The hidden burden of non-viral hepatitis-related hepatocellular carcinoma: a Sri Lankan perspective

Hepatocellular carcinoma (HCC) is a growing public health concern in Sri Lanka. While the incidence is lower than in other Asian countries, it is on the rise. In this point-of-view article, we describe the hidden burden of disease, unique characteristics and associations of HCC in Sri Lanka. We conducted a selective literature search across electronic databases (PubMed, MEDLINE, Embase, and Cochrane Library) to identify relevant publications on HCC in Sri Lanka. Original, descriptive, epidemiological studies and relevant systematic reviews were included. We excluded randomised controlled trials, narrative reviews, evidence-based clinical practice guidelines and expert consensus statements. In Sri Lanka, HCC primarily affects men at age 64 years at diagnosis. Most cases occur in individuals with underlying cirrhosis. Non-alcoholic cryptogenic cirrhosis is the major risk factor. At diagnosis, most HCCs were in an intermediate or advanced stage, often presenting as single large tumours with significant blood vessel invasion. TACE was the most common treatment offered. The overall survival remains limited to less than 2 years.