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Hepatocellular Carcinoma Associated with Hepatitis B Virus

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Hepatocellular Carcinoma

Part of the book series: Current Clinical Oncology ((CCO))

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Abstract

Hepatocellular carcinoma (HCC) is one of the most common malignant neoplasms in the world. Current data indicate that hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most significant hepatocarcinogens for the majority of HCCs in the world. Globally about 80% of HCC is considered to be causally associated with chronic infection with HBV. Although HCC is rare in the United States, it is perhaps the most prevalent cancer in Asia and West Africa where the prevalence of HBV infection is high. Without proper intervention for HBV infection, the HBV carriers are at risk for developing HCC. In a large prospective study of 3,653 HBV carriers in Taiwan, 164 persons developed HCC in a 12-year follow-up period; the most important risk factors for HCC were increased baseline and persistently elevated HBV DNA levels. During the last decade, great strides have been made in the treatment of HBV infection. Prospective and retrospective studies of large numbers of chronic hepatitis B patients with advanced liver disease have demonstrated that the treatment with anti-HBV agent not only delayed the disease progression but also reduced the incidence of HCC.

For HBV-related HCC, primary prevention of HCC is vaccination for all uninfected individuals. Secondary prevention of HCC should focus on those who are already infected. By careful monitoring and discreet antiviral therapy with available antiviral agents we should strive to prevent the development of HCC by suppression of viral replication, elimination of the virus, and thereby delay/prevent the development of HCC in HBV-infected patients.

HBxAg is a trans-activating protein that stimulates virus gene expression and replication, thereby promoting the development and persistence of the carrier state. HBxAg also alters patterns of host gene expression that contribute importantly to the pathogenesis of chronic liver diseases and the appearance of HCC. HBxAg blocks immune-mediated apoptosis by Fas and TNF alpha, thereby promoting the persistence of virus-infected cells.  HBxAg promotes the development of fibrosis at multiple steps, thereby giving rise to intrahepatic lesions from which HCC appears.  Finally, HBxAg activates host genes that support hepatocellular growth and survival and downregulates a number of tumor suppressor pathways that normally keep the growth of cells in check.  Due to these and other varied activities, it is likely that HBxAg will be a very important target for the development of novel therapeutics against hepatitis B in the future.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Hie-Won L. Hann MD

  2. Temple Biotechnology Center, College of Science and Technology, Temple University, Philadelphia, PA, USA

    Mark Feitelson PhD

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  1. Hie-Won L. Hann MD
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  2. Mark Feitelson PhD
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  1. Kimmel Cancer Center, Thomas Jefferson University, S. 10th Street 233, Philadelphia, 19107, Pennsylvania, USA

    Brian I. Carr

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© 2009 Humana Press, a part of Springer Science+Business Media, LLC

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Hann, HW.L., Feitelson, M. (2009). Hepatocellular Carcinoma Associated with Hepatitis B Virus. In: Carr, B. (eds) Hepatocellular Carcinoma. Current Clinical Oncology. Humana Press. https://doi.org/10.1007/978-1-60327-376-3_7

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  • DOI: https://doi.org/10.1007/978-1-60327-376-3_7

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