Liver cancer is a very common malignant tumor, and is the third cause of death from tumors worldwide. Developing countries, especially Asia, are the high incidence areas, and the incidence of liver cancer in China is very high. According to the Ministry of Health and the National Center for Disease Control and Prevention, the mortality rate of liver cancer has ranked second in urban areas and first in rural areas. Among all primary liver cancers, hepatocellular
carcinoma,
The development of HCC is related to multiple etiologies, and cirrhosis is found in 70% to 80% of HCC. Therefore, cirrhosis is the most common precancerous disease of hepatocellular carcinoma, and the key to prevention and treatment of hepatocellular carcinoma is how to prevent and treat cirrhosis and its related diseases.
Chen Xiangyu, Department of Gastroenterology, First Affiliated Hospital of Zhengzhou University Factors related to the occurrence and prevention of hepatocellular carcinoma 1. Hepatitis B virus Hepatitis B virus (HBV) is a hepatophilic DNA virus. According to statistics, there are about 350 million HBV carriers worldwide, of which 120 million are in China. The exact mechanism of HBV causing HCC has not been fully elucidated, but it is speculated that there are two main pathways to cause HCC. one is related to micro-inflammation, cell damage, mitosis, hepatocyte regeneration and cirrhosis of hepatocytes, and regenerative nodules have independent cloning ability and are sensitive to carcinogenic substances; the second is that HBV and chromosomal integration directly activates pro-oncogenes. Therefore, suppression of micro-inflammation in hepatocytes by eradicating or inhibiting HBV replication can reduce the risk of HCC development. The most effective way to prevent HBV-associated HCC is to prevent HBV infection by vaccine. A study of children aged 6 to 14 years in Taiwan, China, showed that the annual incidence of HCC could be gradually reduced from an initial 0.7/100,000 to 0.36/100,000 after application of HBV vaccine. The drugs commonly used for anti-HBV treatment are interferon, lamivudine, entecavir, etc. Available data show that the application of interferon has a very limited effect on the prevention of HCC. Another prospective randomized, placebo-controlled study looking at the long-term follow-up of lamivudine in 651 cases of compensated HBV-associated cirrhosis showed that lamivudine compared with placebo reduced the incidence of HCC by 3.9%
vs 7.4%. 2, HCV Hepatitis C virus HCV is a single positive strand RNA virus. persistent infection and replication of HCV can cause damage to hepatocytes and has a relationship with the development of hepatocellular carcinoma. necrosis of hepatocytes after damage and regeneration leading to cirrhosis may cause liver cancer in patients infected with HCV. In addition, dual chronic infection with HBV and HCV is also an important factor in the development of hepatocellular carcinoma, and its relative risk is much higher than the product of the relative risk of the two alone. the mechanism of HCV infection and liver cancer development is not yet fully elucidated. Interferon helps prevent the development of HCC in patients with HCV-related cirrhosis, and prospective randomized controlled studies have shown that interferon reduces the development of HCC, but only in those HCV-infected patients who respond to interferon therapy. Therefore, how to effectively inhibit HCV replication is an important clinical issue. Interferon combined with ribavirin can enhance the anti-HCV effect and is better than single drug therapy for the prevention of HCC. 3, chronic hepatitis and cirrhosis Regardless of HBV or HCV infection, cirrhosis remains the single risk factor for the greatest risk of HCC. The risk of chronic hepatitis or cirrhosis evolving into hepatocellular carcinoma correlates with the degree of liver fibrosis. For patients with hepatitis C stage 4 fibrosis F4, the annual risk of HCC is about 5.8%, compared to 0.5% to 2.6% for patients with stages F1 to F3. Therefore, in addition to prevention and treatment of HBV and HCV, treatment and delay of liver fibrosis are also important ways to prevent HCC, but there are no good methods to target liver fibrosis. Calcium antagonists have a certain role, and Chinese herbal medicine in the motherland also has certain characteristics, but it needs to be studied in depth and further developed. 4, other environmental and dietary factors such as aflatoxin, alcohol consumption and smoking are also related to the occurrence of HCC. Therefore, in addition to the prevention of the above causes, attention should also be paid to the prevention of environmental and dietary factors.