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What are the risk factors?

HCC most often develops in people with underlying liver disease (cirrhosis). In cirrhosis, healthy liver cells are replaced by scar tissue, which stops the liver working properly.

Causes of cirrhosis include long-term (chronic) infection with the hepatitis B or C virus, drinking too much alcohol, fatty liver disease due to obesity, type 2 diabetes, and having too much iron in the body (haemochromatosis). Cirrhosis may develop slowly over months or years.

It is increasingly common for patients to develop HCC without cirrhosis. This is often associated with non-alcoholic fatty liver disease, obesity, type 2 diabetes and hepatitis B infection. Other factors that increase the risk of HCC are smoking tobacco, being overweight or having a family history of HCC. People with several risk factors have an increased risk of developing HCC.

HCC is most common in Asia, the Pacific Islands and Africa due to high rates of hepatitis B infection. In Australia, HCC is more common in migrants from countries with a higher rate of hepatitis B infection.

The link between viral hepatitis and HCC

Worldwide, about 8 in 10 cases of HCC can be linked to infection with the hepatitis B or C virus.

Hepatitis B and C spread through contact with infected blood, semen or other body fluids. This can happen during unprotected sex with an infected partner, or by sharing personal items, such as razors, toothbrushes or needles, with an infected person. The most common way hepatitis B spreads is from mother to baby
during birth.

Viral hepatitis infects the liver cells (hepatocytes). When the body’s immune system attacks the virus, the liver becomes inflamed. In some people, the virus is cleared by the immune system. If the infection lasts more than six months (chronic infection), this inflammation may lead to liver scarring (cirrhosis) that can increase the risk of developing primary liver cancer.

To limit the spread of hepatitis B and the rate of primary liver cancer, all at-risk people should be vaccinated against the virus. At-risk people include:

  • people from South-East Asia, Africa and the Pacific Islands
  • sexually active partners of people with hepatitis B
  • people living in a household with someone with hepatitis B
  • people receiving blood transfusions
  • people who inject drugs.

If you already have hepatitis B, vaccination won’t help, but you will usually have regular tests to ensure you don’t develop liver problems. If you do have signs of liver damage, you may be offered antiviral medicines to help manage the effects of the infection and prevent further damage.

There is no vaccine to prevent infection with the hepatitis C virus. New antiviral medicines can cure hepatitis C in most people. This lowers the risk of developing
primary liver cancer but does not eliminate it.

Even after successful hepatitis treatment, people with cirrhosis need to manage their health and have regular check-ups.

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This information is reviewed by

This information was last reviewed June 2020 by the following expert content reviewers: Dr David Yeo, Hepatobiliary/Transplant Surgeon, Royal Prince Alfred, Chris O’Brien Lifehouse Cancer Centre and St George Hospitals, NSW; Dr Lorraine Chantrill, Head of Department Medical Oncology, Illawarra Shoalhaven Local Health District, NSW; Michael Coulson, Consumer; Dr Sam Davis, Interventional Radiologist, Staff Specialist, Royal Brisbane and Women‘s Hospital, QLD; Prof Chris Karapetis, Network Clinical Director (Cancer Services), Southern Adelaide Local Health Network, Head, Department of Medical Oncology, Flinders Medical Centre and Flinders University, SA; Dr Howard Liu, Radiation Oncologist, Princess Alexandra Hospital, QLD; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Lina Sharma, Consumer; Dr Graham Starkey, Hepato-Biliary and General Surgeon, Austin Hospital, VIC; Catherine Trevaskis, Gastrointestinal Cancer Specialist Nurse, Canberra Hospital and Health Services, ACT; Dr Michael Wallace, Western Australia Liver Transplant Service, Sir Charles Gairdner Hospital,