Overview
There are two types of liver cancer: primary cancer where cancer begins in the liver and secondary liver cancer where cancer has spread from another organ to the liver. Primary liver cancer in particular is closely associated with liver cirrhosis and hepatitis.
How Common is Primary Liver Cancer?
Primary Liver cancer is a very common malignancy among Chinese. It is the fifth commonest cancer and third leading cause of cancer deaths in Hong Kong. In 2021, the crude annual incidence rate of liver cancer was 24 per 100 000. In 2021, males contracted liver cancer at a rate of 3:1. (Source: Cancer Online Resource Hub.)
What are the Causes and Risk Factors?
- Individuals who have history of liver diseases including hepatitis and cirrhosis
- Hepatitis B or C carriers
- Gender factor as liver cancer is more common in men
- Exposure to environmental pollutants such as PVC in manufacturing plastics increases the risk
- Family history of having a close relative who has had a hepatoma (or haemochromatosis)
- Excessive alcohol consumption
It is recommended that anyone with any of these risk factors should undertake regular checks so that the disease can be detected at an early stage. Once the disease is symptomatic, it is already in a late stage.
Symptoms and Diagnosis
What are Some Common Symptoms?
Liver cancer is often not symptomatic in the early stage. Some common symptoms of liver cancer in late stage include:
- Upper abdominal pain
- Weight loss, decrease in appetite and fatigue
- Swelling of ankles
- Ascites (excess abdominal fluids)
- Jaundice
How Does the Doctor Make the Diagnosis?
The following procedures are indicated for patients who are suspected to have liver cancer:
- Blood test: This is to determine the serum alphafetoprotein (AFP) level, which is usually high in patients with the disease.
- Ultrasound or CT scan of the liver is useful to make a diagnosis and also as a guide to a biopsy or MRI examination.
- Liver biopsy: This is an examination of the liver cells under a microscope to detect any abnormality.
- Magnetic Resonance Imaging, hepatic angiogram and PET scans are sometimes indicated to delineate the extent of the illness and determine the best treatment option.
Procedures and Treatments
How is Primary Liver Cancer Treated?
The following types of treatment may be given alone or together, depending on the patient’s condition:
- Surgery: If the disease is detected at an early stage and has not spread outside the liver, surgical resection is the treatment of choice.
- Thermal ablation: For small tumours that are not amenable to surgery, local ablation with radio-frequency can also be the choice of treatment.
- Intra-arterial therapy: For large tumours that are not suitable for surgery or local ablation, and have not spread outside the liver, intra-arterial therapy can be considered. Intra-arterial therapy can be either in the form of chemoembolisation or yttrium-90 microspheres radioembolisation.
- Chemotherapy: For a disease that has spread outside the liver or is not suitable for the above treatment, the only option of treatment is systemic chemotherapy.
- Targeted Therapy: For metastasized liver cancer, targeted therapy is another treatment option with fewer side effects.
Prognosis for an early stage disease is good because either surgery or local ablation gives good control of the disease. For an inoperable stage disease, the prognosis is less favourable, and treatment is mostly palliative. At all times, the doctor will plan the most appropriate treatment according to the patient’s condition.
How Do You Screen for Primary Liver Cancer?
Unfortunately, it is difficult to detect liver cancer in its early stages. If you have high risk factors such as being Hepatitis B or C carriers, it is recommended to undertake regular body checks and consult your doctor.
How Can Liver Cancer Be Prevented?
It is important to maintain a healthy life to reduce cancer risk. A balanced diet and regular exercise are both important. Consumption of large amounts of alcohol is detrimental to the liver. Vaccination for hepatitis B should be done for individuals who risk contracting the virus and are negative for hepatitis B serology. Those who already have risk factors for liver cancer should undertake regular surveillance for early detection of the disease.
Related Health Info
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