Liver Cancer - HPB Singapore

Liver cancer is the fourth common cancer among males in Singapore (NRDO cancer registry 2006).
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 liver it is called metastatic liver cancer.

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Types of primary 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:

• Stomach
• Intestine
• Breast
• Pancreas
• Lung
• Uterus

Risk factors

• Chronic hepatitis (long standing liver infection) can be caused By Hepatitis B virus and Hepatitis C virus.
• Liver Cirrhosis is a condition in which the normal liver cells are damaged and replaced with scar tissue.
• Exposure to Aflatoxin which is produced by a mould found on peanuts and other nuts, corn and grains.
• Diabetes
• Males are twice likely to get liver cancer than women.
• Family history of liver cancer.
• Bile duct disease called primary sclerosing cholangitis.

Signs & symptoms

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

• Loss of appetite and weight
• Abdominal pain on the right side of your tummy which may extend to your back and shoulder
• Nausea and vomiting
• General weakness and fatigue
• Abdominal swelling with a mass or fluid (ascites)
• Yellowish discoloration of the skin and whites of your eyes (jaundice)

Diagnosis

These include:

• Ultrasound (Scan).
• Liver Biopsy is procedure where a small sample of tissue is taken to be examined under the microscope.
• CT (computerised tomography) and MRI (magnetic resonance imaging).
• Blood tests for the presence of a cancer marker called alpha-fetoprotein (AFP).

Treatment

Treatments for primary liver cancer include:

• Surgical resection of the tumour if the cancer is confined to a localised area and in some cases the tumour can be removed completely.
• Alcohol (Ethanol) injection involves injecting ethanol directly to the tumors through the skin under scan guidance to kill cancer cells.
• Radiofrequency ablation involves the use of electric current in the electromagnetic range to destroy cancer cells.
• Cryoablation involves the application of extreme cold through a metallic probe under ultrasound scan guidance.
• Liver transplantation involves removal of the diseased liver and replacement with a healthy, donor liver.
• Radiation therapy involves the use of high power energy beams to destroy cancer cells or shrink tumours and can be used for localised tumours.
• Chemotherapy involves the use of cancer drugs to kill cancer cells.

Recurrent Cancer

Recurrent cancer means that the cancer has resurfaced after the initial treatment. Most cancers recur within two years of treatment. The treatment may radiotherapy, chemotherapy or combination of both.

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 affect on your mind. Some tips 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 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.

Prevention

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

• Take action! Get vaccinated with Hepatitis B vaccine to reduce the risk of Hepatitis B infection which is effective in both adults and children.
• Take measures to prevent Hepatitis C which include:
  1. Learning more and educating others about viral hepatitis and the way it spreads from person to person.
  2. Not engaging in unprotected sex.
  3. Avoiding body piercing and tattooing as needles if not sterilised properly can spread the virus.
  4. Not abusing drugs and sharing intravenous drug needles.
  5. Avoiding alcohol abuse and addiction.
  6. Being cautious about receiving blood or blood products.

Source: Health Promotion Board, Singapore
www.hpb.gov.sg