Why is Hepatocellular Carcinoma Less Attributable to Viral Hepatitis in Yemen?

  • Published : 2012.08.31


The hepatitis B virus (HBV) and the hepatitis C virus (HCV) are still public health problems in Yemen, with older individuals having much higher prevalence than younger generations. However, research on the prevalence of viral hepatitis in association with hepatocellular cancer (HCC) has not yet been undertaken in Yemen. The aim of this study was to determine the prevalence of HBV and HCV infection among HCC patients and to estimate the risk of these infections being associated with the development of HCC. A cross-sectional study was conducted on patients attending oncology outpatient in Sana'a, Yemen, through the period 2008-mid 2010 with confirmed diagnosis of HCC. A total of 88 cases were studied thoroughly with different investigations such as CT-scan, ultrasound, tumour marker, alpha-feto-protein and histopathological biopsy. A structured questionnaire was also applied and physical examination done to assess the general condition of the patients. Statistical package (SPSS version 16) was used for analysis of the data. The mean age of the cases was 61.2 years (${\pm}12.6$) with half over 60 years. There were fewer male patients (36%) compared to females and most (97%) only had basic /no formal education. Seventy nine (89%) were diagnosed as HCC cases with histopathological biopsy while the rest were diagnosed by ultrasound, CT scan, tumour marker, and alpha-feto-protein. Around one-third of the subjects were positive for HBsAg and HCV antibodies. Multivariate analysis showed infection with HCV and use of smoking was associated with HCC diagnosis. Although an association was observed between the occurrence of HCC and viral hepatitis (either HBV or HCV) and cigarette smoking, but the rate of viral infection was lower than what has been reported elsewhere.


