MOST cancers are "silent" and liver cancer is no exception. In the early or very early stages of the disease, most patients are unaware that they even have the condition.
According to the Global Cancer Observatory 2022 report, liver cancer was the fourth highest cancer in Malaysia, and the fourth leading cause of cancer-related deaths in the country, with 1,700 cases detected that year.
Liver cancer can be divided into primary or secondary cancer and the most common primary liver cancer would be hepatocellular carcinoma, where cancer cells arise from cells in the liver, explains Pantai Hospital Kuala Lumpur consultant general and hepatobiliary surgeon Dr Balraj Singh.
Hepatitis B and C infections remain the most common causes of liver cancer in Malaysia, he adds
Apart from these two infections, alcoholic liver disease is another cause of liver cirrhosis, which can eventually lead to liver cancer.
Also, attention is now being paid to metabolic associated fatty liver disease.
Dr Balraj says this happens due to a very fatty liver because of dietary intake, which converts a normal liver to a fatty liver and eventually progresses to a cirrotic liver, which is a precursor to liver cancer.
"Essentially, fatty liver disease can be due to either alcohol or bad eating habits."
Alcohol directly causes fatty liver disease or what is known as alcohol-related fatty liver disease, while non-alcohol related fatty liver disease, now known as metabolic dysfunction-associated fatty liver disease or MAFLD, is due to diets high in fat, especially fried foods.
SILENT AND DEADLY
Most cases of liver cancer tend to be asymptomatic at the early stage or what's termed as the "treatable stage".
Dr Balraj says given this scenario, patients usually seek help from doctors at more advanced stages of the disease.
"They come to us when they start experiencing distention of the abdomen or ascites. Jaundice is also a sign of the disease, but a late presentation as well."
Even symptoms such as weight loss and poor appetite, which are commonly associated with liver cancer only show up much later.
Similarly, pain related to liver cancer is usually experienced only when the tumours are very big and stretch the tumour capsules.
Dr Balraj says when tumours are small (early stage tumours), or when the disease is in its early stage, patients usually don't feel pain.
Given the fact that this disease works silently in the early stages, screening is crucial to ensure early detection and treatment.
Dr Balraj says in Malaysia, we have a screening programme in place for hepatitis B and C infections.
When these infections are detected, patients will have their health condition monitored and followed up.
When the infected person's normal liver shifts to the cirrhosis stage, tumour markers and ultrasounds will be routinely conducted.
These cases, which undergo screening and monitoring are usually the patients whose liver cancer is picked up at an early stage.
However, those with alcohol-related fatty liver disease and those with MAFLD, are being left out of this screening programme although efforts are underway to detect and include those cases as well.
Dr Balraj says we need a way to screen and pick up the disease early in those two groups as well because currently, they are the ones coming in with very late stages of liver cancer.
TREATMENT AND SURVIVAL
With very early stage liver cancer, surgical resection (where part of the liver is removed to get rid of tumours), or a liver transplant are the two treatment modalities that offer better overall survival compared with other treatment methods.
A liver transplant does provide a cure, but it is only recommended for early or very early stage liver cancer, explains Dr Balraj.
"A liver transplant offers a 70 per cent overall survival rate at five years, but it's best for those with early, or very early stages of the disease as they would have better long term survival from the procedure."
Additionally, Malaysia does not have many liver donors available, making it essential that such transplants target those who would most benefit from the procedure.
The exception would be cases of living-related donors where family members come forward to donate to a particular patient.
For those at the intermediate stage of the disease, systemic chemotherapy is now used, either with or without targeted tumour-centric chemotherapy to ensure a better outcome and longer disease-free survival.
At late stages of liver cancer, only supportive care can be offered, making early detection of the disease even more essential to improve survivability.
LIVER CANCER — CAUSES
* Hepatitis B infection.
* Hepatitis C infection.
* Overconsumption of alcohol leading to alcoholic liver disease and liver cirrhosis.
* A high fat diet leading to fatty liver disease and liver cirrhosis.
WHO'S AT RISK
* Men are more affected than women in Malaysia.
* Most patients are in their 50s or 60s.
HEPATITIS AND LIVER CANCER
* Hepatitis B is passed from mother to child.
* Hepatitis C is related to the exchange of bodily fluids and most commonly seen among intravenous drug users.
*Vaccination is available for hepatitis B.
* Hepatitis C is treated with medication.
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