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Usually, individuals at risk for developing liver cancer are those with cirrhosis (advanced liver disease with permanent liver scarring). In other words, cirrhosis is a precancerous condition. In fact, patients with cirrhosis regardless of the underlying cause are at increased risk of developing liver cancer, for example, patients with cirrhosis from chronic hepatitis C, chronic hepatitis B, hemochromatosis, alcohol, and fatty liver. Some of these groups of patients should have periodic ultrasound examinations of the liver as well as blood tests for alpha fetoprotein (a blood test that is produced by liver cancers) to detect the development of liver cancer early.
There is one group of patients without cirrhosis that is at risk of developing liver cancer; that group of patients has chronic infection with the hepatitis B virus. A typical patient would be somebody born with hepatitis B infection contracted from his/her mother at birth (common in Asia). The baby's immature immune system does not recognize the hepatitis B virus as "foreign" and thus tolerates the virus. (The body's immune system does not wage war against the virus.) The hepatitis B virus is able to multiply and flourish in the body without causing the hepatitis (liver inflammation caused by the immune system) that leads to cirrhosis. However, the virus can damage the DNA in the liver cells and cause liver cancer. These patients typically have high levels of hepatitis B virus in their blood but normal liver enzymes and normal liver biopsies. Such patients should have ultrasound examinations of the liver and alpha fetoprotein blood tests every six months to look for developing liver cancers.
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"Clinical manifestations and natural history of hepatitis B virus infection"