Fahmeda Akther

ENG 21003, Sec. A

Professor Sidibe

November 26, 2018

 

Factors of Hepatocellular Carcinoma (Liver Cancer)

 

Hepatocellular carcinoma is the most frequent type of primary liver cancer. While there is no definite cause of liver cancer, there are many cases of hepatocellular carcinoma being a result of hepatitis B or hepatitis C infection. Approximately 5% of the world population is infected with hepatitis B, in which 75% are Asian. Blood tests, imaging tests, and liver biopsies are used to diagnose hepatocellular carcinoma. Even though Asian Americans are more likely to have a college education than other groups, they also have a higher poverty rate than the national average. While liver cancer is related to the prevalence of the hepatitis B, there can be several other potential factors that contribute to hepatocellular carcinoma having the highest rates among Asian Americans.

Asian Americans are the fasting growing minority group in the United States. The Census Bureau predicts that by 2050, they will be considered as 11% of the US population. While hepatitis B virus is rare among white non-Hispanics in the United States, it is more common among Asian Americans. As many as 1 in 10 Asian Americans carry the virus. According to Erby et al., “A recent study in New York City found that 14.8% of Asian Americans were chronically infected with HBV”. (Erby et al.) Even though Asian Americans are more likely to have a college education compared to other groups, a vast majority of Asian Americans end up not getting a screening for hepatitis B. To reduce the untreated virus from being cancerous, screening should be increased in communities and clinical settings.

 

  

Figure 1. Prevalence of hepatitis B and availability of preventive services.

 

According to Figure 1, there are more testing centers for hepatitis B in Brooklyn, Manhattan and Bronx. Queens has a greater population of Asian Americans, yet there is only one testing center available. By the limited access to clinical services, Asian Americans are not getting the required screening needed to be informed about such illnesses.

Occupational exposure is another factor leading to hepatocellular carcinoma. According to Bertino et al., “..it is very commonly reported that vinyl chloride monomer (VCM) induced angiosarcoma of the liver”. (Bertino et al.) Building and chemical workers, painters, workers exposed to solvents and those in the textile industry are often at a high risk of hepatocellular carcinoma. Some occupational exposures that are concerning include vinyl chloride (found in plastics), acrylamide, PFOA or perfluorooctanoic acid (found in dry cleaning methods), polychlorinated biphenyls (PCBs), perfluorinated chemicals (PFCs), benzo(a)pyrene (BaP), and trichloroethylene. Due to chemical substances at these occupations, it can lead to hepatocellular damage, cholestatic injury, fatty liver, granulomatous disease, cirrhosis and malignancies. Harmful chemical agents target the liver because of its blood supply and the many metabolic and excretory processes that it is involved in.

The most common factor leading to hepatocellular carcinoma is excessive alcohol use. Based on a recent study in the British Medical Journal, a disproportionate rise in liver cancer may be due to alcohol misuse or abuse. In comparison to age groups, there is a difference between what “drinking socially” means for a 40-year-old patient versus a 20-year-old patient. According to Dr. Blaszka, a gastroenterologist, “Social drinking for my 40-year-old patients means two glasses of wine every other Sunday, while social drinking for my younger patients often means drinking to the point of intoxication or even blacking out.” (Englewood Health) There is a misconception that it would take decades of excessive and daily drinking to cause liver cancer. However, the truth is that it can take less than a decade and doesn’t even require daily drinking to cause this cancer. In America, students start drinking alcohol as early as high school; maybe even middle school. Parents, educators, and society in general has to do a better job at effectively educating people about alcohol use from an earlier age.  

Table 1. Association between liver cancer incidence and risk factor scores.

As shown in Table 1, followed by infection risk scores, alcohol-related morbidity had the second highest influence on liver cancer. The table also shows the disparities between poverty levels for the alcohol score. High poverty neighborhoods are more likely to have a higher alcohol score than low poverty areas.

Iron is essential to humans for normal functioning. But when there is too much, it can not be disposed and can be harmful to cells in the body. Hereditary hemochromatosis is a disease that causes the body to absorb too much iron. When there is an excess amount of iron, the storage protein is denatured and large amounts of iron are released into the cytoplasm of the hepatocytes. People with hemochromatosis are twenty times more likely to get liver cancer than the general population. This occurs because of mutations in certain genes concerned with iron absorption. Relating back to hepatitis virus, patients are more likely to have an iron overload when they already have the virus.

In conclusion, there are several factors that can lead to liver cancer. It is essential for one to be informed and educated about the opportunities that are available. It is always important to get the proper screening and testing, to be prepared for any type of illness coming in one’s way. Even though there is still no cure to cancer, people can take more precautions to protect their health.

 

Works Cited

Bertino, Emanuele. “Hepatocellular Carcinoma and the Risk of Occupational Exposure.” World Journal of Hepatology, 8 May. 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4858622/

Kamath, Geetanjali R., et al. “Liver Cancer Disparities in New York City: A Neighborhood View of Risk and Harm Reduction Factors.” Frontiers in Oncology, Frontiers Media S.A., 14 June 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6011126/.

Kew, Michael C., “Hepatic Iron Overload and Hepatocellular Carcinoma.” Karger Liver Cancer, 4 Mar. 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995380/

Kwon, Simona C., et al. “Chronic Hepatitis B and Liver Cancer Risks among Asian Immigrants in New York City: Results from a Large, Community-Based Screening, Evaluation, and Treatment Program.” Cancer Epidemiol Biomarkers Prev,1 Nov. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373070/

Dang, Julie. “Hepatitis B Among Asian Americans: Prevalence, Progress, and Prospects for Control.” World Journal of Gastroenterology, 14 Nov. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4641114/

Erby, Lori A. H., et al. “Hepatitis B and Liver Cancer Among Three Asian American Sub – Groups: A Focus Group Study.” Journal of Immigrant and Minority Heath, 21 Oct. 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3804298/  

“Cirrhosis and Liver Cancer Rates on the Rise – What You Need to Know.” Englewood Health, 19 Sept. 2018, https://www.englewoodhealth.org/cirrhosis-and-liver-cancer-rates-on-the-rise-what-you-need-to-know