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World J Hepatol. Mar 27, 2012; 4(3): 99-104
Published online Mar 27, 2012. doi: 10.4254/wjh.v4.i3.99
Hepatocellular carcinoma in developing countries: Prevention, diagnosis and treatment
Michael C Kew
Michael C Kew, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
Author contributions: Kew MC solely contributed to this paper.
Correspondence to: Dr. Michael C Kew, K Floor, Old Main Hospital Building, Groote Schuur Hospital, Main Road, Observatory 7935, Cape Town, South Africa.
Telephone: +27-021-7822949 Fax: +27-021-4486815
Received: February 28, 2011
Revised: March 8, 2012
Accepted: March 17, 2012
Published online: March 27, 2012

Hepatocellular carcinoma (HCC) occurs commonly and with increasing frequency in developing countries, where it also carries an especially grave prognosis. The major risk factor for HCC in these regions is chronic hepatitis B virus (HBV) infection, although dietary exposure to aflatoxin B1 also plays an important etiological role. Prevention of HCC in developing regions is unlikely in the foreseeable future. Although an effective vaccine against HBV is available, the percentage of babies born in developing countries that receive the full course of immunization remains low. Moreover, the usually long interval between infection with HBV and the development of HCC means that 30 to 50 years will elapse before the full effect of the vaccine will be realized. Practical measures to prevent aflatoxin B1 exposure are not in place. Serum α-fetoprotein levels are a useful pointer to the diagnosis of HCC in low-income countries, but definitive diagnosis is hampered both by the lack of the sophisticated imaging equipment now available in developed countries and by obstacles to obtaining histological proof. In the majority of patients in low-income regions, the tumor is inoperable by the time the patient presents. Hepatic resection is seldom possible in sub-Saharan Africa, although the tumor is successfully resected in a larger number of patients in China. Liver transplantation for HCC is rarely performed in either region. Sophisticated new radiotherapy techniques are not available in developing countries. The beneficial effects of the multikinase inhibitor, sorafenib, are encouraging, although financial considerations may restrict its use in low-income countries.

Keywords: Hepatitis B virus infection, Aflatoxin B1, α-fetoprotein, Hepatic resection, Hepatic transplantation, Sorafenib