Liver Cancer 101: Symptoms, Causes, Stages & Treatment

As cancer cases amongst Malaysians rise over the years, early detection and care become all the more important. Here’s everything you need to know about liver cancer. 

What is Liver Cancer?

As its name suggests, liver cancer is cancer that begins in your liver cells — this is specifically termed “primary liver cancer”. One of the major organs in the body, our liver carries out tasks essential for life, such as making essential proteins, processing and storing carbohydrates, destroying toxins and so on. 

It is the sixth most common cancer worldwide and is among the top 10 most common cancer in Malaysia. It affects roughly 24 out of 100,000 people a year. It’s more common in South-East Asia, Japan, Korea and China. 

Types of Liver Cancer

The two primary types of liver cells are the main liver cells (hepatocytes) and cholangiocytes (bile duct cells). Different cancers originate from these different types of cells, and can also develop from other parts of the body (this is called “secondary liver cancer”).

Hepatocellular Carcinoma (HCC)

Originating from the main liver cells, hepatocellular carcinoma (HCC) is the most common form of liver cancer in adults — making up 85% of primary liver cancers. 

Some HCCs begin as a single tumour, while others start as many small cancer nodules that slowly spread throughout the liver (this is often seen in people with chronic liver scarring or damage). 

Intrahepatic Cholangiocarcinoma (Bile Duct Cancer)

10-20% of primary liver cancer originates from the bile ducts within the liver, which carry bile to the gallbladder. This is called intrahepatic cholangiocarcinoma. Treatment for this type of liver cancer is often the same as for HCCs. 

Angiosarcoma and Hemangiosarcoma

A sarcoma is a cancerous tumour that forms from connective tissue cells — in the case of the above two cancers, they originate from the blood vessel cells in the liver. 

These rare cancers consist of tumours that grow very quickly and typically spread too far to be removed by the time they are discovered, hence making them difficult to treat. 

In almost half of the cases, there is no likely cause identified, though hereditary hemochromatosis (an inherited medical condition in which the body absorbs too much iron from food) and exposure to chemicals such as vinyl chloride, thorium dioxide or arsenic are theorised to increase chances of developing these cancers. 

Secondary Liver Cancer 

As opposed to primary liver cancer, secondary liver cancers begin in another place in the body — such as the colon or rectum — before spreading to the liver. This is also known as metastatic cancer and is typically more common than cancer that starts from the liver itself. 

Risk Factors of Liver Cancer

Risk factors that may increase one’s risk of getting this type of cancer include: 

• Chronic Hepatitis (Liver Infection). The most common risk factor for liver cancer, is long-term infection by the Hepatitis B virus and Hepatitis C virus can lead to cirrhosis (scarring).
• Liver Cirrhosis is a disease whereby normal liver cells become damaged and are replaced with scar tissue. Cirrhosis can be caused by different factors, including HBV and HCV infection as well as heavy alcohol consumption.
• Heavy Alcohol Use
• Smoking
• Diabetes and obesity are also other factors. Obese people are more likely to experience fatty liver disease and cirrhosis, while Type ll diabetics are likely to be at higher risk of developing liver cancer (compounded by the fact that many type ll diabetics tend to be overweight or obese)
• Male are twice as likely to get this type of cancer as compared to women. However, one rare subtype of HCC called fibrolamellar is most often seen in women under 35. This occurs in less than 1% of HCCs and typically has a better outlook compared to other HCCs.
• Family history of liver cancer
• Bile duct disease

Liver Cancer Stages and Survival Rate 

The general 5-year survival rate for liver cancer is 20%, though it largely depends on different factors, including the stage of cancer. 

Early-stage detection increases the survival rate, while late-stage liver cancer may see the survival rate dropping to 3%. Surgery generally helps to increase the survival rate of liver cancer across all stages. 

Here are the different stages: 

Stage IA

A small tumour smaller than 2cm is detected in the liver, with no spread to the lymph nodes or blood vessels.

Stage IB

A small tumour larger than 2cm is detected in the liver, with no spread to the lymph nodes or blood vessels.

Stage II

One or more tumours not more than 5cm are detected that have grown into blood vessels but have not spread to the lymph nodes. 

Stage IIIA

One or more tumours larger than 5cm. No spread to the lymph nodes or beyond.

Stage IIIB

At least one tumor that has grown into the large vein of the liver (portal or hepatic vein). No spread to the lymph nodes or beyond.

Stage IVA

Any tumor that has spread to lymph nodes but not to distant sites. 

Stage IVB

Any tumor that has evidence of distant spread in the body. 

