POSSIBLE CONSEQUENCES OF CHRONIC HBV - Q & A ON CIRRHOSIS, AND LIVER CANCER

1. Is Hepatocellular Carcinoma (HCC) associated with cirrhosis?
    Answer: Yes, almost 70-90% of those with HCC will have underlying cirrhosis.

2. If I have chronic Hep B, what are the chances that I will develop cirrhosis or HCC in my life time?
    Answer: Cirrhosis occurs in 20-30% of those with hepatitis B virus (HBV). About 25% of these may develop HCC. However, about 30% of HCC may develop without any cirrhosis.

3. Is there a chance that I may get cirrhosis or HCC early?
    Answer:: If you have active hep B liver disease, there is an overall 15- 20% chance of developing cirrhosis in 5 to 10 years. Adverse factors for getting cirrhosis include having the E antigen (HBeAg) and having had HBV for a long time, more than 10 years.


Within any 5-year period for those who have chronic hepatitis B:
~~20% will go from chronic Hep B to compensated cirrhosis. ~~20% will go from compensated cirrhosis to decompensated cirrhosis ~~ And 5% (West) or 15% (Asia Pacific) of those with cirrhosis will get HCC.

4. What are the chances of surviving cirrhosis or HCC.?
    Answer: 5-year survival figures are--
~~For compensated cirrhosis: 80-85 %
~~For decompensated cirrhosis: 15-35 %
~~For HCC: 10%

Being e antigen negative decreases the death rate due to cirrhosis by 2.5 %. In Chinese who have chronic HBV infections, the life-time risk of dying from hepatitis B-related liver disease is: 40% in men, 15 % in women.

Factors that contribute to a worse prognosis in those with chronic hepatitis B include:
~~The degree of disease activity (inflammation)
~~Older patient age
~~Male sex
~~Recurrent hepatitis "flares" (sharp rise in liver enzymes such as ALTs in serum) not followed by clearance of the "e" antigen (HBeAg)
~~Lengthy persistence of HBV replication

Factors that contribute to better prognosis include:
~~Being negative for the "e" antigen (HBeAg)
~~Normal liver enzyme-ALT levels
~~HBV-DNA readings are undetectable
~~Proactivity on the part of the patient

5. How is HCC diagnosed?
    Answer: Based on recommendation from the European Association for the Study of Liver Meeting in 2000:
~~Focal lesion > 2 cm with arterial hypervascularisation, at least seen by two of the following techniques: Ultra-Sound, MRI, or triple-phased CT Scan.
~~Combined criteria of one imaging technique above, plus AFP > or equal to 400 ng/ml.
~~In lesions < 2 cm: Fine needle liver biopsy. (Complications: bleeding in the abdomen-< 0.5%; tumor seeding along needle tract 3-5% chance)

HCC can be confused with the following, usually found through ultrasound:
~~Regenerating liver nodule in cirrhosis
~~Cancer nodule from elsewhere ( metastatic cancer). This may sometimes be the first sign of cancer in lung, colon, prostate or breast.
~~Parasitic nodule or cyst ( more common in developing nations)

6. What is the survival rate for HCC?
    Answer: If treated, the 5-year HCC survival rate when tumor < 5 cm (or HCC with 3 lesions or less, each lesion less than 3 cm) is:
~~If treated by resection: 51 %
~~If treated by transplant: 74%
~~If treated by non-operative measures: 27%

7. What are life-threatening complications from cirrhosis?
    Answer: Life-threatening complications include:
~~Variceal bleeding (each episode of variceal bleeding has 30-60% mortality rate)
~~Refractory ascites (fluid in the abdomen that doesn't respond to treatment)
~~Encephalopathy (impaired sensory reaction)
~~Hepatorenal syndrome (kidney shut-down).

8. Is fibrosis/cirrhosis reversible? Are there any treatments to reverse fibrosis on the horizon?
   Answer: Yes, there is evidence in animal models that liver fibrosis can be reversed, albeit the reversal may be a slow process. Several approaches are under investigation and there is hope for the future, but no drug treatment is currently recommended.

9. What are the definitions of fibrosis, cirrhosis, and necrosis?
    Answer:. Here are the definitions:
~~Necrosis means death of tissue. When liver cells die from hepatitis B (usually from our immune system fighting infected liver cells), that is called necrosis.
~~When liver cells die, they form scar tissue called fibrosis.
~~The liver consists of tiny nodules, and bridging fibrosis is when the scar tissue connects from nodule to nodule
~~Cirrhosis occurs when the scar tissue encloses nodules and any liver cells left inside die because all blood circulation to that nodule is cut off (necrosis again).

It's best to avoid fibrosis of cirrhosis in the first place. The multi-pronged approaches being considered include:
~~Controlling inflammation and immune activity in the liver through medication such as interferon
~~Removing the primary disease (such as getting rid of the virus).
~~Inhibiting the cells responsible for fibrous tissue formation
~~Stimulating degradation of scar tissue.

10. How long can a patient with cirrhosis live?
    Answer:
~~Those with Child A cirrhosis have a 10-year plus survival rate that is comparable to a normal life span. (Many times, during autopsies, people are found to have had Child A cirrhosis, but have died of another ailment.)
~~A Child B patient has a 40-60% five-year survival rate
~~A Child C has a 20-40% one-year survival rate.
(Child stage A is considered mild cirrhosis, while those with stage C have advanced liver disease and are candidates only for a liver transplant. The Child stage B is somewhere in between.)

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