By Dr Vincent Lai Wai Kwan, Gastroenterologist
There are two types of liver cancer and they are:
1. Primary liver cancer
These are cancers that develop from the liver cells itself. The most common type of primary liver cancer is hepatocellular carcinoma (HCC). Other rare types are cholangiocarcinoma or angiosarcoma.
2. Secondary liver cancer
These are cancers from other parts of the body that has spread to the liver. Commonest type is from colorectal cancer. But almost every type of cancer can spread to the liver including stomach, breast and pancreas.
For the purpose of this article we will be discussing about hepatocellular carcinoma.
Hepatocellular Carcinoma (HCC)
This is the commonest primary liver cancer worldwide and the 3rd most common cause of cancer-related death globally. It accounts for approximately 780,000 deaths per annum globally. Approximately 75% of the disease burden load is in Asia. It is more prevalent in males and most patients present in their 40s to 50s.
Do you have a relative with hepatitis B or C? Have a conversation with them today about HCC
In Asia 85% of the HCC is due to hepatitis B or C (HBV and HCV). The rest would be due to aflatoxins or cirrhosis secondary to alcohol, fatty liver or autoimmune hepatitis.
Aflatoxins are cancer-causing substances made by a fungus that contaminates peanuts, wheat, soybeans, ground nuts, corn, and rice. Storage in a moist, warm environment can lead to the growth of this fungus. Although this can occur almost anywhere in the world, it is more common in warmer and tropical countries. Long-term exposure to these substances is a major risk factor for liver cancer.
The risk is increased even more in people with HBV or HCV infection.
What are signs that you might have liver cancer?
Signs and symptoms of liver cancer
Signs and symptoms of liver cancer often do not show up until the later stages of the disease. Some of the most common symptoms of liver cancer are:
Inadequate management of hepatitis B or C increases your risk of HCC
Individuals who are at risk and should have screening:
- Hepatitis B carrier
- Family history of HCC
- Cirrhosis from any aetiology (HBV, HCV, fatty liver, etc)
Individuals at risk should go for a screening, as recommended by
The Singapore Health Promotion Board (HPB).
Unfortunately, most liver cancers present late and the chance of cure at the time of presentation is less than 30%. However, if at-risk individuals are offered screening, the chances of picking up early cancer is much higher, resulting in more than 60% chance of a cure.
Screening is simple, reproducible and generally acceptable with an ultrasound scan of the liver and AFP every 6 months.
In our next post, Dr Lai discusses the potential cures for HCC.