Primary liver cancer and its relationship to chronic infection with the hepatitis B virus

Chronic infection with the hepatitis B virus is etiologically related to the development of hepatocellular carcinoma, one of the most frequent cancers in several heavily populated areas of the world. Chronic infection with the HBV is extremely frequent among HCC patients and it may be true that more than three quarters of the world cases of HCC are positive for HBsAg. The clinical and laboratory features of HCC associated with chronic HBV infection appear to vary geographically. An attempt was made, however, to outline its main clinical aspects including possibilities in “early” diagnosis. Although cirrhosis is present in more than two thirds of HBsAg positive HCCs, it is usually compensated and even clinically latent, particularly in the high-incidence areas of HCC. HBsAg positive HCC can also arise as a result of chronic hepatitis, in only slightly fibrotic or even normal livers. The causal role of HBV in HCC has been discussed on the basis of existing evidence. Chronic HBV infection in conjunction with other factors may lead to the development of HCC by creating a continuous stimulus for regeneration and growth, by modifying the biotransformation system of hepatocytes, by initiating and promoting resistant dysplastic hepatocytes, and by transforming directly liver-cells to malignant ones after integration of the viral DNA into the host genome. Regardless of these speculations it is hoped that prevention of chronic HBV infection may significantly reduce, in the future, mortality from HCC.