Articles Characteristics, management, and outcomes of patients with hepatocellular carcinoma in Africa: a multicountry observational study from the Africa Liver Cancer Consortium (original) (raw)
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2013
World Digestive Health Day 2013 (WDHD 2013) will attempt to focus the world's attention on the global health crisis caused by hepatocellular carcinoma (HCC). Why did WGO choose liver cancer? HCC, is the fifth most common cancer in the world 1,2 and the third most common cause of death from cancer (second most common in men) 1,2. In some countries, it is either the number one (Mongolia) or number 2 malignant neoplasm (China). In the United States of America, it is the fastest rising cancer by incidence and death rate 3. Every 30 seconds, one person in the world dies from liver cancer, which is almost entirely preventable. The annual global death rate from HCC of just under 700,000 approximates the annual incidence, reflecting the limited therapeutic options as well as the late diagnosis in most cases 4. MEET ouR SuPPoRTERS The World Gastroenterology organisation and the WGo Foundation thank the following WDHD 2013 supporters for their generosity and support of the 2013 campaign. WGO is particularly grateful to the following corporations for their support towards helping to better understand and recognize the global burden of liver disease: WGO Supporters are engaged in long-term, multi-faceted partnerships with the WGO in support of World Digestive Health Day.
Hepatocellular Carcinoma in Sub-Saharan Africa
JCO Global Oncology
More than 80% of global hepatocellular carcinoma (HCC) patients are estimated to occur in sub-Saharan Africa (SSA) and Eastern Asia. The most common risk factor of HCC in SSA is chronic hepatitis B virus (HBV) infection, with the incidence highest in West Africa. HBV is highly endemic in SSA and is perpetuated by incomplete adherence to birth dose immunization, lack of longitudinal follow-up care, and impaired access to antiviral therapy. HBV may directly cause HCC through somatic genetic alterations or indirectly through altered liver function and liver cirrhosis. Other risk factors of HCC in SSA include aflatoxins and, to a lesser extent, African iron overload. HIV plus HBV co-infection increases the risk of developing HCC and is increasingly becoming more common because of improving the survival of patients with HIV infection. Compared with the rest of the world, patients with HCC in SSA have the lowest survival. This is partly due to the late presentation of HCC with advanced sy...
Problem of hepatocellular carcinoma in West Africa
World journal of hepatology, 2014
The incidence of hepatocellular carcinoma (HCC) is known to be high in West Africa with an approximate yearly mortality rate of 200000. Several factors are responsible for this. Early acquisition of risk factors; with vertical or horizontal transmission of hepatitis B (HBV), environmental food contaminants (aflatoxins), poor management of predisposing risk factors and poorly-managed strategies for health delivery. There has been a low uptake of childhood immunisation for hepatitis B in many West African countries. Owing to late presentations, most sufferers of HCC die within weeks of their diagnosis. Highlighted reasons for the specific disease pattern of HCC in West Africa include: (1) high rate of risk factors; (2) failure to identify at risk populations; (3) lack of effective treatment; and (4) scarce resources for timely diagnosis. This is contrasted to the developed world, which generally has sufficient resources to detect cases early for curative treatment. Provision of pallia...
Etiology of hepatocellular carcinoma in West Africa, a case-control study
International journal of cancer, 2018
Hepatocellular carcinoma (HCC) is a leading cause of cancer in West Africa where HBV infection is endemic. However, limited information is available on other risk factors such as alcohol use, HCV and HIV infection. A case-control study was conducted in referral hospitals of Abidjan (Cote d'Ivoire), Bamako (Mali) and Lome (Togo). Cases were matched with controls on age, gender and participating site. The diagnosis of HCC relied on the combination of one or more space-occupying lesions suggestive of an HCC on a standardized abdominal ultrasound and an α-fetoprotein level ≥400 ng/ml. HIV, HBV and HCV serology were performed. Hazardous alcohol use was assessed using the AUDIT questionnaire. A conditional logistic regression model was used to measure odds ratio (OR) with their 95% confidence intervals (CI). A total of 160 cases and 320 controls were included. Cases were predominantly men (80.0%) with a median age of 47 years (IQR 38-57). Hazardous alcohol use (OR = 4.5 [CI 1.1-18.5])...
