Misconceptions and late diagnoses are contributing factors to the low survival rates for liver cancer.

When it comes to liver cancer, Asian men are leading the way. Hepatocellular carcinoma (HCC), the most predominant type of liver cancer, is three to five times more likely to affect men than women in general and seven to 10 times more likely in men under 50 years of age.

About 80% of liver cancer cases in the world occur in Asia and it is the third most common cause of cancer-related deaths in the Asia Pacific region. It is also the most prevalent form of cancer in countries like Laos, Mongolia, Taiwan and Thailand.

This is mainly because of the lack of vaccination against the Hepatitis B virus (HBV) in Asia. There are no clear answers yet however, on why HCC seems to occur more in men although some experts have suggested that it could be due to hormones or genetics.

What causes HCC?

Contrary to popular belief, the leading cause of liver cancer in Asia is actually Hepatitis B infections, not alcohol consumption. Infants who are not vaccinated against HBV can develop a chronic and incurable infection that in later years causes cirrhosis of the liver, an irreversible condition in which damaged cells are replaced by hard scar tissue, making them more susceptible to cancer.

Other contributing risk factors include Hepatitis C, non-alcoholic fatty liver disease, alcoholic liver cirrhosis, non-alcoholic causes of cirrhosis, non-alcoholic Steatohepatitis (NASH) – an advanced form of non-alcoholic fatty liver disease, tobacco smoking, obesity and diabetes.

“We are seeing an increase in the number of cases related to lifestyle such as non-alcoholic fatty liver disease and NASH-related cases due to the increasing number of overweight and obese people. Fatty liver disease is now the second most common cause of HCC in Singapore, responsible for far more cases than Hepatitis C and alcoholic cirrhosis put together,” says Dr Choo Su Pin, President of Singapore Society of Oncology, Senior Medical Oncologist at Curie Oncology, Mount Elizabeth Novena.

Is HCC a death sentence?

Like most cancers, the prognosis for HCC patients varies depending on the stage of the cancer when it is detected. Unfortunately, majority of the patients only present symptoms at the advanced stage of the disease.

According to Dr Murallitharan Munisamy, Director of National Cancer Society Malaysia (NCSM), in Malaysia the survival rate for HCC is generally very poor, because of delayed diagnoses.

“A general lack of understanding and awareness of liver cancer is one of the contributing factors to the high mortality rates for the disease. Even though treatment options are available in earlier stages of HCC, because diagnoses happens late the average life expectancy of a newly-diagnosed HCC patient in Malaysia is less than a year,” he says.

(Left) Dr Murallitharan Munisamy, (Right) Dr Choo Su Pin

Treatments for HCC

If detected early, that is at Stage I or II, a partial hepatectomy or resection can be performed to remove the tumour. With a successful curative surgery, the chance of survival beyond five years is more than 40%.

“Sometimes, a liver transplant is recommended as it both removes the cancer as well as the underlying diseased liver, giving the patient about 70% chance of a five-year survival,” says Dr Choo.

For more advanced Stage II and III cancers which are still localised to the liver, loco-regional therapies like radiofrequency ablation (using heat to destroy the cancer), chemotherapy (TACE) or radiation directed into the liver are prescribed.

Significant advancements have also been made in the treatment of late-stage HCC in recent years, with targeted therapies using TKIs or tyrosine kinase inhibitor drugs, which target and inhibit specific pathways that promote cancer growth, as well as immunotherapy drugs which stimulate the patient’s immune system to recognise the cancer cells and attack them. These therapies have been shown to prolong patients’ survival in HCC for Stage IV liver cancer patients.

Today, a combination of immunotherapy drugs or an immunotherapy combined with a TKI is becoming the accepted first-line treatment for Stage IV HCC.

Early screening and prevention

There are no widely recommended screening tests for liver cancer for those without symptoms or history of cancer. However, doctors may recommend testing those at higher risk such as patients who have long-standing liver cirrhosis.

While HCC is not entirely preventable, vaccinating newborns against HBV could be the most crucial step in reducing the risk of the disease, as observed in countries like Taiwan and Singapore.

Reducing the risk of Hepatitis B and C infections through healthier lifestyle choices – such as limiting alcohol consumption, avoiding tobacco and drug usage, and practicing safe sex – can help prevent HCC. Doctors also recommend maintaining a healthy body weight through a balanced diet and regular exercise, to keep diabetes and fatty liver disease at bay. This not only reduces the risk of HCC but prevents a host of other diseases as well


Featured image by Shutterstock.
Dr Murallitharan Munisamy photo courtesy of himself.
Dr Choo Su Pin photo courtesy of herself.

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#livercancer #livercirrhosis #nationalcancersocietymalaysia #HepatitisB #HepatitisC