02 Jan 2010
It is estimated that between 70 and 80 per cent of all primary liver cancers (hepatocellular carcinoma or HCC) occur in Asia, with men being more susceptible than women.
And doctors are saying that even with a new effective treatment on the horizon, prevention is still the best bet for beating one of the most lethal cancers around.
“It is definitely mainly an Asian problem and it has to do with the high prevalence of chronic hepatitis B infections in Asia,” said Associate Professor Pierce Chow, Senior Consultant, Department of General Surgery, Singapore General Hospital, and Visiting Senior Consultant at the National Cancer Centre Singapore.
With chronic hepatitis B carriers 100 times more likely to develop liver cancer than non-carriers, it is not surprising that immunisation against it, as well as other cancer-causing viruses, will be highlighted on World Cancer Day on Feb 4.
Are Singaporeans safe?
Fortunately for many young Singaporeans, vaccination against hepatitis B was implemented in 1985 as part of the childhood immunisation programme. But that still leaves many adults without protection.
“Everyone should get immunised and if you are a hepatitis B carrier, you need to be screened every six months for liver cancer since it’s one of the fastest-spreading cancers.
The earlier you catch it, the earlier the stage of cancer, and thus, the more effective treatment will be,” advised Prof Chow.
When liver cells are severely damaged by long-standing diseases or chemicals, the organ hardens, leading to liver cirrhosis. This irreversible condition raises one’s risk of developing liver cancer.
Besides hepatitis B or C carriers, risk groups include those who have fatty liver, a condition associated with metabolic syndrome, which is linked to diabetes and cardiovascular disease. Excessive alcohol consumption is also a cause, albeit to a lesser extent.
No early warning
There are usually no early signs. When symptoms like abdominal swelling, weight loss or loss of appetite appear, the liver cancer normally has already progressed quite significantly.
There are several treatments for liver cancer. Of these, liver resection – removing the affected parts – is recognised as the standard treatment as it has been shown to consistently provide the best chances of survival. If liver resection is not possible because the patient’s liver function is very poor and if the tumour is too big, then liver transplantation may be considered.
New effective therapies
Survival among patients whose tumour could not be operated on used to be very poor. More recently, radiofrequency ablation (RFA) and targeted therapy drugs have been used. The former uses heat to destroy the tumour while the latter turns off specific molecular pathways of cancer cells to inhibit their functions. While RFA is recognised as potentially curative when tumours are small, drugs only prolong survival and do not offer a cure.
But the future is looking brighter for liver cancer patients, said Prof Chow, who has led several clinical trials of new and combined therapies for these patients.
He cited one that uses the technology of selective internal radiation for liver cancer patients who do not qualify for surgery. This therapy involves feeding radiation particles into affected areas of the liver where they then deliver localised radiotherapy to kill the cancer cells. Most patients require only one application.
Early results look promising but Prof Chow stressed: “While it’s important we have such clinical trials, the best protection against liver cancer is immunisation for all and screening of risk groups. We are working towards a nationwide screening programme at the primary healthcare level. That will definitely bring new hope in fighting the disease.”
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