Characteristics of Hepatocellular Carcinoma in Two Tertiary Hospitals in Nigeria - Has anything Changed?

Hepatocellular carcinoma (HCC) is a global health problem accounting for 5.6% of all human cancers although less developed countries are disproportionately affected.[1]It is the fifth most common cancer in men (554,000 cases) and the ninth in women (228,000 cases). In both sexes, it is the sixth most common cancer responsible for 748, 000 new cases of cancer annually and the third leading cause of cancer related death exceeded only by cancers of the lung and stomach.[2]The incidence of HCC is increasing both in the developed and developing countries. This has been attributed to the rising prevalence of its risk factors; chronic hepatitis B and C infection, alcohol abuse, non-alcoholic fatty liver disease (NAFLD) associated with type 2 diabetes and obesity.[3-5] HCC is characterized by several epidemiological features including dynamic temporal trends, variation among geographic regions, racial and ethnic groups and the presence of several preventable risk factors.[6] Although HCC was one of the first cancers to be linked epidemiologically to hepatitis B virus which is preventable, its incidence remains high in regions of the world where the virus is endemic.[7] In 2002, it was estimated that 82% of all liver cancers occurred in the developing countries of south-eastern Asia and sub-Saharan Africa. In these regions, majority of HCC tend to occur in persons with chronic hepatitis B virus infection and to a lesser extent in patients with chronic hepatitis C virus infection.[1] Other potential contributory factors include high dietary exposure to aflatoxin, a common contaminant of foodstuffs such as nuts, grains and legumes, dietary iron overload, alcohol abuse and non-alcoholic steato-hepatitis (NASH) associated with type 2 diabetes and the metabolic syndrome.