Liver cancer – Are you at risk ?
Dr Mark Fernandes advises early and simple screening can reduce risks of malignancy
A50-year-old gentleman recently saw us for abdominal bloating . He was diagnosed with advanced multi-focal liver cancer . He passed away within a month . He was not aware that he had any risk factors associated with liver disease .
The truth is though , liver cancer is curable if detected early , and regular screening is an essential part of detecting liver cancer early . There are also now many non-invasive methods for assessing one ’ s liver to understand if they are at risk of liver cancer at all .
Liver cancer accounted for the sixth highest number of new cases of cancer globally and the third highest number of deaths due to cancers globally in 2020 . Asia remains the region with the highest incidence for liver cancer in the world , largely due to the prevalence of hepatitis B .
Symptoms of liver cancer A common misconception is to wait until one has symptoms before seeing a doctor . Unfortunately , patients with symptoms due to liver cancer are usually in the advanced stages of the disease . These include jaundice , abdominal pain and distension , and weight loss . Liver cancer in its early stages usually is asymptomatic and hence screening is essential in patients at risk .
Risk factors for liver cancer The most common risk factor for liver cancer in Asia is hepatitis B , with the prevalence in many Asian countries above 10 percent . Other risk factors around the world include hepatitis C and fatty liver disease , particularly in the developed world . Hepatitis B and C can be detected through a simple blood test . Fatty liver disease is associated with obesity and the metabolic syndrome and can be detected through an ultrasound scan . These risk factors either increase the risk of liver cancer on their own or as a result of continued inflammation in the liver over many years , resulting in liver disease progression and cirrhosis ( scarring of the liver ).
Liver cancer screening Patients with hepatitis B or liver cirrhosis should be followed up by a doctor and screened regularly for liver cancer . This usually involves an ultrasound scan of the liver every six months . New nodules or lesions detected on ultrasound require further characterisation with either a CT or MRI scan .
Methods of treatment for liver cancer Liver cancer in its earliest stages can be treated ideally with either surgical resection or liver transplantation . However , patients who are not suitable for either due to age or existing medical conditions can be treated with minimally invasive techniques such as radio-frequency ablation or trans-arterial chemoembolization . Patients with more advanced disease now also have access to molecular targeted therapies or immunotherapy .
Unfortunately , patients with symptoms due to liver cancer are usually in the advanced stages of disease .
Screening for liver fibrosis and cirrhosis Screening for liver fibrosis ( or scarring ) and cirrhosis ( chronic degeneration ) is an essential part of knowing whether you are at risk for liver cancer or not and whether you require screening for liver cancer . Many different modalities exist to evaluate liver fibrosis and cirrhosis . In the past , the primary method was using a liver biopsy . However , today there are tests , such as the Fibroscan liver stiffness measurement and MRI elastography , that can non-invasively detect liver fibrosis and cirrhosis accurately .
Dr Mark Fernandes is a Gastroenterologist at gutCARE
• Digestive • Endoscopy Liver Associates . His main clinical interests are in liver disease including fatty liver , hepatitis B and C and liver cancer . Find out more at www . gutcare . com . sg
66 OCTOBER 2021 GlobalHealthAndTravel . com