevalent cancer in Asian males, often diagnosed late with poor prognosis.
- Cirrhosis associated with hepatitis B and C infections are common risk factors for HCC.
- Late diagnosis in Malaysia leads to a high mortality rate within months of detection.
Purpose of the Study:
- To evaluate the effectiveness of screening for early detection of hepatocellular carcinoma (HCC).
- To identify high-risk populations for HCC screening.
- To discuss the impact of screening on survival rates and compare regional outcomes.
Main Methods:
- Review of current screening practices for HCC, including serum alpha-fetoprotein (AFP) and abdominal ultrasound.
- Analysis of survival rates based on tumor size and treatment modality (surgical resection).
- Discussion of cost-effectiveness and regional variations in HCC screening efficacy.
Main Results:
- Early detection of small HCC tumors (<5 cm) through screening significantly improves survival rates, with 5-year survival reaching 68% after resection.
- Smaller tumors (<2 cm) yield better outcomes.
- Screening is most effective in high-incidence regions and for specific high-risk groups (e.g., >45 years with chronic hepatitis B/C, cirrhosis, or family history).
Conclusions:
- Screening for HCC is beneficial for early detection and improved survival, especially in high-risk populations.
- Regular screening every 3-6 months is recommended for individuals with chronic hepatitis B/C, cirrhosis, or family history.
- Primary prevention through hepatitis B vaccination and HCV screening holds significant long-term promise for HCC control.
Abstract:
Hepatocellular carcinoma (HCC) is one of the commonest cancers in Asian males. In Malaysia, it is one of the ten most common cancers amongst the male population. Most of our patients with HCC present to us rather late and almost all die within 4 months of diagnosis. HCC occurs more commonly in patients with cirrhosis associated with hepatitis B and C infections. Screening for HCC can lead to early detection of small tumours (< 5 cm) that are more amenable to surgical resection, resulting in improved survival rates. The average 5-year survival rate for those who have undergone surgical resection is 68% (range, 22-73%). Better results are obtained with the smaller tumours (< 2 cm in diameter). Patients with chronic hepatitis B and C infection especially those who are > 45 years of age, who have concomitant cirrhosis or have a family history of HCC should be examined every 3-6 months with periodic serum alpha-fetoprotein (AFP) measurements and abdominal ultrasound examinations. Abdominal ultrasound is useful in the detection of small tumours. While mass screening for HCC is not cost-effective in countries of low incidence of HCC, screening of high risk groups may be justified in countries with a high endemicity of HBV infection. Screening for HCC in Japan, Taiwan and China appears to yield better results than those in the West. Nonetheless, primary prevention with mass hepatitis B vaccination and blood donor screening for anti-HCV is expected to make a much greater impact in the control of HCC in the years to come.