Liver Cancer
Understanding the causes and symptoms of liver cancer, effective prevention and treatment, improve survival rates
Liver cancer is the third deadliest cancer in Hong Kong after Lung Cancer and colorectal cancer. Liver cancer is caused by viral infections, environmental pollution, alcohol abuse, and eating moldy food. Liver cancer is divided into primary liver cancer and metastatic liver cancer. Early-stage liver cancer symptoms are not obvious, but as the tumor grows larger in the middle and late stages, it becomes more difficult to diagnose and treat. The survival rate of liver cancer patients is closely related to the time of detection, diagnosis, and treatment; therefore, it is recommended to seek medical attention immediately if symptoms are found. a
The liver is an important organ in the human body and the only organ that can repair damage on its own. It is responsible for various important functions such as absorbing useful substances, detoxification, producing proteins, storing vitamins and minerals, and promoting red blood cell metabolism. If liver cells go through abnormal division and mutation, liver cancer will develop and severely affect the body.
The Hospital Authority stated that liver cancer ranks third among the deadliest cancers in Hong Kong, with approximately 1,800 new cases diagnosed annually, 75% of which are male and concentrated in the elderly. There are also over 1,500 deaths annually, a number not far off from the number of new cases. The latest government data indicates that the crude mortality rate for liver cancer per 100,000 population, broken down by sex, is 33.0 for men and 9.8 for women. The age-standardized mortality rate per 100,000 standard population is 16.3 for men and 4.1 for women. However, both the incidence and mortality rates of liver cancer have been declining over the past two decades.
Symptoms of Liver Cancer
Liver cancer is prevalent in people aged between 50 to 70 years old, and its incidence rate in men is about four times that of women. As the liver has the ability to repair itself, it can function normally even when most areas have lost their functions. Therefore, early-stage liver cancer is usually asymptomatic, and only has the following possible symptoms upon reaching the intermediate and advanced stages:
- Abdominal swelling, hard lump in the upper right abdomen, pain near the shoulder blade.
- Ascites and sometimes visible blue veins on the abdomen
- Yellowing of the whites of the eyes, itchy skin
- Brown urine and light grey-coloured stools
- Prone to bleeding in injuries due to inadequate blood clotting factors
- Loss of appetite and unexplained weight loss
- Nausea and vomiting
- Fever and fatigue
The above symptoms are not exclusive to patients with liver cancer and may not be present in all liver cancer cases. If the above symptoms persist or even worsen, seek immediate medical advice to identify the cause.
Causes of Liver Cancer
The main causes of liver cancer are related to viral infections, environmental pollution, alcohol abuse, and consumption of moldy food. The following are common causes of liver cancer:
- Hepatitis B and C
Hepatitis B is an epidemic disease in Southeast Asia, and causes 55% of liver cancers worldwide. The hepatitis B carrier rate in Hong Kong has always been at a moderate to high level. Compared with normal people, hepatitis B patients have a 100-times higher chance of developing liver cancer, while hepatitis C patients even have a 150-times higher risk.
- Cirrhosis
When the liver is under long-term damage which exceeds its ability to recover, it enters the late stage of scarring which is called cirrhosis, and eventually develops into liver cancer.
- Consumption of mouldy food
Aflatoxins produced by mould in peanuts, grains, corn, soybeans and dried fruits can cause liver cancer.
- Various metabolic disease
The disorders include fatty liver disease, hyperlipidaemia (high cholesterol), hypertension (high blood pressure), hyperglycaemia (high blood sugar), low HDL cholesterol, etc. Metabolic disorders can damage the liver, which leads to cirrhosis and liver cancer.
- Environmental Pollution
Long-term exposure to harmful chemicals, such as polyvinyl chloride used in plastic factories.
- Alcohol Abuse
Excessive consumption of alcohol can lead to cirrhosis and result in liver cancer.
- Having cholangitis or congenital choledochal cysts may lead to cholangiocarcinoma
- Family medical history is also a factor. If a family member has had liver cancer, this may increase your risk of developing cancer
Survival Rate of Liver Cancer
Screening of Liver Cancer
If the patient is suspected of having liver cancer, the doctor will detect the possibility of liver cancer through routine examinations.
- Liver function test
Blood tests assessing liver function to determine if it is sufficient to maintain normal bodily functions can help determine if a patient is suitable for cancer treatment.
- Alpha-fetoprotein (AFP) Tumour Marker Test
Alpha-fetoprotein is a tumour marker for liver cancer, therefore serves as an indicator for screening tests. An adult with a high AFP level in blood may indicate the presence of liver cancer.
Diagnosis of Liver Cancer
After initial examinations, if liver cancer is suspected, doctors will perform a more comprehensive liver ultrasound scan using specialized equipment. Common diagnostic methods for liver cancer include liver ultrasound, computed tomography (CT) scans, magnetic resonance imaging (MRI), angiography, and biopsy. Doctors will stage the patient's condition based on diagnostic test results and then decide on the appropriate cancer treatment method.
- Liver ultrasound scan
A device will be used to move across the liver area. It will emit ultrasound waves to the liver, then the reflected waves will be converted by a computer into an image to identify the size and location of the tumor.
