Challenges of Managing Hepatocellular Carcinoma in Sub-Sahara Africa

  • MC Kew

Abstract

The high incidence of hepatocellular carcinoma (HCC) in sub-Saharan Black Africans and the advanced stage of the disease when the patients usually seek medical attention, as well as the inadequate diagnostic and, more importantly, treatment facilities for the tumour pose enormous challenges in managing HCC in sub-Saharan Africa. At present HCC in Black Africans is seldom amenable to surgical intervention, in the form of either resection or transplantation, at the time the diagnosis is made. An immediate challenge will be to provide the expertise and facilities that will make it possible to increase the number of patients amenable to and undergoing successful surgical treatment, and to have available to the many patients chronically infected with hepatitis B virus (or less often hepatitis C virus) anti-viral agents that will prevent postoperative tumour recurrence. A further immediate challenge is the provision of expertise in locoregional therapy with transarterial chemoembolization, percutaneous ethanol injection, or radiofrequency ablation for downstaging inoperable tumours to meet the requirements for either resection or transplantation. The introduction of molecular targeted therapies that act on pathways critical for cancer progression and survival has created a new hope for the effective chemotherapy of inoperable HCC. Positive results have been reported in populations other than Black Africans with the use of Sorafenib, an oral multikinase inhibitor, and trials urgently need to be conducted in Black African patients. Other major challenges, in the longer term, in managing HCC in sub-Saharan Africa are presymptomatic detection of the tumour and prevention of hepatitis virus infections, dietary exposure to aflatoxin, and dietary iron overload, the major causes of HCC in Black Africans.
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print ISSN: 2251-0079