FAQ on Liver Cancer

by Lim Wey Wen

If the liver was a machine that exists in our modern world, it would be the embodiment of the perfect workhorse. It will be able to work 24/7 with little rest, juggle multiple tasks at the same time, and regenerate parts that are old or damaged so they will continue to work at peak performance, day in, day out.

And that's not all. If there is a greater demand of its services, it will be ready to work harder to take on the challenge.

But while the liver's ability to regenerate itself when damaged can be a blessing, it can also be a curse, because when it has trouble recovering from damage, or coping with the demands placed on it, you can not really feel it.

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Late Stages

The liver is an organ that does not complain very much until it is very late. Because of that, patients with liver cancer often see their doctors in late stages of the disease, where treatment options are limited.

Liver cancer is dangerous because the liver is our powerhouse, when it comes to internal organs. It stores all our energy and vitamins, nourishes us by manufacturing amino acids (building blocks of proteins), secretes hormones and bile, and helps to emulsify the fats in our body. It is an organ that is virtually life itself.

The good news is that many liver cancers can be prevented. However, not many people know that.

How do the cells in the liver become cancerous?

When the DNA of normal liver cells are damaged, cell mechanisms can repair it to some extent. However, when the damage is too severe, the cells will die, and new cells will be formed to take their place.

Sometimes these processes can go wrong.

When they go wrong, the cells that are repaired or regenerated may contain DNA that is different from normal cells. So, unlike normal cells that grow, multiply, and eventually die in a tightly controlled manner, these new cells can now multiply freely. And when they get old or damaged, they do not die, as they should. This will cause the extra cells to accumulate into a mass of tissue called a growth, nodule, or tumour.

While some of these growths, nodules, or tumours are benign (they do not grow and multiply aggressively, invade surrounding tissues or travel to other parts of the body), some of them, which are malignant or cancerous, do.

What are the types of liver cancer?

If the cancer starts in the cells of the liver, it is called primary liver cancer. However, the 4 types of primary liver cancer are categorised according to the types of cells that become cancerous first.

The most common form of liver cancer (hepatocellular carcinoma) begins in hepatocytes, the main type of cells in the liver. Others begin in the cells in the bile duct (cholangiocarcinoma), and very rarely, blood vessels in the liver (angiosarcoma or hemangiosarcoma). When it happens to children under the age of 4, it is called hepatoblastoma.

What are the causes?

Most of the causes of liver cancer are those that cause long term damage to liver cells. As acute infections such as Hepatitis A do not affect the liver in the long term, it does not result in chronic liver disease, hence it is not a risk factor for liver cancer.

While chronic infection of viruses such as Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are the more common causes of liver cancer, chemicals that cause cancer (carcinogens) and alcohol can also cause it. However, in most of Asia, chronic HBV infection is the main cause of liver cancer.

You will also have a higher risk of developing liver cancer if you smoke, are obese, diabetic, or have a history of cirrhosis (when your liver has been scarred by chronic disease).

Are there any early symptoms?

Before looking at the symptoms, it is good to note that liver cancer affects more men than women, usually in their 40s to 50s. Worldwide, men who are diagnosed with liver cancer outnumber women 3 to 1.

Unfortunately, many people do not experience signs or symptoms in the early stages of liver cancer.

But as the cancer progresses, some may notice some of the following symptoms :

* Weight loss

* An ongoing lack of appetite

* Feeling very full even after a small meal

* A hard lump on the right side just below the rib cage

* Pain around the right shoulder blade

* Yellow-green colour to the skin and eyes (jaundice)

* Discomfort or pain in the upper abdomen on the right side

* Unusual tiredness

* Nausea

As these symptoms are non-specific and can be caused by many health problems other than liver cancer, it is always wise to consult your doctor to have them checked out.

Are blood tests useful in detecting early liver cancer?

Blood tests, like liver function tests (which tests for proteins produced by the liver and enzymes found in the liver) and tumour markers can be used to detect changes in the liver that may indicate the presence of liver cancer. However, they are not very reliable.

As the test results could be influenced by other factors as well, most of the time, a doctor needs to investigate the abnormal blood test results further with ultrasounds, MRI, and CT scans, or biopsies to determine the presence of a cancerous growth in the liver.

Who do you see when your blood tests are abnormal?

It depends on the type of blood test. If they are liver function tests, all doctors should be able to advise you. But if they are serology tests for hepatitis infections, your doctor might refer you to another doctor who specialises in liver diseases (hepatologist).

Also, if your doctor suspects you may have liver cancer, he or she will also refer you to a cancer specialist (oncologist).

Nevertheless, your best bet is to visit your family doctor or a general practitioner first, because he or she will be able to treat you or advise you on which doctor to see next, whether it is a hepatologist or oncologist.

Are surgery and chemotherapy the only treatment options for liver cancer?

No. Although surgery to remove the cancer is still the main method of treatment, many liver cancer patients could not be operated upon. Often, when the cancer is diagnosed too late, the cancer has spread to a large area of the liver, or has occurred in too many sites. Sometimes, it is just a matter of the cancer growing too close to an important artery.

For these patients, doctors may consider starving the cancer to death by cutting off the blood supply through a procedure called embolisation.

And if embolisation is not possible, doctors may consider killing the cancer by freezing (cryoablation), heating (radiofrequency ablation) or damaging it with chemicals (chemotherapy).

In the year 2008, the Malaysian Ministry of Health had approved the use of a drug initially licensed for the treatment of kidney cancer (sorafenib) as a treatment for liver cancer that could not be operated upon.

However, it is not easily accessible to many liver cancer patients due to its cost.

Therefore, to make sorafenib more accesible to patients, its maker has collaborated with the Malaysian Liver Foundation in a programme that allows eligible patients to purchase two months supply of the drug and get the rest of the year's supply free.

How do I prevent liver cancer?

As chronic hepatitis B infection is the main cause of liver cancer here in Asia, the best way to prevent it is to get vaccinated against it.

But what if you are already infected with the HBV or HCV? The answer is to get your liver monitored regularly (about every 6 months) by your doctor to detect liver cancer early if it develops. (Not all people who are infected with the viruses develop liver cancer.)

Of course, by reducing all other risk factors, including obesity, diabetes, smoking, and alcohol consumption, you will also reduce your chances of developing liver cancer.

More info on LIVER CANCER here.

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