We read the abstracts of these articles, extracted the published work that seemed to be relevant and useful for surveillance and diagnostic imaging, read the original articles, and finally selected articles, mainly English-language articles providing high-level evidence. For this second version, we extracted articles related to surveillance and diagnostic imaging for hepatocellular carcinoma published between 2003 and June 2007, again read the original articles, and finally selected
articles, mainly those providing high-level evidence. CQ4 In what patient subsets should regular hepatocellular carcinoma screening be performed? The risk factors for hepatocellular carcinoma are cirrhosis, chronic hepatitis C, chronic hepatitis B, male sex, advanced age, habitual alcohol consumption, obesity and diabetes mellitus. Smoothened Agonist order Among these, regular hepatocellular carcinoma screening is recommended in patients with type C chronic liver disease, type B chronic liver disease or non-viral cirrhosis. (grade B) Hepatocellular carcinoma is a cancer that has been observed to show marked regional clustering. Hepatitis B virus (HBV) and hepatitis C virus (HCV), and also several environmental factors, are considered to have a great impact on the risk of development of hepatocellular carcinoma. In Japan, approximately 85% of hepatocellular carcinoma patients have underlying type B or C chronic liver disease (Report of the 17th Nationwide
Follow-up Survey of Primary Liver Cancer in Japan). Besides these virus-related factors, buy DZNeP male sex, advanced age, heavy alcohol consumption, smoking, aflatoxin, obesity and diabetes mellitus have been reported as risk factors for development of liver C-X-C chemokine receptor type 7 (CXCR-7) cancer. These risk factors for hepatocellular carcinoma are discussed in further detail below. Persistent HBV infection is the most significant risk factor for development of liver cancer. HBV carriers have a
223-fold higher risk of carcinogenesis than non-carriers (LF072091 level 2a). Among HBV carriers, HBe antigen-positive persons are at a higher risk for carcinogenesis than HBe antigen-negative persons (relative risk: 6.3 times) (LF072052 level 3, LF038253 level 2a, LF072084 level 3, LF072065 level 3, LF038776 level 3, LF071987 level 3, LF071998 level 2a). Among the patients with type B chronic liver disease, those with cirrhosis are at higher risk. Persistent HCV infection is also as significant a risk factor for carcinogenesis as persistent HBV infection. Particularly in some developed countries, including Japan, it is the most common predisposing factor for development of liver cancer (LF072029 level 4). A characteristic feature of carcinogenesis attributable to hepatitis C is that liver cancer develops against a background of cirrhosis in the majority of cases (LF0357510 level 2a, LF0240411 level 2b). The annual incidence of HCV-related cirrhosis is extremely high, approximately 3–8%, although it varies among countries.