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Liver Cancer

  • What is Liver Cancer?

    Liver cancer is a disease in which harmful cancer cells develop in the tissues of the liver. Primary liver cancer occurs when the cancer cells start in the liver, and the different types of primary liver cancers are usually named after the types of cells from which the cancer has developed.

    liver cancer awareness sign

    Hepatocellular carcinoma (HCC) or hepatoma comes from the main cells of the liver called hepatocytes and makes up about 85% of primary liver cancers. A less common type of primary liver cancer starts from cells that line the bile duct called cholangiocytes and is therefore called cholangiocarcinoma or bile duct cancer.

    The liver is also the site of another type of cancer called secondary, or metastatic, liver cancer. In this condition, the main cancer begins elsewhere in the body and secondary deposits are formed in the liver. A common example is colorectal cancer spreading to the liver through the bloodstream.

    How Common is Liver Cancer?

    According to the information provided by the American Cancer Society and the Cancer Journal for Clinicians, men are 2 – 3 times more likely to suffer from liver cancer than women. In Singapore, liver cancer is the 4th most common cancer for men, as reported by the Singapore Cancer Society.

    What are the Risk Factors for Liver Cancer?

    The 3 main risk factors for developing HCC (the most common primary liver cancer) are chronic hepatitis B infection, chronic hepatitis C infection and high alcohol consumption. The risk of someone with chronic hepatitis B infection developing HCC is 100 times more than an uninfected person.

    Other less common risk factors include aflatoxin (a poison found in mouldy peanuts, wheat, soya and grain), inherited conditions (eg. haemochromatosis, alpha-1 anti-trypsin deficiency) and any cause of cirrhosis (scarring of the liver) like autoimmune hepatitis.

  • Signs & Symptoms

    Patients with advanced liver cancer usually have the same symptoms as chronic liver diseases, such as jaundice, where there is yellowish skin and eyes, and swelling of the stomach with fluid. Other symptoms of advanced liver disease include encephalopathy (altered mental state and delusions) and bleeding in the stomach and intestinal tract can indicate severe damage to the liver that can often develop into liver cancer.

    symptoms of liver cancer

    Some patients may also have mild to moderate upper abdominal pain, weight loss, sleepiness (despite sleeping normally), loss of appetite or an obvious mass in the upper abdomen. The problem is that most of these symptoms can be due to many common diseases affecting the liver and other nearby organs, like the stomach and intestines, making it difficult for patients to identify symptoms early.

     

     

     

    Can We Screen for Liver Cancer?

    Yes. Regular liver screening can help doctors find and treat liver cancer early, while the cancer is limited to one area of the body and more easily removed by surgery. Early detection can provide better treatment options and improve the chances of survival. Those with chronic hepatitis B infection and liver scarring (cirrhosis) due to hepatitis C or other causes are at increased risk and should be screened for liver cancer regularly.

    Screening involves:

    • A blood test for alpha-fetoprotein (AFP) every 3 – 6 months
    • An ultrasound scan of the liver every 6 – 12 months
  • Diagnosis & Assessment

    The following tests and procedures may be performed to diagnose liver cancer and show the stage of cancer development:

    • Physical examination for general signs of health. An examination of the abdomen will also be done to check for hard lumps in the liver and abdominal swelling.
    • Blood tests to check liver function and the amount of alpha-fetoprotein (AFP) present, which can be higher in people with primary liver cancer (hepatocellular carcinoma).
    • A liver ultrasound scan uses sound waves to produce a picture of the liver and reveal any existing tumours. This is a painless test that usually takes several minutes to perform.
    • A computed tomography (CT) or magnetic resonance imaging (MRI) scan of the abdomen to create a 3-dimensional picture of the liver. It can produce a more detailed picture that shows the size and position of a tumour, and whether it has spread.

    Although a diagnosis of liver cancer can be made based on the amount of AFP in the blood and on specific MRI scans, a liver biopsy may sometimes be needed to confirm the diagnosis. If the cancer has not yet spread and if there is a chance it can be removed, then a biopsy might not be done. This is due to the small risk of the cancer spreading along the path made by the biopsy needle when it was inserted and removed. In this situation, the diagnosis is confirmed after an operation to remove the tumour.

