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Frequency of Hepatocellular Carcinoma and its

associated Hepatitis B and C in Patients
attending Mogadishu hospitals

Article · September 2012

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 Frequency of Hepatocellular Carcinoma and its associated
Hepatitis B and C in Patients attending Mogadishu hospitals
Mohamed A. Hassan-Kadle1, Abdullah M. Hassan, Abdullah M. Yasin, Asad H. Sheikh, Mohamed Sh.
Omar, Sayid Ali M. Barre
Email: Kadlesom@gmail.com1
ABSTRACT

OBJECTIVE: The purpose of this study was to determine the frequency of hepatitis B and
Hepatitis C in patients with hepatocellular carcinoma.
DESIGN: Descriptive cross sectional study.
SETTING: This study was conducted at Dufle Specialist Clinic and Aden Abdulle Osman
Medical Diagnostic Centre at Mogadishu.
PERIOD: 1st January 2012 to 30thJune 2012.
MATERIAL AND METHODS: Clinically diagnosed hepatocellular carcinoma (HCC)
cases were confirmed using ultrasound. Demographic and clinical information was conducted
using interview questionnaire and serological assessment for hepatitis B and hepatitis C.
RESULTS: A total of 156 cases of hepatocellular carcinoma were included in this study.
Hepatitis B Virus (HBV) was present in 61 (39.10%) cases, non markers was present in 56
(35.90%) cases, HCV was present in 30 (19.23%) and dual infection 9 (5.77%) where having
markers of both HBV and HCV. The study shows that there is male pre-dominance up to
69.23% while females were 30.77% with ratio of 9:4.
CONCLUSION: HBV was most frequent infection in HCC patients followed by HCV and
non markers.

KEYWORDS: Hepatocellular carcinoma, Hepatitis B, Hepatitis C.

INTRODUCTION More than 350 000 people die from hepatitis

Hepatocellular carcinoma (HCC) is a global
health problem and is a malignant tumor
which arises from hepatic parenchyma cells,
the major cell type in the liver. HCC is the
sixth most common cancer in the worldwide,
it is the fifth most common cancer in men and
eighth most common in women worldwide
and it is the third most common death causing
disease from cancer after lung and stomach
cancer1.
In 2008, an estimated 748,000 new cases of
liver cancer occurred and approximately
696,000 people died of this cancer
worldwide3.
According to the World Health Organisation
(WHO), approximately 480 million to 540
million persons are living worldwide with
chronic viral hepatitis2.
Worldwide, an estimated two billion people
have been infected with the hepatitis B virus
and more than 240 million have chronic liver
infections. About 600 000 people die every
year due to the acute or chronic
consequences of hepatitis B2.
Every year, 3–4 million people are infected
with the hepatitis C virus. About 150 million
people are chronically infected and at risk of
developing liver cirrhosis and/or liver cancer.
C-related liver diseases every year2.
Globally, an estimated 78% of primary liver
cancer and 57% of liver cirrhosis are caused by
chronic viral hepatitis and about one million
deaths from viral hepatitis occur each year2.
The role of hepatitis B and C in the etiology of
HCC greatly varies geographically and may
also change over time4.
In this context, this study was designed to
estimate the proportion of patients seen at
two selected hospitals in Mogadishu who had
positive hepatitis B and hepatitis C test
results, to determine the association of HBV
and HCV infection in HCC patients in
Mogadishu – Somalia.
MATERIALS AND METHODS
This is a descriptive cross sectional study was
conducted at two selected internal medicine
hospitals of Mogadishu – Somalia, Dufle
Specialist Center and Aden Adde Hospital,
from 1st January 2012 to 30thJune 2012. All
diagnosed cases of hepetocellular carcinoma
(HCC) were selected for this study. The clinical
diagnosed cases of HCC patient were sent an
ultrasound for confirmation and there is lack
of Alpha fetoprotein (AFP) test in the country.
A predesigned perform was used to collect
demographic and clinical information. At the Table II:
time for diagnosis ultrasound data were Baseline characteristics of patients of
interviewed the patient and recorded the age, Hepatocellular carcinoma (n= 150)
gender, clinical information: history anorexia, Variable N /%
weight loss, abdominal pain, abdominal mass, Gender
jaundice and ascites, modality of transmission Male 108 (69.23%)
of hepatitis and knowledge and believes about Female 48 (30.77%)
the hepatitis. Serological assessment was Etiological
performed in each case using rapid blood test HBV 61 (39.10%)
kit. HCV 30 (19.23%)
HBV+HCV 9 (5.77%)
Statistical analysis Non markers 56 (35.90%)
Information from the laboratory analysis and
Clinical information
questionnaires were collected and analyzed
Anorexia
descriptively following entry into statistical Yes 146 (93.6%)
program using Statistical Package for Social No 10 (6.4%)
Sciences; (IBM SPSS Version 20).
Weight loss
RESULTS
Yes 147 (94.2%)
One Fifty hundred diagnosed cases of HCC
No 9 (5.8%)
were selected for the study. Among them 108
(69.23%) were males and mean age of the
Right Upper Abdominal Pain
study subjects 59.87 years with SD of 17.079
Yes
in age between 15 – 90 years . HBV alone was 144 (92.3%)
No
found to be the major etiological factor 12 (7.7%)
present in 61 (39.10%) cases. These
Ascites
characteristics are detailed in Table II. Gender
Yes
distribution causative factor is detailed in 69.87%
No
Table I. 30.13%
Table I:
Jaundice
Sex distribution of causative factor in cases
Yes
of Hepatocellular carcinoma (n=156) 57.05%
No
Cause Male Female 42.95%
n= 108 n= 48
Hepatomagly
HBV 34 27 87.82%
Yes
HCV 24 6 No 12.18%
HBV+HCV 7 2 Modality Transmission
Non 43 13 Number of marriage:
markers Monogamy 33.33%
Polygamy 66.67%
Traditional healing:
Yes 53.85%
No 42.95%
Unknown 3.21%
Knowledge and believes of hepatitis
Vaccination:
Yes 9.62%
No 55.77%
Unknown 34.62%

