الفهرس 
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Abstract
Cirrhosis is the most advanced stage of most types of chronic liver diseases. It represents a major worldwide health problem. According to the World Health Organization about 800,000 people die from cirrhosis annually.
In Egypt, cirrhosis is considered one of the most critical and most
striking health problems; this is due to the high prevalence rate of hepatitis C virus in the general Egyptian population, which is considered the major risk
factor for cirrhosis in Egypt.
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the Liver. It is also responsible for at least 5% of all cancer deaths worldwide. In Egypt, HCC is the 3rd most common cancer in males and the sixth among females. The major etiologic risk factors for HCC
are chronic viral hepatitis and cirrhosis, and HCC mainly develops in the context of chronic liver disease and cirrhosis.The incidence of HCC is
expected to increase significantly in the next decade. This is also because of
the high prevalence rate of HCV in the general population which accounts
for most of the cirrhosis and HCC cases.
Cirrhosis is pathologically defined by three main characteristics: fibrosis, nodular transformation, and distortion of hepatic architecture.
Therefore fibrosis is considered the primary event in the development of
cirrhosis.
Fibrosis is a pathological process involving multiple cellular and
molecular events that lead ultimately to deposition of excess matrix proteins
in the extracellular space. This is achieved through activation and
differentiation of hepatic stellate cells (HSCs) into myofibroblasts, which are then involved in synthesis of matrix proteins and regulation of matrix
degradation.