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**Detection / Prevention / Prevalence** 

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**16** 

*1Colombia 2USA* 

**Hepatocellular Carcinoma: Methods of** 

*2Beth Israel Deaconess Medical Center, Center of Life Science, Division of Endocrinology, Diabetes and Metabolism, Boston,* 

Natalia Olaya1 and Franck Chiappini2

**Circulating Tumor Cells (CTC) Measurements** 

Hepatocellular carcinoma (HCC) is responsible for significant morbidity and mortality in cirrhosis and also accounts for between 85% and 90% of primary liver cancer (Caldwell & Park 2009; Hussain & El-Serag 2009; Tandon & Garcia-Tsao 2009). Most of HCC in the world occur in the setting of cirrhosis and over half-million of people develop liver cancer every year and an almost equal number die of it (Caldwell & Park 2009; Hussain & El-Serag 2009). Liver cancer prognosis is determined by factors related to the tumor (etiologies) and factors related to the cirrhosis i.e. parameters of liver dysfunction (CLIP 1998; Llovet et al., 1999; Okuda et al., 1985; Tandon & Garcia-Tsao 2009). During the last 30 years the HCC-incidence rate increased dramatically, despite the development of the HBV-vaccine and the program for newborn vaccination against HBV, developed in European and Asian countries (El-Serag

Since 1997, and after implementing a program for vaccination of newborns against HBV, Chinese and Japanese populations began to show a decrease in HCC incidence, especially among males (Plymoth et al., 2009; Yu S. Z. 1995). In the other hand, HCV-infection is rising around the world (Davila et al., 2004; Kong S. Y. et al., 2009; Min et al., 2009; Yoon et al., 2009; Yu M. L. & Chuang 2009) counter balancing the benefit effects of HBV-vaccination. This increase in incidence rate is observed through the world and it does not belong to a specific region. For example, the USA and Europe have the same positive incidence slope (Davila et al., 2004; Donato et al., 2006; El-Serag 2002; El-Serag 2004; El-Serag et al., 2003; Hassan et al., 2002; Hussain & El-Serag 2009; Scatton et al., 2009; Wu et al., 2000). The etiologies of HCC remain the same; the most important causes are the HBV and HCV infections, heavy alcohol consumption, aflatoxin B1, age and gender (males are more susceptible than females), race (Asian and African over 20 years old) , tobacco consumption and obesity associated with non-alcoholic fatty liver disease and the increase of the Diabetes II mellitus that rise the risk factor between 2 and 3, genetic hemochromatosis, primary biliary cirrhosis, alpha1-antitrypsin deficiency and autoimmune hepatitis (Banks et al., 2006; Borgen et al., 1998; Bostick et al., 1998; Caldwell & Park 2009; CLIP 1998; Collier & Sherman

**1. Introduction** 

et al., 2003; Hussain & El-Serag 2009).

*1Laboratorio clínico, de patología y banco de sangre/ Fundación Valle del Lili Cali* 
