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The important factors in the causation of hepatocellular carcinoma (HCC) in Africa include hepatitis B virus (HBV), aflatoxin and possibly malnutrition. The evidence in support of an association of HBV with HCC is mainly epidemiological and includes: (a) the similarity between the geographical distribution of chronic carriers of hepatitis B surface antigen (HBsAg) and that of HCC; (b) the increased prevalence of HBV markers in the serum of patients with HCC when compared with the general population; and (c) the observation that HBV infection precedes the general development of the tumour and that HBV infection increases the risk of HCC over 200-fold. Laboratory evidence has shown that HBV DNA is integrated in the host tissue in patients with HCC. A vaccination programme in Senegal showed that hepatitis B vaccine reduced HBV infection and it is hoped that it will eventually lead to a reduction in HCC. Studies in East Africa have shown a correlation between aflatoxin contamination and the incidence of HCC. The possible roles of malnutrition and/or alcohol are discussed.

Bleomycin either alone or in combination with radiotherapy was used in the treatment of 24 patients with non-resectable cancer of the oesophagus. Improvement in performance (swallowing) status was observed in 75% of patients, although only 19% were known to be alive after 1 year of follow-up. Patients with liver cancer were treated with adriamycin. The response rate was dose dependent and was 40% at best. Combination of adriamycin with other drugs did not improve the response rate. Intra-arterial adriamycin appears more efficacious and gave a response rate of 60%.

Hepatitis B surface antigen positive sera for 34 African residents in Uganda were analysed for antigenic determinants and ethnic groups. Twenty four of the subjects belonged to Bantu ethnic groups and the rest to non-Bantu ethnic groups. Nineteen of the Bantu had antigenic subtype adw and only one of the non-Bantu had subtype adw. The association between subtypes and ethnic groups was found to be statistically significant (p less than 0.01). The results in this preliminary report agree with reports from West Africa of a high preponderance of hepatitis B surface antigenic subtype ayw among the non-Bantu West Africans.