Silent killer
Liver cancer is the fourth most common form of cancer among men here, often striking with no symptoms.
By Tan Yi Hui
The Sunday Times
12 March 2008
Page L10
LIFE-SAVER: If not for his wife insisting that he go for a health check-up, Mr Woo would not have known that he had liver cancer.
FOUR years ago, doctors discovered a malignant tumour bigger than a tennis ball in Mr Woo Kum Tim's liver. He was diagnosed with liver cancer.
The 51-year-old housing agent was a hepatitis B carrier, but had not been going for regular check-ups. It was only when he started complaining to his wife about feeling tired and having dry lips that she insisted on a health check-up.
'She went to the scanning centre to book a date for me. I didn't know about it,' recalls Mr Woo, about his wife's life-saving decision.
Liver cancer is the fourth most common form of cancer in men here, according to the Singapore Cancer Registry. It is one of the more aggressive cancers, and there is no known cure.
Last month, Hong Kong comedian Lydia Sum, 62, died after her battle with cancer. News reports have speculated that it was either liver cancer or bile duct cancer, which is even more rare.
In 2006, it was reported that Sum had a tumour removed from her liver. In August last year, reports said she was undergoing chemotherapy and the media followed developments of her ailing health till her death on Feb 19.
Recounting his brush with death, Mr Woo says that he was already prepared to 'wait for my D-day'.
But the father of two got lucky. A liver resection operation, which saw surgeons removing about 1kg of his liver, worked. And he has not had a relapse.
Liver cancer is more prevalent in Asia because of the higher incidences of hepatitis B, a virus that attacks the liver and is transmitted through unprotected sexual contact, blood transfusions and re-use of contaminated needles. It can also be passed from mother to child.
Those who consume large amounts of alcohol are also at risk, according to doctors.
Dr Tay Khoon Hean, a surgeon at Gleneagles medical centre, says: 'The hepatitis B virus destroys the liver cells and leads to scarring of the liver called cirrhosis.
'The virus continues to attack the liver over time and it forms cancer. It's usually over a period of 10 years or longer.'
According to Dr Toh Han Chong, a medical oncologist at the National Cancer Centre, for those in the advanced stages of the cancer, prognosis is usually anywhere from three to six months.
It's not a losing battle however, and early treatment, usually involving surgery, can give a five-year survival rate of between 50 and 60 per cent. 'The earlier the stage, the easier to treat. This is true for any cancer,' says Dr Toh.
But liver cancer is also known as a silent killer because 'sometimes, you have no symptoms', he adds.
According to him, that is why more than half the liver cancer patients are already in the intermediate and advanced stages by the time they are diagnosed.
Treatment for liver cancer may range from surgery and radio-frequency techniques to chemotherapy and even a liver transplant, depending on the extent of the disease and the overall health of the patient.
Doctors say that surgery has the highest success rate. It usually involves cutting out the portion of the liver with the tumour.
But in cases where the patient's liver has been ravaged by hepatitis B to an extent that the remaining portion after surgery cannot sustain normal functions, it is not an available option.
According to Gleneagles' Dr Tay, about 70 per cent of the liver can be removed if the remaining portion is healthy enough.
Even then, a relapse of the cancer may arise. 'For a liver affected by hepatitis, there is a recurrence rate of up to 90 per cent in up to 18 months,' he says.
Hepatitis B is a disease preventable by vaccination. As for those already with hepatitis B, 'our advice is to go for screening', says Dr Toh.
Such screening involves a six-monthly to yearly round of ultrasound scans, as well as six-monthly blood tests that monitor liver function and cancer traces.
Clinical trials have been under way to find other methods besides chemotherapy to treat liver cancer. In recent months, the drug Sorafenib has been made available to patients, although not routinely prescribed.
It works by slowing down the process and therefore buying some time for the patient - about two to three months - but doctors differ in their views about its usefulness, given the high costs.
Overall though, they say there have been improvements in the treatment of liver cancer.
Mr Woo is an example of one of the lucky few who pulled through. He has some stoic words of advice on how he dealt emotionally with the disease.
'Think positive. If you have it, you have it. Keep on going and let it be,' he says.tanyihui@sph.com.sg
Look out for...
VERY often, patients with liver cancer display no symptoms. But when symptoms do appear, they may include:
- Heaviness, discomfort or pain in the right side of the abdomen.
- Loss of appetite or loss of weight.
- Yellowness of the white of the eyes or jaundice.
- Pain in other parts of the body if the cancer has spread, such as bone pain.
- A small group of patients may experience a sudden intense pain in the abdomen as a result of the tumour rupturing.
Treatment
- Liver resection: Surgery to remove the cancerous mass in the liver.
- Tace: Transarterial chemoembolisation. The blood supply leading to the tumour is blocked and chemotherapy is done directly to the tumour.
- Radiofrequency ablation: A probe goes through the skin and into the tumour. Sound waves are then sent through, creating heat energy which 'kills' the cancer cells.
- Systemic therapy: Drugs are taken orally or injected into the bloodstream to ensure distribution to almost every part of the body, mainly to work against the cancer that may have spread.
Source: National Cancer Centre, Singapore 
