Liver Cancer

Liver cancer is common in Asian countries and regions, such as Hong Kong, Taiwan and Singapore. In the early stages, most patients may not have any specific symptoms.


What is Liver Cancer? 

Liver cancer is cancer that originates in the cells of the liver, an organ in the upper-right portion of the abdomen, beneath the diaphragm and above the stomach. The liver is one of the major organs responsible for removing toxins from the body. 

Liver cancer is the fourth most common cancer among males in Singapore. When the cancer occurs in the cells of the liver, it is called primary liver cancer. When cancer from other organs such as colon, lung and breast spreads to the liver, it is called metastatic liver cancer. 

Primary liver cancer is classified based on the type of cells affected by cancer:
Hepatocellular carcinoma starts in the liver cells, which are called hepatocytes
Cholangiocarcinoma or bile-duct cancer begins in the bile ducts
Hepatoblastoma is a rare type of liver cancer affecting young children
Hemangiosarcoma is a rare cancer arising from the blood vessels of the liver

Metastatic liver cancer is more common than primary liver cancer and spreads to the liver from the:

Liver Cancer Causes

People who are at risk include:
Chronic carriers of Hepatitis B virus and Hepatitis C virus
Those with liver cirrhosis
Those with Hepatitis B- or C-related diseases
Those with a bile-duct disease called primary sclerosing cholangitis
Alcohol abusers (alcohol abuse can lead to liver cirrhosis)

People who think they may be at risk should discuss this with their doctor.

Liver Cancer Symptoms 

Early-stage liver cancer may not produce any signs. As the cancer advances to a later stage, it may produce the following symptoms:
Loss of appetite and weight
Weakness and fatigue
Nausea and vomiting
Abdominal swelling/bloated
Lump in the abdomen
Abdominal pain
Yellowish discolouration of the skin and whites of eyes (jaundice

If you develop any of the above symptoms, you should consult your doctor. 

What You Can Do to Help Prevent Liver Cancer 

Prevent Hepatitis B by:
Getting vaccinated
Avoiding body piercing and tattooing
Not abusing drugs or sharing intravenous drug needles

Prevent Hepatitis C by:
Not engaging in unprotected sex
Avoiding body piercing and tattooing
Not abusing drugs or sharing intravenous drug needles
Limiting alcohol intake to less than one drink a day or avoid completely

Liver Cancer Screening

Screening for liver cancer is still under investigation. However, patients who are in the high-risk group, i.e. those who have liver cirrhosis, are Hepatitis B carriers or have chronic Hepatitis C infection, are often advised to consider regular evaluations with a:
Blood test for alphafetoprotein (AFP) and liver function assessment every three months
Ultrasound scan of the liver every six months

Liver Cancer Diagnosis

If you have one or more of the above symptoms, your doctor will try to find out if it is caused by liver cancer or something else. You may be asked to do one or more of the following tests:
Blood tests: liver function abnormalities may be revealed by conducting blood tests
Imaging tests: ultrasound, computed tomography (CT) scans and magnetic resonance imaging (MRI) scans may be performed
Laparoscopy: in this procedure, a thin, lighted tube with a camera on the tip is inserted through a small incision in the front of the abdomen to examine the liver and other organs. It can help doctors confirm the extent of the cancer
Biopsy: a sample of tissue is removed to see if it is cancerous. Different procedures such as a needle biopsy, a laparoscopic biopsy or a surgical biopsy may be performed

Liver Cancer Treatment

There are different treatments available for liver cancer depending on the stage of the cancer as well as the health of your liver. Treatment options may include:


Suitable patients may undergo liver resection surgery which involves the surgical removal of the tumour and surrounding liver tissue from the liver. Patients with small tumours may also be suitable for a liver transplant.

Liver-directed Therapies

Radiofrequency ablation: this procedure destroys the tumour without removing the liver. High-energy beams travel down a thin metal probe that is inserted into the liver and through the tumour. Ultrasound is used to guide the probe into place and the heat that is emitted destroys the tumour.
Trans-arterial chemoembolisation: chemotherapy is the use of anti-cancer drugs to destroy cancer cells or stop them from dividing. It may be administered as part of a treatment called chemoembolisation, which involves the insertion of chemotherapy drugs directly into the tumour in the liver, together with a gel or tiny plastic beads to block blood flow to the cancer (embolisation). Embolisation prevents the tumour from growing as it is deprived of blood.
Selective internal radiation therapy: this technique involves the use of many tiny beads in delivering extremely high dosages of radiation. The radiation travels directly to the tumour through the hepatic artery. This limits the amount of radiation that the normal tissue in the liver is exposed to.

Targeted Cancer Therapy 

This uses drugs or other substances that block the growth and spread of cancer by interfering with specific molecules involved in cancer growth and progression. A targeted drug called Sorafenib may be used to treat patients with advanced liver cancer. Sorafenib targets cancers by stopping them from growing their own blood vessels. As cancer cells need blood supply to bring nutrients and oxygen, Sorafenib may therefore limit the cancer’s ability to develop. Sorafenib has been demonstrated to prolong survival in patients with advanced hepatocellular carcinoma, or HCC, compared with supportive care alone. Sorafenib is an oral treatment and is usually taken twice a day.

Coping with Liver Cancer 
It can be challenging to live with a life-threatening condition such as liver cancer. As it is often diagnosed at an advanced stage, it can have a devastating effect on your mind. Some tips to cope include:
Learning all about your illness from credible resources such as books and reliable sites on the internet
Involving close family members and friends to combat the pain and anxiety associated with advanced stages of cancer
Staying active and taking time to relax. It is important to eat well and get enough rest to fight fatigue and the stress of cancer
Coming to terms with your disease and discussing issues which are important to you, such as hospice care, with your family and medical team
Seeking the services of an oncology counsellor or religious counsellor to discuss end-of-life issues or ethical issues which are important to you


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