This book aims to illuminate the causes, incidence, and treatments of Hepatocellular Carcinoma(HCC) or liver cancer in the politically important and societally diverse region of the Middle East. Taking a flexible and inclusive view, it examines the influences of geography, crops and diet, ethnicity, and local behavior on both diagnosis and outcomes of this disease. Understanding the different causes of liver cancer enables effective strategies for both prevention and early diagnosis while knowledge of the different treatment modalities, their uses and limitations, availability and costs, works to inform rational treatment provision and selection. Divided into four sections, this book considers the causes and clinical syndromes associated with HCC, provides a detailed overview of clinical HCC and treatment modalities, describes country-specific clinical HCC experience and practice, and considers future needs and the potential for HCC collaborations across the region. Liver Cancer in the Middle East is a useful resource for clinicians seeking insight into the second highest cause of death from cancer worldwide, governments planning social and medical services for their peoples, as well as for international aid agencies prioritizing donations.

This atlas illustrates the latest available data on the cancer epidemic, showing causes, stages of development, and prevalence rates of different types of cancers by gender, income group, and region. It also examines the cost of the disease, both in terms of health care and commercial interests, and the steps being taken to curb the epidemic, from research and screening to cancer management programs and health education.

Cancer is low or absent on the health agendas of low- and middle-income countries (LMCs) despite the fact that more people die from cancer in these countries than from AIDS and malaria combined. International health organizations, bilateral aid agencies, and major foundations—which are instrumental in setting health priorities—also have largely ignored cancer in these countries. This book identifies feasible, affordable steps for LMCs and their international partners to begin to reduce the cancer burden for current and future generations. Stemming the growth of cigarette smoking tops the list to prevent cancer and all the other major chronic diseases. Other priorities include infant vaccination against the hepatitis B virus to prevent liver cancers and vaccination to prevent cervical cancer. Developing and increasing capacity for cancer screening and treatment of highly curable cancers (including most childhood malignancies) can be accomplished using "resource-level appropriateness" as a guide. And there are ways to make inexpensive oral morphine available to ease the pain of the many who will still die from cancer.

Mycotoxins, from the Greek "mukes" referring to fungi or slime molds and toxin from the Latin "toxicum" referencing a poison for arrows, have earned their reputation for being potentially deleterious to the health and well being of a consuming organism, whether it be animal or human. Unfortunately, mycotoxins are a ubiquitous factor in the natural life cycle of food producing plants. As such, control of the potential impact of mycotoxins on food safety relies heavily upon accurate analysis and surveys followed by commodity segregation and restricted use or decontamination through processing. The purpose of this book is to provide the most comprehensive and current information on the topic of mycotoxins and assuring food safety. Chapters represented in the book reflect such diverse topics ranging from occurrence and impact, analysis, reduction through processing and plant breeding, toxicology and safety assessments to regulatory perspectives. Authors represent a range of international perspectives.

This book provides an evaluation of measures to reduce exposure to highly toxic and carcinogenic contaminants in staple diets in Africa as well as parts of Asia and Latin America. Many of the poorest people in these regions are exposed to the pervasive natural toxins, aflatoxins and fumonisins, on a daily basis by eating their staple diet of groundnuts, maize, and other cereals. Exposure to mycotoxins at these high levels substantially increases mortality and morbidity. Aflatoxins are a cause of human liver cancer, and fatalities from acute aflatoxin poisoning outbreaks occur in Africa and Asia. The International Agency for Research on Cancer convened a Working Group of world-leading experts to review the health effects of aflatoxins and fumonisins and to evaluate intervention measures. The panel concluded that these mycotoxins not only are a cause of acute poisoning and cancer but also are a likely contributor to the high levels of stunting in children in affected populations. The Working Group also identified effective measures to reduce exposure in developing countries. The panel evaluated 15 interventions, considering the strength of the evidence as well as its completeness and its transferability at an individual, community, or national level. Four of the interventions were judged to be ready for implementation: improvement of dietary diversity; crop sorting; post-harvest measures, including improved storage; and, in Latin America for maize, optimized nixtamalization. These recommendations would be relevant for investment of public, nongovernmental organization, and private funds at the scale of the subsistence farmer, the smallholder, and through to a more advanced value chain.

The book comprehensively covers all aspects of hepatocellular carcinoma (cancer) as it occurs in sub-Saharan black Africans and how the cancer differs from that in other parts of the world, in most of which it occurs infrequently. The first chapter is introduced with a discussion of the difficulty in recording all cases of this cancer in sub Saharan Africa and then covers its epidemiology, emphasising the very high incidence of liver cancer in sub Saharan black Africans. The relatively young age at which the tumor occurs in comparison with the older age of the patients in resource-rich regions is stressed. The sex distribution of the cancer is also discussed. The second chapter describes the ways in which hepatocellular cancer presents in black Africans, its symptoms and signs, and how its presentation differs from that in other parts of the world. The third chapter summarises the grave outlook for patients with the tumor, the very short survival times of the patients, and the reasons for their deaths. The fourth chapter discusses the diagnosis of the cancer and why this is far more difficult than it is in resource-rich countries. The fifth chapter deals with the pathology of the tumor-its similarities and differences from that in other parts of the world. The sixth chapter is the longest in the book, and it deals comprehensively with the causes of liver cancer in sub-Saharan Africa. The major cause is chronic infection with the hepatitis B virus, an infection acquired in early childhood, and the possible mechanisms by which this may cause the cancer. Other less common but still important causes in the subcontinent-such as exposure to the fungal carcinogen, aflatoxin, chronic hepatitis C virus infection, dietary iron overload among Africans, and membranous obstruction of the inferior vena cava-are also discussed. The seventh chapter discusses the difficulty in treating hepatocellular cancer and the poor results obtained in sub-Saharan Africa in comparison with the results of treatment in industrialized countries. The penultimate chapter presents possible ways to prevent the cancer or, at least, to detect it at a far earlier time than is currently the case and when it may be more amenable to treatment. The current status of vaccination in preventing hepatitis B virus infection, and hence liver cancer, is discussed in detail. The final chapter asks the question, "How can we improve the diagnosis and treatment of this dreadful malignant disease?"

Testing and diagnosis of hepatitis B (HBV) and C (HCV) infection is the gateway for access to both prevention and treatment services, and is a crucial component of an effective response to the hepatitis epidemic. Early identification of persons with chronic HBV or HCV infection enables them to receive the necessary care and treatment to prevent or delay progression of liver disease. Testing also provides an opportunity to link people to interventions to reduce transmission, through counselling on risk behaviors and provision of prevention commodities (such as sterile needles and syringes) and hepatitis B vaccination. These are the first WHO guidelines on testing for chronic HBV and HCV infection and complement published guidance by WHO on the prevention, care and treatment of chronic hepatitis C and hepatitis B infection. These guidelines outline the public health approach to strengthening and expanding current testing practices for HBV and HCV, and are intended for use across age groups and populations.