- Computed Tomography (CT Scan)
Detailed cross-sectional images are taken to determine the size and location of the tumor.
- Magnetic Resonance Imaging (MRI)
A magnetic field is used to create a cross-sectional image of the body. This helps determine the location, size and possible malignancy of tumors, and to observe the condition of the soft tissues and blood vessels in the liver.
- Angiography
X-ray is used to observe the blood flow and identify the blood vessels that provide nutrients to the tumor, which helps to locate the tumor.
- Biopsy
A few tissues from the tumor are taken for laboratory examination to determine if the tumor is benign or malignant.
If the above examinations reveal metastatic cancer, further tests such as bone scans and positron emission tomography (PET) scans will be needed to formulate a suitable treatment plan for the patient.
Treatment of Liver Cancer
Doctors generally determine the treatment plan based on the type of cancer cells, the size, number, location, and extent of the tumor, as well as the patient's age, health status, and ability to tolerate side effects.
- Ablation Therapy
Doctors will heat the area around the patient's tumor. When the temperature exceeds 60 degrees Celsius, the tumor tissue will die. This method is suitable for early-stage primary liver cancer and metastatic liver cancer.
- Transarterial chemoembolization, TACE
The doctor will locate the blood vessel supplying nutrients to the tumor, and then inject drugs through an arterial catheter to block the vessel. This procedure blocks the growth of the tumor or even kills it without affecting the surrounding normal tissues. It is suitable for patients whose tumors have spread to both sides of the liver but have not metastasized to other organs.
- Radiology
This can be divided into traditional external beam radiation therapy and microsphere embolization radiation therapy. Microsphere embolization involves injecting radioactive microspheres through a catheter into the tumor's hepatic artery, emitting short-range radiation that can kill cancer cells while minimizing damage to normal liver function.
- Liver transplant
This is suitable for patients with liver cancer combined with cirrhosis, as it can effectively treat both conditions simultaneously.
- Targeted Therapy
Targeted Therapy is suitable for patients with advanced liver cancer undergoing ablation therapy or transarterial chemoembolization. Sorafenib is a targeted therapy drug for liver cancer registered in Hong Kong; please consult your doctor for usage details.
- Immunotherapy
Recent studies indicate that Immunotherapy using PD-1 inhibitors is an effective second-line treatment for liver cancer. It can block the binding of PD-L1 on tumor cells to PD-1 on immune cells, allowing our immune cells to recognize tumors as enemies and attack them. This helps the immune system actively eliminate cancer cells. Currently, various clinical studies are exploring the combination of immunotherapy with targeted drugs to enhance treatment efficacy.
Recovery and Rehabilitation of Liver cancer
After completing treatment, the patient's condition should have improved. However, during the recovery period, the patient should pay extra attention to details of daily life to ensure the best possible outcome from the treatment.
- Consume food rich in protein and vitamins, such as milk, eggs, fruits, and vegetables. Reduce the intake of animal oil.
- Refrain from tobacco and alcohol. Quit smoking and drinking as soon as possible.
- Regular follow-up examinations are necessary. Follow your doctor's instructions and seek medical attention as soon as possible if any abnormalities are found. Get appropriate treatment promptly.
- Maintain a cheerful or calm state of mind and communicate with family, friends and social workers, etc. if necessary.
Liver cancer protection
Because early symptoms of liver cancer are not obvious, early prevention and regular check-ups are crucial, especially for hepatitis B carriers, to reduce the risk of developing the disease. The following are methods to reduce risk factors for liver cancer prevention:
- Quit smoking and drink moderately
- Maintain a regular sleeping habit
- Eat more vegetables and fruits
- Receive a blood test to confirm the presence of antibodies if you have a family member with hepatitis B.
- Receive hepatitis B vaccine three times in six months.
- Take safety precautions before sexual intercourse
- Do not share syringes to avoid infection with hepatitis B or C through body fluids
- Store food in a dry place and do not consume mouldy or spoiled food
Lung Cancer FAQ
Q. Where does liver cancer spread?
If left untreated, liver cancer can spread to any part of the body. Typically, as liver cancer cells divide and grow, they first spread to the veins in the liver or nearby lymph nodes, and then to distant organs such as bones or lungs.
Q. Is liver cancer hereditary?
Liver cancer is rarely hereditary, but some inherited metabolic disorders increase the risk of cirrhosis, which is a common risk factor for liver cancer. For example, people with hereditary hemochromatosis absorb too much iron from their food. If enough iron accumulates in the liver, it may lead to cirrhosis and liver cancer.
Q. What does liver pain feel like?
Liver pain can appear in many different forms and vary according to the person's body type. Some people have reported the symptoms of a throbbing or tingling sensation, pain in the lower back or shoulders, and swelling that does not subside.
References
- Hong Kong Cancer Registry. https://www3.ha.org.hk/cancereg/pdf/overview/Overview%20of%20HK%20Cancer%20Stat%202018_tc.pdf . Accessed 30 June 2021.
- https://www.chp.gov.hk/tc/healthtopics/content/25/52.html
- https://www.cancer-fund.org/liver-cancer/
