Expert Warns That Liver Cancer Has No Symptoms
Thursday, 23 February 2006

13 Feb 06 – For-59-year old Ms Gan (not her real name) in sales, and Mr Hu, a 47-year-old father of two, they knew that something was amiss but couldn’t quite place a finger on their problem.

They are in fact victims of Hepatitis(Hep) B and liver cancer. 80% of liver cancer or hepatocellular carcinoma (HCC) patients in Singapore are Hep B related. The cancer attacks the human body furtively. Liver cancer is the second most lethal cancer for males and the 5th most lethal cancer for females in Singapore. It is the fourth most common cancer worldwide- with 626, 000 new cases each year.

Said A/Prof London Ooi, Head of Hepatobiliary, Surgical Oncology and Chief of Hepatobiliary Surgery in National Cancer Centre Singapore (NCCS), liver cancer (HCC) has no symptoms but is associated with Hepatitis as well as alcohol abuse. “The frightening part about liver cancer is that in most patients, there would not be any symptoms and most would not feel pain until too late. By the time that liver cancer was detected, the tumour would have grown very big, “ said A/Prof Ooi.

Suggested Subtitle: Detection only after thorough investigation

Initially Ms Gan had gone through a battery of tests without finding the problem. Finaly, specialists at NCCS diagnosed her as having liver cancer. “I just felt uneasy, with a feeling of fullness and general pains in the stomach which came on and off.”

For Mr Hu, the route to detection was similarly baffling. According to his wife, Cindy Hu, “About 3 to 6 months prior to being diagnosed with liver cancer, I noticed that he wanted ice cold water every morning after waking up. He did not have this habit previously and I began to suspect that something was wrong,” she added.

At that time Mr Hu kept saying “it is nothing, don’t be afraid and don’t worry”. In the end, he listened to his wife and went for a thorough check-up. The ultrasound showed that he had a big 15.5 cm tumour in the liver.

Suggested Subtitle: Elevated risk of liver cancer for Hep B and C carriers

According to A/Prof Ooi , Hep B carriers have to be extra cautious as their risk of contracting liver cancer is 100 to 300 times higher than non Hepatitis carriers. Hep B carriers have to adopt a healthy lifestyle and go for regular check-ups and it would be best for them not to consume alcohol.

A/Prof Ooi also advised: “For non-Hep B carriers, they should also not indulge in excessive drinking beyond recommended limits. The alcohol can further damage a liver that is already damaged by hepatitis.

Suggested Subtitle:Hope for liver cancer patients

For Mr Hu, although the prognosis was poor initially because the tumour was large, surgery did save him. Now a year and half after surgery, he has already resumed his normal life and work in the real estate business for some time.

Said A/Prof Ooi, doctors would not be able to help patients who presented with such big tumours ten years ago as they could not be removed surgically. At that time, a five centimetre tumour was deemed terminal and doctors would classify the cases as inoperable surgically. However, currently medical advances have made it possible to successfully remove even huge tumours.

Since 1996, National Cancer Centre has performed more than 400 surgeries which removed liver tumours. The tumour size ranged from 2 cm to 30 cm, with an average of 8 cm. The average time required for surgery is 150 minutes, the average length of hospital stay is 5 days and the mortality rate is 2.17%.

Suggested Subtitle: Complex Liver Cancer surgery

According to A/Prof Ooi, if the patient did not receive treatment after being diagnosed with HCC, the average life span would be 3 to 6 months. Liver tumours, like all solid organ tumours, are best treated by surgery. This liver resection involves removing all the tumour with a clear margin to obtain primary control and cure for the tumour. At NCCS, surgeons perform between 80 to 100 HCC cases a year. Surgery performed by the team has yielded high results of up to 45% 5-year survival, comparable to worldwide standards.

A 30-year-old executive who was treated at NCCS after being diagnosed with liver cancer in July 1998 and subsequently underwent surgery said: “I felt assured at NCCS by the range of expertise and experience of the team.”

For metastatic liver cancer, although considered as an advanced stage cancer, selected patients benefit from liver resection as well, and in some cases with a combination of chemotherapy and surgery.

The surgical team works with medical and radiation oncologists to derive the optimal course of treatment for the individual patient. Ms Gan said, “I was very pleased that the staff helped me fix an appointment to see two doctors within the same day.”

When surgery is not possible for HCC, liver cancer treatment options include radiofrequency ablation (RFA), and localised chemotherapy known as transarterial chemoembolisation (TACE).

About National Cancer Centre Singapore

The National Cancer Centre Singapore(NCCS) is a national and regional centre directed at the prevention and treatment of different cancers including thoracic, hepatobiliary, pancreatic, head and neck cancers . Physically and operationally designed to provide integrated and holistic patient-centred clinical services, it allows cross-consultation among cancer experts of different specialties. Patients can therefore enjoy personalised, prompt and customised cancer treatment recommended by a team of radiation, surgical and medical oncologists (cancer experts) during the same visit and in the same clinic.

As a one stop specialist centre housing Singapore's largest pool of oncologists, it has state of the art equipment and employs the latest therapies including mini transplants and targeted therapies which maximise outcomes and minimise undesirable side effects. NCCS also conducts clinical and basic research as well as public cancer education programmes wholly directed at the prevention and treatment of cancer.

For foreign patient service, pls contact: 65 62369433, E-mail: foreign_patient@nccs.com.sg