Morgan TR, Mandayam S, Jamal MM.
Gastroenterology Section, VA Medical Center, Long Beach, California, USA. timothy.morgan@med.va.gov
More than 18 million adults
in the United States abuse alcohol, a prevalence 5 times higher than that of
hepatitis C. Chronic alcohol use of greater than 80 g/day for more than 10 years
increases the risk for hepatocellular carcinoma (HCC) approximately 5-fold;
alcohol use of less than 80 g/day is associated with a nonsignificant increased
risk for HCC. The risk for HCC in decompensated alcohol induced cirrhosis approaches
1% per year. The risk does not decrease with abstinence, and HCC can occur in
a noncirrhotic liver. Alcohol use in chronic hepatitis C doubles the risk for
HCC as compared with the risk in hepatitis C alone. Furthermore, there may be
synergism between alcohol and hepatitis C in the development of HCC, and in
these patients HCC may occur at an earlier age and the HCC may be histologically
more advanced. Studies in the United States and Italy suggest that alcohol is
the most common cause of HCC (accounting for 32%-45% of HCC). The mechanisms
by which alcohol causes HCC are incompletely understood, but may include chromosomal
loss, oxidative stress, a decreased retinoic acid level in the liver, altered
DNA methylation, and genetic susceptibility. Alcohol use is increasing in many
countries, suggesting that alcohol will continue to be a common cause of HCC
throughout the world.
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