  1. Aarnio M, Mecklin JP, Aaltonen LA, Nystrom-Lahti M, Järvinen HJ (1995). Life-time risk of different cancers in hereditary non-polyposis colorectal cancer (HNPCC) syndrome. Int J Cancer, 64, 430-3.
  2. Adloff M, Arnaud JP, Schloegel M, Thibaud D, Bergamaschi R(1986). Colorectal cancer in patients under 40 years of age. Dis Colon Rectum, 29, 322-5.
  3. Ajao OG, Adenuga MO, Ladipo JK (1988). Colorectal carcinoma in patients under the age of 30 years: a review of 11 cases. J R Coll Surg Edinb, 33, 277-9.
  4. Al-Jaberi TM, Yaghan RJ, El-Heis HA (2003). Colorectal cancer in young patients under 40 years of age. Comparison with old patients in a well defined Jordanian population. Saudi Med J, 24, 871-4.
  5. Ansari R, Mahdavinia M, Sadjadi A, et al (2006). Incidence and age distribution of colorectal cancer in Iran: Results of a population-based cancer registry. Cancer Letters, 240, 143-7.
  6. Atkin W S, Edwards R, Kralj-Hans I, et al (2010). Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet, 375, 1624-33.
  7. Bedikian AY, Kantarjian H, Nelson RS, Stroehlein JR, Bodey GP (1981). Colorectal cancer in young adults. South Med J, 74, 920-4.
  8. Bener A, Moore MA, Ali R, El Ayoubi HR (2010). Impacts of family history and lifestyle habits on colorectal cancer risk: a case-control study in Qatar. Asian Pac J Cancer Prev, 11, 963-8.
  9. de Silva MV, Fernando MS, Fernando D (2000). Comparison of some clinical and histological features of colorectal carcinoma occurring in patients below and above 40 years. Ceylon Med J, 45, 166-8.
  10. Devroede GJ, Taylor WF, Sauer WG, Jackman RJ, Stickler G B (1971). Cancer risk and life expectancy of children with ulcerative colitis. N Engl J Med, 285, 17-21.
  11. Domergue J, Ismail M, Astre C, et al (1988). Colorectal carcinoma in patients younger than 40 years of age. Montpellier Cancer Institute experience with 78 patients. Cancer, 61, 835-40.<835::AID-CNCR2820610432>3.0.CO;2-X
  12. Ferlay J, Shin H, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer.
  13. Gallagher E, Zeigler MG (1972). Rectal carcinoma in patients in second and third decades of life. Am J Surgery, 124, 655.
  14. Griffin PM, Liff JM, Greenberg RS, Clark WS (1991). Adenocarcinomas of the colon and rectum in persons under 40 years old. A population-based study. Gastroenterology, 100, 1033-40.
  15. Hampel H, Peltomaki P (2000). Hereditary colorectal cancer: risk assessment and management. Clinical Genetics, 58, 89-97.
  16. Herszenyi L, Miheller P, Tulassay Z (2007). Carcinogenesis in inflammatory bowel disease. Dig Dis, 25, 267-9.
  17. Isbister WH (1992). Colorectal cancer below age 40 in the Kingdom of Saudi Arabia. Aust N Z J Surg, 62, 468-72.
  18. Isbister WH, Fraser J (1990). Large-bowel cancer in the young: a national survival study. Dis Colon Rectum, 33, 363-6.
  19. Jensen HK, Konradsen F, Jørs E, Petersen JH, Dalsgaard A (2011). Pesticide Use and Self-Reported Symptoms of Acute Pesticide Poisoning among Aquatic Farmers in Phnom Penh, Cambodia. J Toxicol, 63, 981-4.
  20. Jarvinen HJ, Mecklin JP, Sistonen P (1995). Screening reduces colorectal cancer rate in families with hereditary nonpolyposis colorectal cancer. Gastroenterology, 108, 1405-11.
  21. Liu B, Farrington SM, Petersen GM, et al (1995). Genetic instability occurs in the majority of young patients with colorectal cancer. Nat Med, 1, 348-52.
  22. MacGillivray DC, Swartz SE, Robinson AM, Cruess DF, Smith LE (1991). Adenocarcinoma of the colon and rectum in patients less than 40 years of age. Surg Gynecol Obstet, 172, 1-7.
  23. Martin EW, Joyce S, Lucas J, Clausen K, Cooperman M (1981). Colorectal carcinoma in patients less than 40 years of age: pathology and prognosis. Dis Colon Rectum, 24, 25-8.
  24. McCart AE, Vickaryous NK, Silver A (2008). Apc mice: Models, modifiers and mutants. Pathology Res Pract, 204, 479-90.
  25. Meyer JE, Narang T, Schnoll-Sussman F H, et al (2010). Increasing incidence of rectal cancer in patients aged younger than 40 years: an analysis of the surveillance, epidemiology, and end results database. Cancer, 116, 4354-9.
  26. Noeman SA, Sharada K, el Dardiry S, Rahim AA, Zaki Y (1994). Significance of tumour markers in colorectal carcinoma associated with Schistosomiasis. Bangladesh Med Res Counc Bull, 20, 12-20.
  27. O'Connell JB, Maggard M A, Liu J H, et al (2003). Rates of colon and rectal cancers are increasing in young adults. Am Surg, 69, 866-72.
  28. O'Connell JB, Maggard MA, Livingston EH, Yo CK (2004). Colorectal cancer in the young. Am J Surg, 187, 343-8.
  29. Ohman U (1982). Colorectal carcinoma in patients less than 40 years of age. Dis Colon Rectum, 25, 209-14.
  30. Okuno M, Ikehara T, Nagayama, M, et al (1987). Colorectal carcinoma in young adults. Am J Surg, 154, 264-8.
  31. Peters RK, Garabrant DH, Yu MC, Mack TM (1989). A casecontrol study of occupational and dietary factors in colorectal cancer in young men by subsite. Cancer Res, 49, 5459-68.
  32. Pratt CB, Rivera G, Shanks E, et al (1977). Colorectal carcinoma in adolescents implications regarding etiology. Cancer, 40, 2464-72.<2464::AID-CNCR2820400912>3.0.CO;2-D
  33. Sampson JR, Jones S, Dolwani S, Cheadle JP (2005). MutYH (MYH) and colorectal cancer. Biochem Soc Trans, 33, 679-83.
  34. Siegel RL, Jemal A, Ward EM (2009). Increase in incidence of colorectal cancer among young men and women in the United States. Cancer Epidemiol Biomarkers Prev, 18, 1695-8.
  35. Singh Y, Vaidya P, Hemandas AK, Singh KP, Khakurel M (2002). Colorectal carcinoma in Nepalese young adults: presentation and outcome. Gan To Kagaku Ryoho, 29, 223-9.
  36. Soliman AS, Bondy ML, Levin B, et al (1997). Colorectal cancer in Egyptian patients under 40 years of age. Int J Cancer, 71, 26-30.<26::AID-IJC6>3.0.CO;2-5
  37. Urbani C, Sinoun M, Socheat D, et al (2002). Epidemiology and control of Mekongi schistosomiasis. Acta Trop, 82, 157-68.
  38. van Lier MG, Wagner A, Mathus-Vliegen EM, et al (2001). High cancer risk in Peutz-Jeghers syndrome: a systematic review and surveillance recommendations. Am J Gastroenterol, 105, 1258-64.
  39. Yilmazlar T, Zorluoglu A, Ozguc H, et al (1995). Colorectal cancer in young adults. Tumori, 81, 230-33.

Cited by

  1. Application of Data Mining Techniques to Explore Predictors of HCC in Egyptian Patients with HCV-related Chronic Liver Disease vol.16, pp.1, 2015,
  2. Hepatitis C Virus Epidemiology in Djibouti, Somalia, Sudan, and Yemen: Systematic Review and Meta-Analysis vol.11, pp.2, 2016,
  3. Relative Importance of Hepatitis B and C Viruses in Hepatocellular Carcinoma in EMRO Countries and the Middle East: A Systematic Review vol.16, pp.3, 2016,