Liver cancer/Gallbladder cancer/Bile Duct cancer

The liver is the largest internal organ in our body. It performs more than 500 different vital functions. One of which is the liver act like a detoxifier of the body, helping the body to get rid of toxins. It has a system of tubes within it called the bile ducts which collects a chemical called bile that is produced by the liver. Bile is needed by us to help us to digest fat, along with the help of enzymes produced by the pancreas. This bile is transported by the bile ducts into a main tube outside the liver called the common bile duct, which connects the liver to the small intestine (duodenum). The gallbladder is a small bag-like organ that is attached to the common bile duct. Its function is to store excess bile.

Liver Cancer

What is Liver Cancer?

 

Liver Cancer is cancer of the liver cells called hepatocytes. The liver is actually made up of different cell types like liver cells, bile duct cells, blood vessels, etc. Liver cells (hepatocytes) make up 80% of the liver. The medically scientific term for this kind of cancer is called Hepatocellular Carcinoma (HCC) or Hepatoma for short. Liver cancer is the third most common cancer in the world. Most of the liver cancer cases are found in Southeast Asia, China and Taiwan due to high incidence of Hepatitis B infection in these parts of the world. In Singapore, liver cancer is the 4th most common cancer in Singaporean males.

What are the risk factors of developing liver cancer?

 

  • Hepatitis B infection. This is the most common cause of liver cancer worldwide. A Hepatitis B carrier is 100 times more likely to develop liver cancer compared to a non-carrier. Singapore has a number of Hepatitis B carriers.
  • Hepatitis C infection. Similar to Hepatits B. However this is not so common in Singapore.
  • Liver Cirrhosis – this is a hardening of the liver from repeated or persistent injury to the liver by various factors. This repeated injury or persistent injury leads to chronic inflammation. Over time, the liver scars up and hardens.
  • Chronic alcohol intake, which can cause cirrhosis
  • Fatty liver, which can cause cirrhosis
  • Certain inherited liver diseases or metabolic diseases like Wilson’s disease

What are the symptoms?

 

Most people do not have any symptoms in the early stages of the disease. When they begin to have symptoms, the disease is typically quite advanced already. Symptoms include:

 

  • Upper abdominal pain or discomfort, usually on the right side
  • Abdominal swelling
  • Appetite loss
  • Weight loss
  • Jaundice (yellowing of the whites of the eyes)
  • Easily tired

What will the doctor do to diagnose the cancer?

 

The doctor would usually order a specialized scan such as the CT scan or the MRI scan. He may also order a liver cancer marker, called alpha-feto protein (AFP). Sometimes, he may ask for a needle biopsy of the tumour.

 

What is the treatment of liver cancer?

 

Depending on what is the stage of the cancer, the doctor will then decide on the appropriate treatment. In addition, he also needs to check what is your liver function like, and if the liver is cirrhotic.

 

Surgery is the only treatment that can provide a long-term cure and it’s the best treatment if the cancer has not spread to other parts of the body. The aims of operation are to remove all the tumours in the liver, whilst leaving behind adequate liver to sustain life. The ideal surgery is liver transplant. However, due to the shortage of organs, resection (or surgical removal) of the tumour is the next best option.

 

Liver Resection (Hepatectomy) surgery is the operation to remove the cancerous part of the liver. (Click here to read more about hepatectomy)

 

The liver has eight segments, each segment of the liver has its own independent blood supply and bile drainage.

 

Right Hepatectomy means the removal of segments 5,6,7 and 8

Left Hepatectomy means the removal of segments 2,3,4a and 4b

Central Hepatectomy means the removal of segments 4a, 4b, 5 and 8

Segments may also be removed individually. For example, monosegmentectomy 6 means the removal of just segment 6

 

The surgery can be performed by the traditional open method or by the laparoscopic (keyhole) method. Laparoscopic liver operations (Laparoscopic Hepatectomy) will depend on the size and location of the tumour.

 

However, not all liver cancer is suitable for surgical treatment. If the patient has liver cirrhosis (hardening of liver), surgery will be challenging as the patient may not do well or even die due to insufficient liver function from the liver that is left behind.

 

If the liver cancer cannot be treated by surgery, there are other treatment options such as RFA, TACE and SIRT. [Hover text, info pop up ](Click to read more about these treatment methods)

 

  • Radiofrequency ablation (RFA) – using electrical current to destroy the cancer cells.
  • Radiation therapy – using radiation to kill the cancer cells. This radiation can be delivered using small radioactive beads delivered directly into the tumour (SIRT) or through an external radiation beam (radiotherapy).
  • Chemotherapy involves the use of cancer drugs to kill cancer cells. These drugs can be delivered directly into the tumour itself (TACE) or be administered through an intravenous injection or even oral tablets (systemic chemotherapy)

Are there any other types of liver tumour?

 

The answer is yes. Some of these tumours are:

 

Tumours may arise from the bile ducts within the liver (called bile duct cancer),

Tumours may arise from the blood vessels like the haemangioma; this is the most common benign tumour of the liver

Liver cysts

Benign liver tumours like adenoma (this may be linked to the intake of oral contraceptives). It may potentially turn cancerous

Tumours may be cancer spread from elsewhere. One common example is colon cancer which has spread to liver, and appeared as a tumour within the liver.

 

How to prevent liver cancer?

 

The most effective way is for people who have risk factors for liver cancer to go for regular screening. This is to allow the detection of the tumour when it is still early and therefore increase the chance for cure. High-risk patients include Hepatitis B or Hepatitis C carriers.

 

In Singapore, patients who have Hepatitis B or cirrhosis from any cause are advised to participate in a liver cancer screening programme. This is available at any polyclinic and includes 6-monthly check of alpha-feto protein (a blood test) and a 6-monthly or annual ultrasound of the liver.

 

In addition,

 

Eat healthily and avoid being overweight

Exercise regularly

Drink alcohol in moderation, if at all

Get yourself vaccinated against Hepatitis B

Read More
Bile Duct Cancer

What is Bile Duct Cancer?

 

Bile Duct Cancer is cancer of the cells lining the bile ducts. The scientific term for this kind of caner is called cholangiocarcinoma.

Read More
Gallbladder Cancer

What is Gallbladder Cancer?

 

Gallbladder cancer is cancer arising from the cells of the inner lining of the gallbladder. The scientific medical term for this cancer is gallbladder adenocarcinoma. It is an uncommon cancer. There are certain parts of the world there this cancer has a slightly higher incidence, like Central and South America, Central and Eastern

Read More

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