**5. Liver cirrhosis and other risk factors for HCC**

The majority of HCCs arise from liver cirrhosis, a condition in which liver tissue is replaced by scar tissue [27]. The scar tissue jeopardizes the blood flow through the liver and retains it from functioning correctly. Cirrhosis results mainly from different chronic hepatitis mainly due to viral infections and fatty liver disease related or unrelated to alcohol abuse. Currently, besides HBV, HCV, and HDV, three hepatitis viruses are identified and have been demonstrated to induce hepatitis: hepatitis A virus (HAV), hepatitis E virus (HEV), and hepatitis G virus (HGV). However, HBV and HCV are the most common inducers of hepatitis-related virus infections. People chronically infected with both hepatitis B and C present higher risk for developing HCC.

Besides hepatitis virus infection and fatty liver disease related or unrelated to alcohol consumption, aflatoxin has been shown to increase the risk of developing HCC [28]. Aflatoxin is a family of fungus toxins that could be present at high levels in frequently consumed food such as nuts, grains, and spices that are not adequately selected or properly stored. Aflatoxin enters the food supply and can be found in animal and human-processed foods. Animals can pass aflatoxin derivative products into milk, eggs, and meat. Overweight and obesity constitute other independent risk factors for HCC. Therefore, in order to efficiently prevent hepatitis and HCC, raising awareness through general public education should be highly supported [29].
