Liver Cancer

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.

Primary Liver cancer is a very common malignancy among Chinese. It is the second most common cancer in Hong Kong after lung cancer. In the year 2008, there were 1,745 new cases of liver cancer in Hong Kong. Among them, about 80% were male and the rest female. It is most common in middle age male around 55 to 60 years of age.
 
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 alcoholic consumption.
It is recommended that individuals having any of the 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.
 
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;
  • Jaundice.
Diagnosis
The following procedures are indicated for patients who are suspected to have liver cancer:
  • Blood test: This is to determine the serum alpha-fetoprotein 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 biopsy or MRI examination
  • Liver biopsy: It is an examination of the liver cells under a microscope to detect any abnormality.
  • Magnetic Resonance Imaging, hepatic angiogram and PET scan are sometimes indicated to delineate the extent of the illness and determine the best treatment option.
Treatments
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 for various reasons, 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 most of the time palliative. At all times, the doctor will plan the most appropriate treatment according to the patient’s condition.

Screening
Unfortunately, it is difficult to detect liver cancer in its early stages. If you have the high risk factors such as being Hepatitis B or C carriers, it is recommended to undertake regular body checks and consult your doctor.

Preventions
It is important to maintain a good healthy life to reduce cancer risk. A balanced diet and regular exercise are both important. Consumption of large amount of alcohol is detrimental to the liver. Vaccination for hepatitis B should be done for individuals who have the risk of 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.