Understanding Liver Cancer

Liver cancer is a significant health concern worldwide, with a particularly high incidence in Asia, including Singapore. As the primary filtration system for our blood, the liver plays a crucial role in maintaining overall health. Understanding the differences between liver cancer and liver disease is essential for early detection, effective treatment, and prevention.

Overview of Liver Cancer

Liver cancer, also called hepatic cancer, begins in the liver cells. The most common type is hepatocellular carcinoma (HCC), accounting for about 75% of all liver cancers. (1) Less common types include intrahepatic cholangiocarcinoma and hepatoblastoma.

According to the Singapore Cancer Registry, there were over 1,500 new cases of liver cancer diagnosed between 2015 and 2019.

Signs and Symptoms of Liver Cancer

Early detection of liver cancer can be challenging as the symptoms often do not appear until the disease is in an advanced stage. However, recognising the early signs is crucial for timely medical intervention. Common symptoms include:

• Unexplained Weight Loss: Sudden and unexplained weight loss is a common symptom. (2)
• Loss of Appetite: A noticeable decrease in appetite and feeling full after eating small amounts.
• Abdominal Pain and Swelling: Persistent pain or discomfort in the upper right side of the abdomen, which can sometimes spread to the back or shoulder.
• Nausea and Vomiting: Frequent episodes of nausea and vomiting.
• General Weakness and Fatigue: Persistent tiredness and weakness that does not improve with rest.
• Jaundice: Yellowing of the skin and eyes, indicating a liver problem.
• White, Chalky Stools: Changes in stool color can also be a sign. (3)

Risk Factors for Liver Cancer

Several behaviors and conditions increase the risk of developing liver cancer:

• Obesity: Being overweight or having obesity increases the risk.
• Diabetes: Having diabetes can increase the risk of liver cancer.
• Smoking: Cigarette smoking is linked to a higher risk of liver cancer.
• Alcohol Consumption: Drinking alcohol excessively can lead to liver damage and increase cancer risk.
• Hemochromatosis: This condition, where the body stores more iron than needed, can increase risk. (4)
• Chronic Hepatitis Infections: Long-term hepatitis B or hepatitis C virus infections are significant risk factors.
• Cirrhosis: This scarring of the liver, often caused by hepatitis or alcohol use, significantly raises cancer risk.
• Nonalcoholic Fatty Liver Disease (NAFLD): The presence of extra fat in the liver not caused by alcohol is a risk factor.
• Aflatoxin Exposure: Consuming foods contaminated with aflatoxins, a type of fungus that grows on improperly stored grains and nuts, is a risk factor. (5)

How Liver Cancer Differs from Liver Disease

Liver cancer is a specific malignancy within the broader category of liver diseases. While both can cause liver dysfunction, they differ in cause, progression, symptoms, diagnosis, and treatment. Liver cancer often arises from chronic infections (hepatitis B/C), cirrhosis, or excessive alcohol intake, and progresses rapidly, with symptoms like weight loss and jaundice appearing later. Conversely, liver disease encompasses a wider range of conditions like hepatitis, fatty liver disease, and genetic disorders, with variable progression and symptoms depending on the type. Diagnosing both may involve blood tests, imaging scans, and biopsies, but treatment differs significantly. Liver cancer treatment focuses on removing or destroying cancerous tissue (surgery, ablation), while liver disease treatment depends on the cause, ranging from antiviral medications (hepatitis) to lifestyle changes and potentially liver transplant (cirrhosis).

While liver cancer is a specific type of cancer affecting the liver cells, liver disease is a broader term encompassing various conditions that impair liver function. The primary differences between liver cancer and liver disease include their causes, progression, and treatment.

Prevention and Early Detection

Preventing liver cancer involves addressing the risk factors associated with liver disease. Key preventive measures include:

• Regular Screening: Individuals at high risk, such as those with chronic hepatitis or cirrhosis, should undergo regular screening for early detection of liver cancer.
• Healthy Lifestyle: Maintaining a healthy weight, limiting alcohol consumption, and avoiding exposure to aflatoxins can reduce the risk of liver disease and cancer.
• Safe Practices: Using clean needles, practicing safe sex, and ensuring blood products are tested can prevent hepatitis B and C infections.
• Vaccination: Hepatitis B vaccination helps protect against preventable chronic liver disease. (6)

References

1. Types of Liver Cancer: Common, Rare and More Varieties. (2018, October 5). Cancer Treatment Centers of America. https://www.cancercenter.com/cancer-types/liver-cancer/types  
2. Bhattacharya, R., Hwang, J. H., & Ko, C. (2020). The Patient with Unexplained Weight Loss. Yamada’s Handbook of Gastroenterology, 37.
3. Mayer, L., & Bhikha, R. (2014). Changes in Colours of the Body–the Determinants of Disease. skin, 1, 270.
4. Elmberg, M., Hultcrantz, R., Ekbom, A., Brandt, L., Olsson, S., Olsson, R., … & Askling, J. (2003). Cancer risk in patients with hereditary hemochromatosis and in their first-degree relatives. Gastroenterology, 125(6), 1733-1741.
5. Jackson, P. E., & Groopman, J. D. (1999). Aflatoxin and liver cancer. Best Practice & Research Clinical Gastroenterology, 13(4), 545-555.
6. Hepatitis B Foundation: Hepatitis B Vaccination. (n.d.). Www.hepb.org. https://www.hepb.org/prevention-and-diagnosis/vaccination/