Prevention and surveillance of hepatitis B virus-related hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is associated with hepatitis B virus (HBV) infection in approximately 50% of cases, although the oncogenic mechanisms of HBV are not well understood. Vaccination for HBV has successfully lowered the rates of both HBV infection and HCC. Once chronic HBV infection is established, the objective of antiviral treatment is to prevent disease progression to liver cirrhosis or HCC, or both. Studies have found HBV DNA level to be a strong predictor for the development of cirrhosis and HCC, irrespective of the status of viral and biochemical factors. This article reviews recent clinical trials evaluating sustained viral suppression with interferon alfa and lamivudine. The results support the need to reduce viral load as an important therapeutic goal. For HCC not prevented by these measures, surveillance using ultrasonography and serum alpha-fetoprotein assay every 3 to 6 months is able to detect HCC at an earlier stage and allows curative therapy with survival benefit.