Dr. Hashem El-Serag on the Relationship Between NASH and HCC

Hashem El-Serag, MD, MPH, medicine-gastroenterology, Baylor College of Medicine, discusses the relationship between nonalcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC).

NASH is a condition of where the liver has both fat, inflammation, and scar tissue or fibrous. There is increasing evidence that this condition can lead to HCC, predominantly through the formation of cirrhosis. Nonalcoholic fatty liver disease (NAFLD) by itself is weakly associated with HCC, but NASH, which is a more progressed form of NAFLD, has a higher risk of HCC, around 5% over 20 years of follow-up. Patients that have NASH-related cirrhosis have a much more measurable risk of 1% per year of developing HCC, says El-Serag. Most experts would recommend routine surveillance for HCC for this patient population.

There needs to be more education regarding the association between NASH and HCC, says El-Serag. The vast majority of HCC cases that get diagnosed and the underlining cause is NASH are not recognized as having cirrhosis prior to their diagnosis. Most of them have not undergone routine surveillance and screening. This lack of knowledge is highly disproportionate to the other causes of cirrhosis.