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Yapali et al. Hepatoma Res 2018;4:24 Hepatoma Research
DOI: 10.20517/2394-5079.2018.57

Review Open Access

Epidemiology and viral risk factors for hepatocellular
carcinoma in the Eastern Mediterranean countries

Suna Yapali, Nurdan Tozun

Division of Gastroenterology, Acibadem University School of Medicine, Istanbul 34752, Turkey.
Correspondence to: Dr. Suna Yapali, Division of Gastroenterology, Acibadem University School of Medicine, Istanbul 34752,
Turkey. E-mail: sunayapali@gmail.com

How to cite this article: Yapali S, Tozun N. Epidemiology and viral risk factors for hepatocellular carcinoma in the Eastern
Mediterranean countries. Hepatoma Res 2018;4:24. http://dx.doi.org/10.20517/2394-5079.2018.57

Received: 12 May 2018 First Decision: 29 May 2018 Revised: 13 Jun 2018 Accepted: 14 Jun 2018 Published: 27 Jun 2018
Science Editor: Guang-Wen Cao Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

Abstract
Given the high prevalence of viral hepatitis in the Eastern Mediterranean countries, hepatitis B and C infections are
the major causes of hepatocellular carcinoma (HCC) in the region. Most cases are associated with cirrhosis related
to hepatitis B or C infection. Environmental, host genetic and viral factors can affect the risk of HCC in patients
with hepatitis B and C infection. Understanding the epidemiology and viral risk factors in the region provides the
implementation of strategies for prevention and treatment of viral hepatitis. Herein, we reviewed the epidemiology,
burden of disease and viral risk factors for HCC.

Keywords: Viral hepatitis, Eastern Mediterranean countries, hepatocellular carcinoma, epidemiology, risk factors, burden

INTRODUCTION
Hepatocellular cancer (HCC) is the fifth most common cancer in men and the seventh most common cancer
in women worldwide accounting for 90% of all primary liver cancers. Furthermore, HCC is the third leading
cause of cancer-related death . Because of the low resectability rate, high recurrence rate after resection
[1-3]
and poor response to the conservative treatment, the prognosis of HCC is poor with a 5-year survival rate
[1-3]
of 6.9% . The burden of HCC is higher in developing countries and varies markedly by age, gender, race
and exposure to risk factors in different geographic regions. In the Eastern Mediterranean countries, HCC
has a lower prevalence compared to the highly prevalent regions like Eastern Asia and sub-Saharan Africa.
However, HCC remains to be a major concern for countries like Egypt and Saudi Arabia. This article reviews
the epidemiology and viral risk factors of HCC in Eastern Mediterranean countries.

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
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