Hepatocellullar carcinoma: the Sri Lankan perspective

Abstract

Ragama has become a center of excellence in the management of hepatocellular carcinoma (HCC). Since 2012 we have managed approximately 500 patients with HCC referred from different parts of the country. Sri Lanka appears to have an unique pattern of disease not seen in any other part of the world. The large majority of HCC in our population is related to non-alcoholic fatty liver disease (NAFLD). With novel treatment of hepatitis C and hepatitis B vaccination globally, it is predicted that NAFLD will be the leading cause of liver disease in the future. In Sri Lanka with rapidly rising prevalence of NAFLD, liver cancer will also continue to rise. In this background of NAFLD, diffuse variant of HCC has higher incidence in our patients. Consumption of alcohol is a risk factor to develop diffuse type HCC. Diffuse type HCC has a grave prognosis. A significant proportion of NAFLD patients develop HCC in non-cirrhotic liver. This raises the need to screen at-risk groups in the future. These non-cirrhotic hepatomas are larger in size and have a better prognosis than others. Alpha-feto protein is an unreliable marker in the assessment of our patients with NAFLD induced HCC. Our cohort of patients is an excellent sample to study the future pattern of HCC worldwide.