HIV and Hepatitis which is dangerous:

HIV 54.49%
Hepatitis 15.38%
Unknown 30.13%

DISCUSSION
Hepatocellular carcinoma is one of the most
common cancers in world; the incidence of
hepatocellular carcinoma varies according to
the prevalence of hepatitis B and C infections.
Areas such as sub-Saharan Africa and Asia
with high rates of infectious hepatitis have
high incidence of hepatocellular carcinoma. (5)
Prevalence rate of the Hepatocellular
carcinoma among adults in two selected
hospitals is 1.2%
In this it was revealed of high prevalence of
serological markers of HBV were positive 61
patients (39.10%) in a sample of two selected
Mogadishu hospitals. Study that conducted in
our country before civil war that was
published in 1993 about chronic liver disease
including HCC showed a high prevalence of
both hepatitis B and hepatitis C virus with
result of 37.1% (23/62) subjects had
positive with HBsAg, while in HCV
were showed 40.3% (25/62) to
antibody of HCV positive (10). While
another study conducted Somali
immigrants community in Minnesota
were showed a result of 17.9 %( 5/30)
among HCC subjects had HBsAg
positive while antibody to HCV
showed a result of 75.9 %( 22/30)
among patients with HCC (11).
Chin'ombe N, et al conducted a similar type of
study at Zimbabwe between October 1999
and August 2000 about Primary hepatocellular
carcinoma (PHC) who found that 60 patients
with PHC, 48.3% were seropositive for HBV (6).
The study conducted in National university
hospital of Singapore by Khin, LW, et al (7)
revealed that 74% of cases of hepatocellular
carcinoma were seropositive for hepatitis B
virus.
The gender distribution of the respondents is
revealed that male to female percentage was
69.23% and 30.77% respectively. Male
patient are more affected than female
patients in the ratio of 9 : 4 (M : F) while the
male of study Hyderabad by Shoaib Ansari, et
al was (82.5%) and 17.5% were females with
ratio of 5 : 1.(5) The explanation for this sex
difference might be threefold: firstly, men
could have higher rates of environmental
exposure to liver carcinogens (such as
smoking) and hepatitis virus infections;
secondly, estrogen effects might suppress
interleukin (IL)-6-mediated inflammation in
women, reducing both liver injury and
compensatory proliferation; thirdly,
testosterone effects could increase androgen
receptor signalling in men, promoting liver cell
proliferation.(8,9)
The presentation of HCC in Europe and the
United states is approximately 60 years. This is
in contrast with in Africa and Asia, where it’s
between 20 and 50 years, in our study the
mean was 59.87 years with SD of 17, 07 years
with range of 19 - 90, the most frequent
(mode) was 70 years, while the mean age of
study conducted at Hyderabad by Shoaib
Ansari, et al (5) was 53 with range of 29-90.
Regarding the knowledge about vaccination of
hepatitis the most respondent was believed
there is no hepatitis vaccination like polio,
while other patients are not aware about the
vaccination of hepatitis, a small number of
patients assumed the existence of the vaccine
was 9.62%, because of: (1) Unknowing if there
is vaccine for hepatitis (2) Non introduced the
hepatitis vaccine in Somalia.
Regarding about the awareness of hepatitis
compared by HIV, the HIV was the most
alerted than the hepatitis because HIV it has a
major awareness for our population thought
the media, seminars and workshops.
In this study, we had expected to find HBV
