FREQUENCY OF HEPATOCELLULAR CARCINOMA IN CIRRHOSIS

Objective: To find the frequency of hepatocellular carcinoma in cirrhotic patients of our population. Design: Prospectiveobservational study. Setting: Medical A Unit Hayat Abad Medical Complex Peshawar. Period: 1st January 2010 to 31st July 2011. Material &methods: All patients were screened for presence of Hepatocellular carcinoma (HCC) by performing Alpha fetoprotein and ultra sound (U/S)abdomen. Contrast enhanced computed tomography scan (CT) of abdomen was done in selective cases. European Association for the Studyof Liver Diseases (EASLD) Noninvasive criteria (limited to patients with underlying cirrhosis) was used for diagnosis of HCC i.e. Two coincidentimaging techniques that identify a focal lesion more than 2 cm showing arterial hypervascularization or one imaging modality that identifies afocal lesion more than 2 cm in diameter showing arterial hypervascularization and serum AFP levels greater than 400 ng/Ml. Results: A total of370 patients cirrhotic patients were enrolled in this study. Thirty nine patients (10.5%) were diagnosed as having HCC. Male patients were 30(77%) and 9(23%) were female. Mean age was 49.2% (range 18 to 72 years). Abdominal discomfort was predominant symptom present in 94%patients, followed by anorexia present in 90% patients, abdominal distension in 76%, weight loss in 62%, jaundice was present in 46% patients,altered mental status was notice in 36% patients and history of upper gastrointestinal (GI) bleed and malena was extracted from 26% patients.Ultrasound abdomen and CT abdomen showed unifocal lesion in 48.7% patients, multifocal lesion in 30.7% patients and massive lesion in20.5% patients. Alpha fetoprotein ranged from 45ng/dl to 630ng/dl. Hepatitis C (HCV) was the commonest cause present in 51% patients,Hepatitis B (HBV) in 15.3% patients and HBV and HCV co-infection in 10.25% patients, history of alcoholism was revealed in 5% patients and in2.5% patients alcoholism was present along with HCV and HBV each, while in 10% cases the cause of cirrhosis remained unknown.Conclusions: Hepatocellular carcinoma is the most common primary hepatic tumor and one of the most common cancers worldwide. It isconcluded that HCC is more common in males compared to female cirrhotic patients. Hepatitis C followed by HBV are the leading causes ofHCC related cirrhosis in local Population of Khyber pakhtoonkhwa.