  • Treatment & Care

    The type of treatment for patients with liver cancer will depend on its stage (ie. its size and whether it has spread to other parts of the body) and the patient’s general health. The main treatments used are surgery, tumour ablation (removal), chemotherapy, targeted cancer therapy, and radiotherapy.

    Surgery

    Surgery has a chance of treating the cancer and is therefore the treatment of choice for patients with early stage liver cancer. If only certain parts of the liver are affected by cancer and the rest of the liver is healthy, then surgery may be possible to remove the affected part or parts. This type of surgery is called a liver resection.

    Another form of surgery is a liver transplant. This involves the removal of the entire liver which is replaced with a healthy, donated liver. Such a major operation may be considered when the cancer is in the liver only, if a donor liver is available, and if the medical team believes the cancer is likely to be eliminated by surgery. A healthy liver is capable of growing back, so a living donor liver transplant can also be performed where part of a healthy donor’s liver is removed and transplanted to the patient. In this case, both the remaining liver in the donor and the transplanted liver can grow back fully if the procedure is successful. Anti-rejection drugs (immunosuppressants) will be needed to prevent organ rejection after a liver transplant.

    Tumour Ablation

    Tumour ablation (removal) aims to destroy primary liver cancer cells using either heat (radiofrequency ablation – RFA) or alcohol (percutaneous ethanol injection – PEI). This procedure is usually done in the scanning department so that the ultrasound or computed tomography (CT) can help the doctor with guiding a needle into the liver cancer. A local anaesthetic will be given at the start of the procedure. RFA treatment uses laser light or radio waves passed through the needle to destroy cancer cells by heating them to a very high temperature. PEI treatment uses alcohol injected through the needle into the cancer to destroy the cancer cells. Tumour ablation may sometimes be repeated if the tumour grows again.

    Chemotherapy

    Chemotherapy is the use of anti-cancer drugs to destroy cancer cells or stop them from dividing and growing further. It can help to control symptoms by shrinking the cancer and slowing its development. Chemotherapy drugs are usually given as injections into the vein (intravenously), although they can sometimes be given as tablets (orally). Chemotherapy may also be given as part of a treatment called chemoembolisation. This involves the injection of chemotherapy drugs directly into the liver cancer, together with a gel or tiny plastic beads to block blood flow to the cancer (embolisation). Not everyone is suitable for chemotherapy as it can only be given if the liver function remains suitably well.

    Targeted Cancer Therapy

    Targeted cancer therapy uses drugs or other substances that block the growth and spread of cancer by interfering with specific molecules involved in cancer growth and development, eg. a targeted drug called sorafenib may be used to treat patients with advanced liver cancer. This drug targets cancers by stopping them from growing their own blood vessels. As cancer cells need a blood supply to receive nutrients and oxygen, this may therefore limit the cancer’s ability to grow. It has been demonstrated in 2 large clinical studies to lengthen survival time in patients with advanced liver cancer, compared with supportive care alone. Sorafenib’s side effects include diarrhoea, tiredness, and high blood pressure.

    Radiotherapy

    Radiotherapy uses high-energy rays to destroy cancer cells or keep them from growing further. External radiotherapy uses a machine outside the body to direct radiation to the cancer. Such treatment is not often used to treat liver cancer because the liver cannot take very high doses of radiation. It may, however, be used to relieve pain, eg. in patients whose cancer has spread to the bone. Another method is internal radiation, which involves a radioactive substance implanted selectively to the cancer through the hepatic artery, a major blood vessel that carries blood to the liver.

    Can Liver Cancer be Prevented?

    Yes, there are several things that can prevent liver cancer, these include:

    1. Vaccinate against the hepatitis B virus

    2. Avoid drinking too much alcohol, which causes alcoholic fatty liver disease – a disease that can develop into liver cancer

    3. Avoid eating heavy meat and animal fat, and mouldy peanuts and grains

    4. Go for regular screenings if considered part of the high-risk group