infection was major risk for HCC in the two
selected hospitals at Mogadishu. Indeed, the
proportion of HBV in two selected hospitals
was higher than that if HCV positive (39.10 %,
19.23 %), so HBV is the major factor of HCC in
Somalia. HBV seropositivity was found to have
the strongest association with HCC in two
selected hospitals, making HBV the primary
viral cause of HCC in the sample of two
selected hospitals.
In addition for high proportion of HBV
positive, our study showed that HBV were the
most common cause of chronic liver disease
(liver cirrhosis and HCC), followed by non-
markers and HCV. So the possible
explanations for high rate HBV and HCV
infections are the follows:
1. Poor sterilization of surgical
instruments of traditional healing.
2. Lack of awareness about the mode of
transmission of viral hepatitis.
3. Transfusion of blood not screened.
4. Reuse of syringes and needles by
premedical workers.
5. Hospital procedures performed without
standard infection precautions.
 testosterone levels and risk of
CONCLUSION: hepatocellular carcinoma. Cancer Res.
Hepatocellular carcinoma is the most common 53, 790–794 (1993).
primary hepatic tumor and one of the most
common cancer worldwide. It is concluded 10. Bile K, Aden C, Norder H, Magnius L,
that HCC is more common in males compared Lindberg G, Nilsson L. Important role of
to female patients. HBV followed by HCV and hepatitis C virus infection as a cause of
non markers are the leading cause of HCC in chronic liver disease in Somalia. Scand J
local population of Mogadishu. The authors Infect Dis. 1993;25(5): 559-564.
recommended to do more research about
cirrhosis and hepatocellular carcinoma 11.Abdirashid M. Shire, Dalbir S. Sandhu, et
al Viral Hepatitis Among Somali
Immigrants in Minnesota: Association of
Reference: Hepatitis C With Hepatocellular
1. http://www.worldgastroenterology.org/hepat Carcinoma. Mayo Clinic in Rochester,
ocellular-carcinoma.html : WGO Practice Minnesota (2012)
Guideline - Hepatocellular carcinoma
(HCC): a global perspective
2. www.who.int/topics/hepatitis/en/
Authors Affiliation
3. Ferlay, J. et al. GLOBOCAN 2008, Cancer
Incidence and Mortality Worldwide: Abdullah Mohamed Hassan
IARC Cancer Base No. 10 Lyon, France:
International Agency for Research on Abdullah Mohamed Yasin
Cancer [online], http://globocan.iarc.fr
(2010). Asad Hassan Sh. Mohamed
www.cancer.org/acs/groups/content/.../doc
ument/acspc-027766.pdf
Mohamed Abdulkadir Hassan
4.S A Raza, G M Clifford and Mohamed Sh. Omar Mohamoud
S Franceschi Worldwide variation in
the relative importance of hepatitis B Sayid Ali Mohamoud Barre
and hepatitis C viruses in
hepatocellular carcinoma: a systematic
review, British Journal of Cancer
(2007) 96, 1127–1134. Benadir University
5. Shoaib Ansari, Muhammad Sadik Memon
Faculty of Medicine
and Bikha Ram Devrajani Frequency of
Hepatitis B and Hepatitis C in Patients
with Hepatocellular Carcinoma at Batch V, Group C
Hyderabad
6. Nyasha Chin'ombe ,Evans Chavhunduka
and Hilda T Matarira -Seroprevalence of
HBV and HCV in primary hepatocellular
carcinoma patients in Zimbabwe.
7. Khin, LW, Teo, CJ, Guan, R
(1996)Seroprevalance of hepatitis B
and C viral markers in patients with
primary hepatocellular carcinoma in
Singapore
8. Naugler, W. E. et al. Gender disparity
in liver cancer due to sex differences
in MyD88-dependent IL-6 production.
Science 317, 121–124 (2007).
9.Yu, M. W. & Chen, C. J. Elevated serum

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