9. How does liver cancer develop from HBV?

Hepatitis B is sort of a double whammy when it comes to liver cancer. In hepatitis C, you can’t get liver cancer until you get cirrhosis because what happens is you get the scar tissue as a result of the inflammation and then the liver cells are sort of trying desperately to re-grow and as they try to re-grow, they lose their control mechanism and they take off like crazy and develop and become cancer in hepatitis C and in hepatitis B and cirrhosis. But in addition, hepatitis B, because it’s a DNA virus, can on its own right unleash development of cancer modify the DNA and the liver cells and cause the patient to develop cancer without going through the stage of cirrhosis. So you have this double pronged tendency to liver cancer. Its not uncommon to see a 32-year old Asian person present with liver cancer who has no evidence of cirrhosis and in a sense never sick a day of life had no idea he had liver disease until he got a pain on his right side and was diagnosed with cancer. This is not true of other situations because for the most part in the world, hepatitis C and other reasons, alcohol, any other reasons, the cirrhosis comes first and the liver cancer comes afterwards as an aberration of the cirrhosis. But in this case, you get a lot of these young people who just having had the virus embedded in their own DNA their own DNA and liver cells gets modified to develop cancer.