A 64-year-old man with chronic hepatitis B presents to the clinic for routine surveillance. He feels well and denies abdominal pain, jaundice, or weight loss. He has a history of gastroesophageal reflux disease, peptic ulcer disease, diverticulosis, and irritable bowel syndrome. His medications include pantoprazole and entecavir. He does not drink alcohol. Physical examination is unchanged from previous visits. Laboratory studies reveal a mildly elevated alpha-fetoprotein level. Abdominal ultrasonography identifies a new 2.5-cm hepatic lesion.
Which of the following is the strongest risk factor for developing this patient’s condition?
The correct answer is:
A: Chronic hepatitis B infection.
This patient is undergoing surveillance for hepatocellular carcinoma (HCC), and the new hepatic lesion is concerning for malignancy. Chronic hepatitis B is a major risk factor for HCC and can lead to cancer even in the absence of cirrhosis. Other important risk factors include hepatitis C infection, cirrhosis of any cause, alcohol-associated liver disease, and metabolic dysfunction-associated steatotic liver disease.
Answer choice B: Diverticulosis, is incorrect.
Diverticulosis is a common colonic condition but has no established relationship with HCC.
Answer choice C: Gastroesophageal reflux disease, is incorrect.
GERD affects the esophagus and does not increase the risk of primary liver cancer.
Answer choice D: Irritable bowel syndrome, is incorrect.
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder without malignant potential.
Answer choice E: Peptic ulcer disease, is incorrect.
Peptic ulcer disease is not associated with hepatocellular carcinoma.
Key Learning Point
Chronic hepatitis B infection is a major risk factor for hepatocellular carcinoma and warrants routine surveillance.