Liver Cancer Signs and Symptoms

Image from Gleneagles Hospital

Signs and symptoms of include:

• Pain, particularly at the top right of the abdominal area, near the right shoulder blade, or in the back
• Unexplained weight loss
• A hard lump under the ribs on the right side of the body
• Weakness or fatigue
• Swelling in the abdominal area
• Jaundice (yellowing of skin and eyes, usually a sign of hepatitis)

Symptoms usually don’t become apparent until the later stages of the disease — making regular health screenings important to maintain, especially if you fall into any of the at-risk groups. Some signs may appear earlier, so if you suspect that anything is amiss, do consult your doctor as soon as you can. 

Diagnosing Liver Cancer

Since signs usually don’t appear until later stages of the disease, it can be harder to detect liver cancer in its early stage. However, that doesn’t mean it’s impossible. Early detection often increases the chances of survival and may lead to better treatment options for cancer. 

For people who are at high risk, regular screening for liver cancer may be recommended. These include people who have existing cirrhosis, chronic HBV infection, hereditary hemochromatosis and/or who fall into other risk groups should be screened for liver cancer regularly. 

Some of these general screening tests include: 

Physical Examination

The doctor will check the abdomen for lumps or swelling, as well as a lookout for an abnormal buildup of fluid in the region along with signs of jaundice.  

Blood Test for Alpha-Fetoprotein (AFP) Every 3-6 Months

The doctor may do a blood test for elevated levels of AFP, which may be an indicator of HCC. Liver function tests and tests for HBV or HCV may also be conducted. 

Ultrasound Scan of Liver Every 6-12 Months

A liver ultrasound is used to obtain an image of the liver and reveal any existing tumours or abnormalities. 

Liver Cancer Treatment

Several factors will affect a patient’s treatment for liver cancer, including the cancer’s stage and the patient’s overall health. Treatment for early-stage liver cancer typically focuses on aiming to eliminate the cancer, along with treating the side effects. For late-stage cancer, the goals of treatment may pivot to relieving symptoms and trying to slow the growth of the cancer. 

Some of the main treatments used include:

Radiofrequency Ablation (Tumor Removal)

Ablation therapy involves either radiofrequency ablation or electromagnetic waves (MWA). A needle-like probe is inserted into a liver tumour with the guidance of either an ultrasound or CT scan. THe doctor will then proceed to destroy the affected tumour tissue and leave an adequate border of healthy tissue surrounding the area.

Surgery

If only some parts of the liver are affected during early-stage liver cancer, a liver resection (surgery to remove only those affected parts) may be the treatment of choice. Another option is a liver transplant, which replaces the affected liver with a healthy donor liver. 

Chemotherapy and Radiotherapy

This involves the use of high-energy e-rays to destroy cancer cells, with a number of treatments administered over a set period of time. 

Chemotherapy is a treatment involving the use of drugs to destroy cancer cells, by preventing existing cancer cells from growing and dividing. It may be administered as part of a treatment called chemoembolization, which involves the injection of chemotherapy drugs directly into the liver cancer, together with a gel or tiny plastic beads to block blood flow to the cancer (embolisation). This is only a suitable option for chemotherapy as it can only be given if the liver is functioning well enough. 

Some side effects of chemotherapy may include fatigue, nausea, vomiting, hair loss, dry mouth, diarrhoea, constipation, and loss of appetite. Side effects may vary depending on the drugs used —  do consult your doctor on the potential side effects of each treatment route. 

Liver Cancer Prevention

Protecting Yourself from HBV and HCV

Since chronic HBV and HCV may lead to cirrhosis — and hence liver cancer — getting vaccinated for HBV can reduce one’s risk of getting liver cancer (there’s currently no vaccine against HCV).

In that same vein, protecting against HBV and HCV infection is important as well. Infection can occur through:

• Unprotected sex (use condoms!) 
• Sharing unsterilized needles

If you’re at high risk of contracting HBV or HCV, get tested for these infections so that treatment can be administered if needed.

Lifestyle Changes

Leading a healthy lifestyle with regular exercise, a healthy diet and moderate amounts of alcohol will help lower one’s risk of liver cancer. If you have viral hepatitis, you should reduce or avoid drinking alcohol completely as excessive alcohol can lead to cirrhosis, which can lead to liver cancer. 

Quitting smoking will help reduce your risk of some cancers and other diseases, liver cancer included. 

Managing your weight to prevent obesity lowers your risk of fatty liver disease and diabetes, which both potentially increase your risk of liver cancer. 

Liver Cancer Support Group and Resources in Malaysia

For patients and caregivers, joining a support group provides opportunities to get in touch with cancer survivors, as well as current patients and caregivers. 

For those taking care of loved ones, we have a list of caregiver support groups to assist you through this journey. 

Navigating a cancer diagnosis is never easy. For this journey, we have services for cancer caregivers to support you or your loved ones through the different stages, along with more caregiver resources and articles to help keep your loved ones safe and healthy.

Homage has trained care professionals that are able to provide companionship, nursing care, night caregiving, home therapy and more, to keep your loved ones active and engaged.

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