By Dr. Nerenthran Loganathan
Consultant Physician and Gastroenterologist
KPJ Sabah Specialist Hospital
INTRODUCTION
Liver cancer or also known as Hepatoma / hepatocellular carcinoma has been on the rise and is now a leading cause of cancers in the world according to the recent detailed health screening program conducted by the Ministry of Health Malaysia. According to the research, liver cancer is the third highest leading cause of cancer death and has been identified to be the cause of death in about 250,000 to 1,000,000 people worldwide.
Two of the root causes have been identified as the Hepatitis B and Hepatitis C infections which were estimated to cause around 80% of the total cases of reported liver cancer.
To date, the highest recorded incidences of liver cancer in East Asia are from China, Taiwan, Hong Kong, Malaysia, Indonesia and Thailand.
Based on our own local Malaysian National Cancer registry, the incidence of liver cancer is 2.8/100,000 population in peninsular Malaysia and it had been identified as 1 out of the 10 leading cancers among the male population. Factors and genetic characteristics of the Asian populations might also have a predetermining factor.
It is estimated that as much as 5.2% of our population is suffering from chronic Hepatitis B and 2% from Hepatitis C. Most of them are healthy carriers of the disease and are unaware that they have the highest risk of developing iver cancer. These are the population who will develop chronic liver disease which in time will progress to hardening or scarring of the liver known as liver cirrhosis if not treated early. There is an annual incidence of about 5% of liver cirrhosis patients developing liver cancer.
Besides Hepatitis B and C, other causes of liver cirrhosis includes;
1. Chronic alcohol consumption
2. Fatty Liver or also known as NASH (Nonalcoholic steato-hepatitis)
3. Diabetes Mellitus
4. Certain rare autoimmune diseases like Primary Sclerosing Cholangitis, Autoimmune Hepatitis, Primary Biliary Cirrhosis
5. Obesity
6. Hemochromatosis
7. Wilson’s disease
8. Prolonged use of steroids
9. Fungal infection – prolonged exposure to aflatoxin produced by this fungus
10. Consuming arsenic contaminated water in certain countries.
WHAT ARE THE SIGNS AND SYMPTOMS OF LIVER CANCER?
People suffering from Liver cancer may not have any symptoms at the early stages, however here are some of the symptoms;
• Abdominal Pain especially at the right upper abdominal area.
• Decease in effort tolerance, easy fatigability, loss of weight, loss of appetite and unexplained fever.
• Abdominal Swelling especially at the right upper quadrant of the stomach.
• Jaundice – yellowish discoloration of the skin, eyes and passing dark urine.
• Back ache or bone pain due to spread of the cancer to the bones.
• Ascites – abdominal distension due to accumulation of fluid in the stomach.
• Vomiting blood – due to rupture of blood vessels in the esophagus (food pipe) or stomach.
• Poor appetite.
• Early satiety – fullness after eating a small meal.
• Pain at the left shoulder – referred pain.
• Abdominal discomfort.
• Nausea.
When the persons have these above mentioned symptoms, it is usually in the late stages of the disease. There is not much treatment which may be offered at this stage except symptomatic treatment and palliative care. That is why it is imperative that we detect early cancer so that it may be promptly treated and a possible cure obtained. How we do that is to screen all the high risk population.
Those who are Hepatitis B/C carriers should visit their local doctors and get an ultrasonography of the liver, liver function test and alpha feto-protein (cancer marker) blood test every 6 monthly for life. A computerized tomography (CT scan) of the liver or a Magnetic resonance imaging (MRI) scan of the liver is required once there in an abnormality detected from the above tests to confirm the presence of liver cancer and initiate appropriate early treatment.
Patients suffering from liver cancer may exhibit the following complications:
1. Haematemesis (Vomiting blood)
– as a sequalle of liver cirrhosis and liver cancer , these patients develop a condition called portal hypertension and as a result there is enlargement of blood vessels in the esophagus, stomach, duodenum( small intestine) . When this blood vessel ruptures it will cause hematemesis (vomiting blood) and this could be life threatening.
2. Abdominal pain as a result of bleeding within the liver cancer and bacterial infection of the abdominal fluid known as spontaneous bacterial Peritonitis.
3. Abdominal pain due to enlarged liver compressing the adjacent organs.
4. Jaundice - yellow discoloration of skin and eyes due to high bile pigment levels in the blood.
5. Confusion and coma due to a condition called hepatic encephalopathy where there is high level of ammonia in the blood.
TREATMENT
The treatment for liver cancer is divided in a few stages. Early detection is crucial and the key to a successful treatment. If the patient presents in the late or advanced stage of liver cancer, there is no option for curative treatment except palliative care which is supportive treatment, relief of pain, nutritional support and end of life care.
For those patients who are detected early, the options of surgery for a potential cure is highly possible depending on the stage of the disease and overall condition of the liver. This surgery called hepatic segmentectomy or hepatectomy which is usually done by removing the segment of the liver affected or even removal half of the liver.
For those patients with poor liver reserve or function and who have multiple medical conditions where surgery is too high of a risk or where surgery is not possible, they have other options like TACE (Trans Arterial Chemo Embolization) – directly injecting chemotherapy into the liver cancer or Radio-Frequency Ablation therapy- Using high intensity Radio frequency to burn the cancer. Another option for treatment is a liver transplant.
PREVENTION
Patients suffering from liver cancer on the whole has underlying liver cirrhosis or are a hepatitis B/C carrier. Therefore the best method of prevention is Hepatitis B vaccination, early screening for hepatitis C and regular blood monitoring for other conditions leading to liver cirrhosis like fatty liver.
Those who are carriers of Hepatitis B/C should restraint form alcohol, smoking, unrecognized traditional herbal treatments, direct sales supplements and requires regular visits to a doctor for surveillance. Finally if there is any history of liver cancer in the family, all family members related should go for a blood screening for Hepatitis B and Hepatitis C.
KPJ SABAH SPECIALIST HOSPITAL
Lot No.2, Off Jalan Damai,Luyang, 88300 Kota Kinabalu,Sabah, Malaysia.
Website: http://www.kpjsabah.com/
Tel: 088-322 000 | Emergency: 088-322 199
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