While hepatocellular carcinoma (HCC), a common type of primary liver cancer is the third most fatal cancer in Singapore, early-stage liver cancers are responsive to treatment with either surgery or ablation techniques. The chance of survival for individuals with early-stage liver cancers beyond 5 years is more than 40%.
Treatment for primary liver cancer should be individualised to each patient and depends on:
An individual with cancer should be assessed by a specialist to determine which modality of treatment is best suited for them.
Surgery offers the best chance for cure and long-term survival for primary liver cancer. It can be in the form of resection, where the part of the liver with the cancer is removed, or a liver transplant. Unlike many other organs where complete removal of the organ (such as both breasts, the entire colon or stomach) is possible, a person cannot live without a liver. Resection is undertaken when complete removal of the cancer is feasible and yet leaves enough liver intact for the patient’s needs.
In cases where there are multiple cancer nodules, the cancer is recurrent or the underlying liver disease is advanced, a liver transplant may be recommended. A donor liver can be from a cadaveric donor or from a healthy individual who is willing to donate part of their liver (i.e. a living donor). If a liver transplant is recommended, a series of tests and medical assessments will be carried out to assess if the patient is fit to undergo a liver transplant.
Following a liver transplant, the patient will need to take immunosuppression drugs for life to prevent organ rejection.
Localised chemotherapy and radiotherapy treatments are done when surgery is not possible.
Localised chemotherapy involves delivery of chemotherapy directly to the liver cancer via a tube inserted at the groin. This has the advantage of delivering a higher dose of chemotherapy to the cancer, while minimising side effects to the rest of the body.
Localised radiotherapy with yttrium 90, is similar to localised chemotherapy. It involves delivering radioactive materials directly to the liver cancer via a tube inserted at the groin. A series of tests is performed before administering this form of treatment to determine if a patient is suitable.
Ablation techniques are suitable for small cancers measuring less than 3cm in size. The efficacy of ablation in small cancers is close to that achieved with surgery. The most common form of ablation technique is Radiofrequency Ablation (RFA). This involves inserting a thin rod through the liver into the cancer and using radiofrequency to generate heat, which kills the cancer cells.
Microwave is another source of energy used for ablation. Access of the rod to the cancer can be via the skin and is guided by ultrasound or CT scan. In this situation, general anaesthesia may not be necessary. General anaesthesia is required if access of the rod is directly into the liver via open or laparoscopic (keyhole) surgery.
Systemic treatment is undertaken in advanced cases where other treatment options are not suitable. Sorafenib, which is taken daily as an oral medication, is the most commonly prescribed systemic treatment. Intravenous chemotherapy may be given in selected cases.
In advanced cancer cases where all the above treatment options are not suitable, participation in a suitable clinical trial may be suggested. Clinical trials aim to determine if new treatment medication is effective in controlling the disease.
When treatment is not possible or is ineffective, palliative care can help to ease symptoms such as pain, ascites (collection of fluid in the peritoneal cavity that can cause breathlessness and discomfort) and jaundice (which causes the skin to turn yellow and feel itchy).
Palliative care, also increasingly known as supportive care, is a holistic approach to caring for anyone diagnosed with a serious illness such as cancer, to allow them to live as well as they can, for as long as they can. Palliative and supportive care is specialised support provided by a multi-disciplinary team of doctors, nurses, clinical psychologists, medical social workers and other allied health professionals to help patients.