Early diagnosis of hepatocellular carcinoma in the patients with hepatic schistosomiasis japonica

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Tamahocho, where Yamanashi Medical College is located, was one of the endemic areas of schistosomiasis japonica in Japan. Many inhabitants older than 40 Years of age in this area have histories of schistosomas infection, and are often suffering from portal hypertension with extensive interstitial fibrosis or calcification of the liver. The hepatitis B and alcholic liver cirrhosis are also frequently found among these inhabitants. The area therefore is thought under the high risk condition for the hepatocellular carcinoma. Marked fibrosis or calcification, found in schistosomiasis liver with ultrasonographic examination, some time prevents early detection of silent hepatocellular carcinoma. X-ray CT is the choice of further examination in such a case. In 1985 and 1986, we examined our city inhabitants who have histories of schistomomas infection, and tried to find out such a occult case of hepatocellular carcinoma. Of 260 residents examined by ultrasonography, a patient with hepatocellu … More lar carcinoma and a patient with gastric carcinoma with hepatic metastases were found. The former was treated with hepatic transarterial tumor embolization, and the latter with gastrectomy for his massive hematoemesis. A patient, suspected of hepatocellular carcinoma by ultrasonography and high AFP value, was refered to further examination. Among 73 residents who were examined by X-ray CT in case ultrasonography had given poor information on hepatic tumors because of interstitial fibrosis, 2 patients suspected of hepatocellular carcinoma and a patient suspected of pulmonary carcinoma were found. Among 630 residents whose sera were examined, 6 patients with positive AFP were found. Of them, 2 were happend to be the same patients treated for their cancer, and one was the suspect found by ultrasonography and high AFP value. Another 3 had no hepatic tumors. Two-year experience taught us so far that the effective study of finding hepatocellular carcinoma among those residents are as follows. 1) Serum AFP study for as many residents of more than 40 years of age as possible, 2) screening with ultrasonography in detecting hepatic malignancy, and 3) X-ray CT in detecting hepatic malignancy for those who displayed marked hepatic fibrosis of schistosomiasis. Less