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LIVER CANCER

http://meddev.uio.no/elaring/lcms13/ernaeringslaere/nutr-cancer-epidemiology/illustrations/liver.jpg

See Chapter 7.8 page 277 in WCRF/AICR Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective.

pdf Cancers

626,000 new cases in 2002

In general more common in developing countries, over half of all cases occur in China.

Large geographic variation, perhaps the greatest variation among the major tumour sites.

Incidence rates about twice as high among men as among women.

Almost always fatal.

Includes hepatocellular carcinoma (90%), angiosarcoma, cholangiocarcinoma and hepatoblastoma.

Infection with hepatitis B virus is the predominant cause (80% of cases).

Hepatitis C virus also important

http://meddev.uio.no/elaring/lcms13/ernaeringslaere/nutr-cancer-epidemiology/illustrations/incidence_2008_liver.jpg

Pathogenesis:

  • Hepatitis B established cause for liver cirrhosis and liver cancer.
  • Chronic HBV infection can act as both initiator and promoter of liver cancer.
  • Effect can be augmented by other carcinogens; aflatoxins, specific industrial exposure, and tobacco smoke.
  • Tobacco weakly or modestly associated, possibly more important etiologic factor among cancer cases that do not carry HBsAg (hep B surface antigen).
  • Chronic viral infection which results in widespread cell death and thus compensatory cell proliferation. This can lead to cirrhosis, and possibly to environment where cells with a specific growth advantage such as loss of P53 or of other tumour suppressor genes have a growth advantage...
  • Note that only 10-30% of those with cirrhosis develop liver cancer.

CONVINCING EVIDENCE - decreases risk:

  • None

CONVINCING EVIDENCE - increases risk:

  • Aflatoxins


PROBABLE EVIDENCE - decreases risk:

  • None

PROBABLE EVIDENCE - increases risk:

  • Alcoholic drinks


LIMITED/SUGGESTIVE EVIDENCE - decreases risk:
Fruits

LIMITED/SUGGESTIVE EVIDENCE - increases risk:
Body fatness

Most effective means of preventing:

  • Avoidance of exposure to hepatitis B and C virus
  • Not use tobacco

Most effective dietary means of preventing:

  • Limit alcohol consumption
  • Avoid food that is likely to be contaminated with aflatoxin