Q: How common is liver cancer?

Worldwide, liver cancer is the 7th commonest cancer in males and the 9th commonest in females. In some parts of Asia & Africa, it is the most common type of cancer. In Singapore, it is the 4th among the most frequently occurring cancers in males.

Q: What causes liver cancer?

The exact manner in which the normal liver cells become cancerous is only partially understood. However, scientists believe that it involves damage to the DNA, and replication of cells with the same DNA error. Once this happens, it is too late to repair the damage that may eventually lead to a cancer.

Some of the risk factors are:

· Aflatoxin, which is a poisonous substance produced in a fungus which infects peanuts
· Chronic infection with hepatitis B & C viruses
· Alcohol abuse leading to scar tissue formation in the liver
· Inherited disorders that cause damage to the liver
· Certain chemicals like vinyl chloride
· Long-term use of anabolic steroids
· Drinking water contaminated with arsenic

Q: How is liver cancer diagnosed?

The signs & symptoms of liver cancer usually do not show up until the later stages. A doctor should be consulted if these problems persist:
· Anorexia or persistent lack of appetite
· Unexplained weight loss
· Increasing abdominal girth 
· Persistent pain in the abdomen and around the right shoulder blade 
· Sudden jaundice 
· Dramatic change in the overall condition of a person with chronic hepatitis or cirrhosis
· A lump that can be felt in the area of the liver
· Enlargement of the breast in men

To confirm the diagnosis, a series of investigations that include blood tests, ultrasound, CT scan, needle biopsy, laparoscopy, angiography or MRI may be performed.

Q: How is liver cancer treated?

The treatment option depends on many factors, such as age, general health, personal preference, social circumstances, location and extent of the tumour. Generally, surgery, chemotherapy and radiation therapy are the 3 main methods of cancer treatment.

Surgery involves removal of all cancer visible to the surgeon at the time of operation. Complete removal may not be possible if the cancer is large or if several small cancers are present in different parts of the liver. People with cirrhosis are considered eligible for surgery only if their cancers are very small. Cryosurgery, that is, destruction of tumour by freezing it, has shown promise in delaying the progress of the cancer.

In chemotherapy, anticancer drugs are injected into the bloodstreams that reach all parts of the body. This makes the treatment potentially useful for cancers that have spread to other organs. Chemotherapy, however, also damages some normal cells.

The use of radiation therapy is limited because of the sensitivity of normal liver tissue to radiation.

Q: What happens after treatment?

The doctor will decide which follow up tests should be done and how often. To watch for recurrence or metastasis, abdominal CT scans and other imaging studies may be taken.

Q: Can liver cancer be prevented?

Yes, most liver cancers can be prevented by public health measures that reduce exposure to known risk factors mentioned earlier.

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