Liver Cancer in Arab World

By Heba El Zawahry M.D.

Prof. and Head of Medical Oncology Department National Cancer institute

Cairo University

HCC incidencetripled over the last three decades

Altekruse, JCO 2009

in 2012 worldwide, there were 14.1 million new cancer cases, 8.2 million cancer deaths and 32.6 million people living with cancer (within 5 years of diagnosis)the real problem is that 57% (8 million) of new cancer cases, 65% (5.3 million) of the cancer deaths and 48% (15.6 million) of the 5-year prevalent cancer cases occurred in the less developed regions.

WHO 2012 report

Liver Cancer World (Age-Standardised) Incidence Rates, World Regions, 2008 Estimates

Liver Cancer , Average Number of New Cases per Year and Age-Specific Incidence Rates, world wide 2008-2010

Liver cancer world wide age adjusted incidence

per 100,000

GLOBCAN 2012

Incidence according to etiology

Abbreviations: WD, Wilson s disease; PBC, primary biliary cirrhosis, HH, hereditary hemochromatosis; HBV, hepatitis ′B virus infection; HCV, hepatitis C virus infection.

Prevalence of HCV globally

Global Burden of Hepatitis C: Considerations for Healthcare Providers

Globally, an estimated 130–170 million persons (2%–3% of the world's population) are living with (HCV) infection . More than 350 000 deaths are attributed to HCV infection each year, most of which are caused by liver cirrhosis and HCC. An estimated 27% of cirrhosis and 25% of HCC can be attributed to hepatitis C worldwide, and disease rates can be even more substantial in countries with a high burden of infection. For example, in Japan, up to 90% of all reported cases of HCC are caused by HCV infection

Scientific World Journal. 2012; 2012: 719494. Hepatitis C Virus in Arab World: A State of Concern

Distribution of hepatitis C virus genotypes in Middle East

Incidence of liver cancer

HCC in Arab world

Reports from some Arabic countries:EgyptLebanon Saudi Arabia

HCC in Egypt

• Population based registry• Cancer registry Nationwide • Hospital based registry

Number of cases

Amal samY Ibrahim NCI

ASIR: Age Standardized incidence rate

Presented by:Ali Shamseddine, MD.

Professor, Head Hematology Oncology AUB

VP /NCR

NATIONAL CANCER REGISTRYCANCER IN LEBANON

2003 & 2004

PRIMARY SITES N

AGE-SPECIFIC RATES per 100,000 CRUDE

RATES

ASR

    UN 0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+    

Oro-pharynx 72 12 0.18 0.55 0.70 1.49 9.62 17.47 11.33 17.00 4.03 3.79

Stomach 114 12 0.18 0.55 0.70 4.48 8.25 19.06 36.26 56.65 6.39 6.17

Colon-rectum 281 26 0.55 0.28 4.55 9.96 23.37 43.69 87.25147.3

0 15.74 15.43

Liver 33 3 0.18 0.28 0.35 0.50 2.06 3.1817.0

011.3

3 1.85 1.77Pancreas 58 4 0.00 0.00 0.00 1.49 8.25 9.53 23.80 17.00 3.25 3.38

Larynx 103 11 0.00 0.00 0.35 2.49 9.62 15.89 35.13 59.49 5.77 5.62

Lung 546 51 0.92 0.28 1.40 13.45 55.67112.0

0175.6

3280.4

4 31.6 31.62Skin melanoma 55 5 0.18 1.10 0.00 3.49 6.19 5.56 12.46 31.16 3.08 3.04

Prostate 587 79 0.00 0.00 0.35 0.50 14.43 81.02264.0

1424.9

1 32.89 29.88

Testis 79 2 1.48 3.31 8.75 9.96 5.50 2.8 0.00 2.83 4.43 4.29

Kidney 67 5 0.74 0.28 0.70 2.49 6.87 13.50 19.26 17.00 3.75 3.81

Bladder 569 80 0,18 0.00 2.80 11.46 32.99101.6

7193.7

6311.6

0 31.88 29.51

CANCER INCIDENCE RATES AMONG MALES IN LEBANON 2003

HCC in Saudi Arabia

Incidence of HCC in Saudi Arabia among new cancer cases 16,437

GLOBOCAN 2002

Causes of death among all cancer cases in Saudi Arabi 10,911

GLOBOCAN 2002

Hepatocellular carcinoma in Saudi Arabia: Role of hepatitis B infection.

N=118 N=118

Ayoola EA J Gastroenterol Hepatol. 2004; 19(6):665-9

1.9 per 1000

(2.3 in men, 1.2 in women).

Conclusion - HCC is increasing world wide and showed definite

increase in countries where HCV and HBV are prevalent.

- Egypt represents an example of definite association between chronic HCV and high incidence and HCC.

- Mortality from HCC is accounting for number one cause of death among all male cancers and may be the 4th cause of death in female cancers.

- The real challenge for HCC is that the presence of cirrhosis and patients late presentation threaten the value of any curative treatment.

Call for Co-operative group

Pan Arab hepatocellular carcinoma group

??

العرب .... وكل اوطانى العرب بالداخوانى

عاش العربى الوطن عاش