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Silent Predator: The Hidden Dangers of Liver Cancer

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28 August 2024

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3 minute read

Silent predator The hidden dangers of liver cancer

By Dr. Hema Darshinee A/p Johnson

Liver cancer is a silent predator that could be lurking within our bodies. It often goes unnoticed until it is too late. Imagine: You’re going about your daily routine, perhaps feeling under the weather but attributing it to stress or fatigue. Then, you brush off the symptoms, unaware of something more serious.

In a world where we are constantly on the move, it is much easier for these warning signs to slip under the radar. So, how do we detect this subtle threat amidst all this?

Why 'silent threat’?

Liver cancer, or more precisely hepatocellular carcinoma, is a primary liver malignancy that occurs in the setting of chronic liver disease and cirrhosis. Chronic infection of Hepatitis B or Hepatitis C remains the leading cause of liver cancer, followed by alcoholic and non-alcoholic fatty liver.

For chronic liver disease, it can take up to two to three decades before a malignant transformation occurs. Having said that, patients with liver cancer can remain asymptomatic for a long duration due to the slow-growing nature of liver cancer in the early stages. However, in advanced stages, liver cancer is rather insidious and aggressive in which signs and symptoms are apparent.

Globally, hepatocellular carcinoma is the third leading cause of cancer-related death whereby it accounts for 250,000 to 1,000,000 deaths yearly. It is also the sixth most common cancer affecting Malaysians.

Key Symptoms to Watch For:

Stages of liver disease

Stage 1: Healthy Liver

Stage 2: Inflammation

It all starts with a condition called hepatitis. Hepatitis refers to the inflammation of liver cells which can be caused by various factors such as Hepatitis B or Hepatitis C infection, drug-induced, alcohol, as well as autoimmune conditions.

Stage 3: Fibrosis

When the inflammation of liver cells is dysregulated and prolonged, it can lead to fibrosis or scarring of the liver.

Stage 4: Cirrhosis

Consequently, severe irreversible scarring of the liver will eventually result in liver cirrhosis. Cirrhosis represents a progressive and irreversible deterioration of liver health that can ultimately develop into malignancy over time. Liver cirrhosis is one of the major risk factors for hepatocellular carcinoma. In addition, there are other less common types of liver cancer which include intrahepatic cholangiocarcinoma and hepatoblastoma.

Stage 5: Liver Cancer

Formation of malignant tumor in the liver.

Stage 6: End Stage Liver Disease

Liver function ceased entirely.

Warning signs of liver cancer

Since liver cancer patients are often asymptomatic in the early stages of the cancer, it would be difficult to diagnose liver cancer at a curable stage. More often than not, patients with liver cancer tend to exhibit non-specific symptoms such as fatigue, weight loss, frequent stomach bloating, loss of appetite, and abdominal discomfort.

Symptoms like jaundice, pain in the right abdomen, bleeding tendencies, and ascites (accumulation of fluid in the abdomen) become apparent in advanced stages of liver cancer, reflecting the damage inflicted upon the liver.

Turning the tide through early detection

The overall prognosis for survival is dismal, with a 5-year relative survival rate of 21.6%. Patients with localized disease fare slightly better, with a relative 5-year survival of 37.3%, whereas those with regional disease have a rate of 14.3%, and those with distant disease have the lowest survival rate at 3.5%, according to stage.

In this context, localized disease refers to cancer that is confined to the primary site and has not spread to surrounding tissues or organs. Regional disease indicates that the cancer has spread to nearby lymph nodes or tissues, but has not yet metastasized to distant parts of the body. Distant disease refers to cancer that has spread to distant organs or tissues.

Hence, it is evident that diagnosing liver cancer at an earlier stage permits time for curative intervention. Keep in mind that there are many other factors that could influence the outcome of patients with liver cancer such as patients’ age, comorbidities, socioeconomic factors, and access to optimal healthcare. Ultimately, prevention is always better than cure.

Navigating the waves: Risk factors and screenings

Chronic alcohol use, hepatitis B, hepatitis C, and non-alcoholic fatty liver disease are major risk factors for hepatocellular carcinoma. On the other hand, Wilson’s disease, hereditary hemochromatosis, alpha1-antitrypsin deficiency, primary biliary cirrhosis, and autoimmune hepatitis are the less frequent causes.

Not to forget, Aspergillus flavus and related fungi create aflatoxin, a mycotoxin that contaminates stored foods such as rice, corn, soybeans, and peanuts. It is one of the main risk factors for hepatocellular carcinoma in several parts of the world, particularly in Asia and Africa.

To reiterate, liver cancer can remain asymptomatic for almost a decade. Thus, patients who have mentioned risk factors require regular screening that may vary between blood investigation, radiological imaging, and OGDS followed by necessary preventive measures. Moreover, screenings can detect this condition in early curable stages. Screenings also play a huge role in identifying high-risk groups of patients as it will allow preventive measures to be implemented. For example, treatment to reverse inflammation from further progression.

Healing journeys

Management of liver cancer is tailored to the disease stage and patients’ performance. Some of the treatment options include surgical resection, chemo-embolization, radiofrequency ablation, systemic chemotherapy, immunotherapy, and various arrays of targeted therapy.

Advancements in oncological research not only contribute towards effective screening and diagnosing, they have also shifted the paradigm in liver cancer management. This inevitably has also improved the overall prognosis and treatment outcome of liver cancer over the years. Besides, various clinical trials also broaden the treatment options for patients with liver cancer.

Lowering liver cancer risk

The key to cancer prevention lies in maintaining a balanced and healthy lifestyle. Specifically addressing liver cancer, preventive measures must include avoiding high-risk behaviors such as chronic alcohol consumption, smoking, drug abuse, unprotected sexual practices, and poor management of fatty liver, all of which significantly elevate the risk of developing liver cancer. Furthermore, in today’s era of rapid advancements in science and technology, we are fortunate to have access to effective screening and diagnostic tools. We must capitalize on this wealth of information available at our fingertips to educate ourselves about the available healthcare resources. Together, we can win this battle.

This article first appeared in Healthcare Today, 27 May 2024.

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28 August 2024

•

3 minute read

Silent predator The hidden dangers of liver cancer

By Dr. Hema Darshinee A/p Johnson

Dr. Hema Darshinee A/p Johnson

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