Epidemiology and aetiology of hepatocellular carcinoma in Sub-Saharan Africa
Hepatoma Research, 2021
With the highest annual fatality ratio (mortality-to-incidence ratio), reported for a human cancer, hepatocellular carcinoma (HCC) ranks as the third leading cause of cancer-related deaths worldwide and its distribution is not uniform. In Sub-Saharan Africa (SSA), HCC is the second leading cause of cancer-related deaths for men and the fourth for women in 2020, with average age-standardised mortality rates of 8.2 and 4.2 per 100,000 persons/year, respectively. In this region, HCC presents in younger age groups and has a median survival rate of ~3-4 months. The major risk factors for HCC include viral [hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV)] and environmental [dietary aflatoxin and iron overload] factors, with more than 50% being attributable to HBV, which is endemic in SSA. HCC control efforts in SSA are faced with a number of unique challenges, including resource restrictions, a paucity of good data, few cancer registries, inaccessibility of treatment for HBV and HCV, co-infection with human immunodeficiency virus (HIV), exposure to co-carcinogen aflatoxin B1, unique (sub)genotypes of HBV and changing natural history and aetiology of HCC as a result of antiretroviral therapy rollout for HIV and changing lifestyles. The unique features of HCC in SSA, together with the challenges faced in its prevention and appropriate public health intervention, diagnosis and treatment, all suggest that HCC in SSA is deserving of an in depth understanding by further focused research. Considerable motivation of policymakers, work and resources are required to reduce the burden of this cancer on the subcontinent.
Hepatocellular carcinoma in Jos, Nigeria
Nigerian Journal of Medicine, 2008
Background: Hepatocellular carcinoma (HCC) is the most common abdominal malignancy, representing 80-90% of primary liver malignancies around the world. There is a disturbing trend of increased incidence of HCC around the world. We therefore, determined the trend of HCC in Jos. Methods: A ten-year retrospective review was done of all cases of HCC which diagnoses were histologically confirmed as recorded in the Cancer Registry of Jos University Teaching Hospital. The patients' clinical case notes (including surgical and radiological findings) were also reviewed. Results: A total of 71 cases of HCC (31.3% 0f 227 liver biopsies in the same period) were diagnosed within the 10-year period. There were 46 males and 25 females with a male/female ratio of 1.8:1. The age range of the patients was 23 years to 75 years, with a mean age of 45.4±13.1 years. Seventy two percent (72%) of them were between ages 21 years and 50 years. Only 28% were between 51 years and 80 years. The highest rate of 12(17.1%) was seen in the year 2004. Conclusion: The study showed that there was a high prevalence of HCC in Jos, and that HCC was more prevalent in the younger age group compared to what obtains in developed nations.
Reasons why West Africa continues to be a hotbed for hepatocellular carcinoma
Nigerian medical journal : journal of the Nigeria Medical Association
Hepatocellular carcinoma (HCC) exhibits a huge disease burden on West Africa, with a large proportion of all HCC cases worldwide occurring in the sub-region. The high HCC prevalence is due to the endemicity of a number of risk factors, most notably hepatitis B, C and HIV. West African HCC also displays a poor prognosis. Generally speaking, this is owing to more aggressive tumours, late patient presentation and inadequate management. Exposure to chronic viral hepatitis, more carcinogenic West African strains of hepatitis B virus and carcinogens such as aflatoxin B1 all encourage tumour growth. Lack of patient confidence in the healthcare system contributes to poor health-seeking behaviors and management of the disease can be lacking, due in part to poor health infrastructure, resources available and lack of access to expensive treatment. There is also much we do not know about West African HCC, especially the effect rising obesity and alcohol use may have on this disease in the futur...