Patient Guide

Liver Cancer

What is Liver Cancer?

Primary liver cancer refers to cancer occurring in the cells of the liver. It 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
  • There are many other rare forms of liver cancer

Metastatic Liver Cancer refers to cancer spread from other organs such as colon, lung, breast and stomach to liver. Metastatic liver cancer is more common than primary liver cancer.

DID you know …

In Singapore liver cancer is the fourth most common cancer among men.*

The liver is one of the major organs of the body. It involved in many processes, such as synthesising bile, processing nutrients, storing glycogen and destroying toxins among others.

* NRDO, cancer registry 2006

Causes

The risk of liver cancer is increased in:

  • Chronic carriers of Hepatitis B virus and Hepatitis C virus
  • Those with liver cirrhosis (liver hardening)
  • Those with a bile duct disease called primary sclerosing cholangitis
  • Heavy alcohol drinkers and alcohol abusers (Alcohol abuse can lead to liver cirrhosis)
  • Those with exposure to Aflatoxin which is produced by a mould found on peanuts and other nuts, corn and grains
  • Those with a family history of 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 discoloration of the skin and whites of eyes (jaundice)

Diagnosis

  • Ultrasound (Scan)
  • Liver Biopsy is a procedure where a small sample of tissue is taken to be examined under the microscope
  • Computerised Tomography (CT) and Magnetic Resonance Imaging (MRI)
  • Blood Tests for the presence of a cancer marker called alpha-fetoprotein (AFP). It is important to note that AFP levels may be normal even in the presence of liver cancer and hence it is NOT used in making a diagnosis

Treatment

  • Surgical removal of the tumour
  • Liver Transplantation
  • Local Ablative Therapies:
    • Radiofrequency Ablation involves the use of electric current at the needle tip to destroy cancer cells by heat energy.
    • Cryoablation involves the application of extreme cold through a metallic probe under ultrasound scan guidance.
    • Microwave Ablation involves use of microwave energy to destroy tumour cells.
  • Radiation Therapy involves the use of high power energy beams to destroy cancer cells or shrink tumours and can be used for localised tumours. Most common radiation therapy is called Selective Internal Radiation Therapy (SIRI) and is given by injection to blood vessels in the liver.
  • Chemotherapy is the use of anticancer drugs to destroy cancer cells or stop them from dividing. Chemotherapy can be consumed by oral medicine (Sorafenib) or given by injection directly into the liver (Transaterial Chemotherapy – TACE).
  • Alcohol (Ethanol) injection involves injecting ethanol directly to the tumours through the skin under scan guidance to kill cancer cells.

Prevention

  • Prevent Hepatitis B and C by:
    • getting vaccinated for Hepatitis B
    • not engaging in unprotected sex
    • avoiding body piercing and tattooing
    • not abusing drugs or sharing intravenous drug needles
  • Limit alcohol intake
  • Chronic carriers of Hepatitis B virus and Hepatitis C carriers are advised to consider regular screening

Download PDF here.

References:

  1. Liver Cancer [Accessed 1 Sep. 2015]
  2. Liver Cancer - National Cancer Centre Singapore. [Accessed 1 Sep. 2015].

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