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Primary liver cancer is a cancer which originates from the liver cells. The liver is made up of different cell types like liver cells, bile duct cells, blood vessels, etc. Liver cells (hepatocytes) make up 80% of the liver tissue.

Due to mutations in the genetic structure of the liver cells, these liver cells gradually turn cancerous and start to grow uncontrollably. The liver cancer cells can also invade nearby organs and spread through the blood to other parts of the body like the brain and bone.  Primary liver cancer is also known as Hepatocellular Carcinoma (HCC) or Hepatoma for short.

Liver cancer is the third most common cancer in the world. Most patients will die within a year from diagnosis. Most of the liver cancer cases are found in Southeast Asia, China and Taiwan. This is due to the high incidence of Hepatitis B infection in this part of the world. Hepatitis B is the most common cause of liver cancer worldwide. According to the most recent report from the Singapore cancer registry, liver cancer is the 4th most common cancer in Singaporean males. Men are much more likely than women to have liver cancer.

In general, any disease that can cause a chronic inflammation of the liver cells can cause liver cancer. This chronic inflammation and continual damage leads to permanent scarring of the liver, known as cirrhosis.

Some of these risk factors are:

1.    Hepatitis B.

    • Hepatits B virus (HBV) carriers have a 200 times higher risk of developing liver cancer compared to non-carriers.
    • Male HBV carriers with liver cirrhosis have a very high risk of liver cancer.

2.    Hepatitis C.

    • Hepatitis C will cause chronic inflammation in the liver, which results in liver cirrhosis

3.    Steatohepatitis.

    • This is a severe form of fatty liver in which the fat deposition within the liver cells causes chronic ongoing inflammation, which can then result in liver cirrhosis.
    • Given the increasing incidence of obesity, especially in developed countries, fatty liver may overtake hepatitis B as the cause of liver cancer in the future.

4.    Alcohol.

    • Chronic alcohol consumption can lead to chronic liver damage, and hence liver cirrhosis.

5.    Aflatoxin.

    • This is a chemical produced by a mould called Aspergillus flavus, which is found in food that has been stored in a hot and humid environment for a long time. This mould is found in foods such as peanuts, rice, soyabeans, corn and wheat.

6.    Drugs.

    • Females on oral contraceptive pills containing oestrogen may develop a benign tumour known as hepatic adenoma. This benign tumour may turn malignant and result in liver cancer.

7.    Haemochromatosis.

    • This is a hereditary disease where there is abnormal iron deposition in the liver cells leading to chronic inflammation.

Sometimes, the liver cancer can occur without any known risk factors or cause. This is called cryptogenic primary liver cancer.

In early stages of liver cancer, most patients do not have any symptoms. When symptoms appear, they may include some or all of the following:

  • Loss of appetite
  • Loss of weight
  • Upper abdominal discomfort especially on the right side
  • Tiredness
  • Generalised abdominal swelling
  • Jaundice

As many liver cancers occur in patients with liver cirrhosis, there may be an exacerbation or deterioration of the symptoms of liver cirrhosis.

The cancer can also spread or metastasize to the other organs and cause those organs to fail as well. It commonly spreads to the bone and brain, causing bone pain and altered mental status.

Because the symptoms of liver cancer are very non-specific, it is not surprising that by the time many patients consult a doctor, the cancer is too advanced for cure. In general, if you experience unexplained weight loss or appetite loss, or prolonged tiredness, you should consult your doctor.

To increase the chance of cure, a patient needs to see the doctor when the tumour is still at an early stage, before even any symptoms appear.

Patients who have risk factors for liver cancer should go for regular screening. This is to allow the detection of the tumour when it is still early and has a higher chance for cure. High-risk patients include Hepatitis B or Hepatitis C carriers. In Singapore, patients who have Hepatitis B or cirrhosis from any cause are advised to participate in a liver cancer screening programme.

We will do 2 things:

  1. To confirm the diagnosis. A scan (either a CT scan or a MRI scan) is usually needed. A blood test called alpha-feto protein (AFP) will also be ordered.
  2. To assess the state of your liver’s health. Because of the scarring (cirrhosis), the liver function of such patients is often affected. Hence, an assessment of the residual liver function is needed to help choose the most appropriate treatment for each individual patient.

Surgery is the only treatment that can provide a long-term cure. Surgery can be in the form of Liver Resection, or Hepatectomy (removing the cancerous part of the liver) or Liver Transplantation.  Because of the liver scarring (cirrhosis) which is frequently found in such patients, some patients may not be fit for a liver resection.

Treatment options for primary liver cancer are summarized as follows.

  1. Liver resection (hepatectomy) – surgically removing part of the liver where the tumour lies.
  2. Liver transplantation – surgery to remove the entire diseased liver, and replacing it with a healthy liver.
  3. Radiofrequency ablation – using electrical current to destroy the cancer cells.
  4. Alcohol (Ethanol) injection – injecting concentrated alcohol directly into the tumour to kill the cancer cells.
  5. Cryoablation – involves the application of extreme cold through a metallic probe placed on the tumour to kill the cancer cells
  6. Radiation therapy – using radiation to kill the cancer cells. This radiation can be delivered using small radioactive beads delivered directly into the tumour (SIRT) or through an external radiation beam (radiotherapy).
  7. Chemotherapy involves the use of cancer drugs to kill cancer cells. These drugs can be delivered directly into the tumour itself (TACE) or be administered through an intravenous injection or even oral tablets (systemic chemotherapy).

You can reduce the risk of developing liver cancer by protecting yourself from hepatitis infection and cirrhosis.

Get yourself vaccinated against Hepatitis B if you have not done so. You can read more about how to protect yourself against Hepatitis B and Hepatitis C by clicking on the relevant topic.

Go easy on the alcohol. Read more about healthy drinking habits here.


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