Cancer Type

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liver cancer Introduction

Liver cancer is the fifth most common cancer in Hong Kong, with 1,742 new cases in 2018. Of these, 1,487 people died from liver cancer. The median age of onset is between 65 and 71 years old, and the incidence rate in men is about four times that in women.

Hepatitis B, hepatitis C, cirrhosis, alcoholic liver disease, and fatty liver disease are the main risk factors for liver cancer. In Hong Kong, approximately 10% of the population are carriers of the hepatitis B virus, and about 80% of liver cancer cases are related to hepatitis B.

Because many liver cancer cases are caused by hepatitis B, the liver has been damaged by the hepatitis B virus for a long time. In addition, early-stage liver cancer lacks obvious symptoms, so most patients are diagnosed at an intermediate or advanced stage, increasing the complexity and difficulty of treatment. Fortunately, with the advancement of medicine and technology, the treatment of liver cancer has become more diversified in recent years, and even some intermediate or advanced liver cancer cases still have the opportunity to have the tumor completely removed.

Liver cancer develops when liver cells mutate and grow uncontrollably. Cancer originating in the liver is called "primary liver cancer," while cancer cells that spread to the liver from other parts of the body are called metastatic liver cancer, also known as secondary liver cancer. Colorectal cancer, pancreatic cancer, stomach cancer, lung cancer, and breast cancer are all common cancers that metastasize to the liver. 

II. Symptoms of liver cancer

Early-stage liver cancer often lacks obvious symptoms. However, as the disease progresses to the middle and late stages, the following symptoms may appear:

Abdominal distension

Lumps appear in the upper right abdomen

Water in the abdomen

Yellowing of the whites of the eyes and skin

Itchy skin

Urine is brown

Loss of appetite

Unexplained weight loss

Nausea and vomiting

Inexplicable tiredness

Risk factors for liver cancer

People with hepatitis B have a 100 times higher risk of developing liver cancer than the general population.

Having hepatitis C increases the risk of developing liver cancer by 150 times compared to the general population.

Cirrhosis of the liver

Excessive alcohol consumption leads to alcoholic liver

Diabetes, obesity and smoking

Family member has suffered from liver cancer

III. Staging of Liver Cancer

Doctors determine the stage of liver cancer based on factors such as the location, size, and extent of metastasis of the cancer cells. Generally, liver cancer can be divided into stages I to IV, as detailed below:

IA

The tumor is no more than 2 cm in diameter and has not yet invaded blood vessels or spread to nearby lymph nodes.

IB

The tumor is only confined to the uterine body or endometrium.

IIA

A single tumor larger than 2 cm in diameter that has invaded blood vessels; or more than one tumor, but the total diameter of the tumors does not exceed 5 cm. Neither has yet spread to lymph nodes or other tissues.

IIIA

The tumor was over 7 centimeters in size and had spread to the entire lung, lymph nodes, mediastinum, etc., but had not yet spread to other parts of the body outside the chest cavity.

IIIB

More than one tumor, at least one of which is larger than 5 centimeters in diameter, but has not yet spread to the lymph nodes or other more distant tissues.

IVA

Limited stage: The tumor has invaded the main trunk of the great vein of the liver at least once, but has not spread to the lymph nodes or other tissues further away.

IV. Diagnostic methods for liver cancer

Organizational inspection

Blood tests for liver function and alpha-fetoprotein

Liver ultrasound

Computer scanning

Magnetic resonance imaging (MRI)

Positron scanning

V. Treatment of Liver Cancer

Surgery

Surgical removal of the tumor is the ideal treatment for liver cancer. However, few liver cancer patients are clinically suitable for surgery. It is appropriate for cases with good liver function, suitable tumor location, and no spread of cancer cells. The risks of surgery include infection, thrombosis, and bleeding.

Radiofrequency ablation and high-intensity focused ultrasound (HIFU) therapy

Various methods, including high-energy radio waves, heat, cold gases, and concentrated alcohol, are used to destroy liver cancer cells. This is suitable for early-stage primary and metastatic liver cancer, as well as patients who cannot undergo surgery due to poor liver function. Side effects include abdominal pain, bleeding, or infection. In recent years, the next generation of high-intensity focused ultrasound (HIFU) therapy has fewer side effects. It emits high-intensity ultrasound waves from outside the body, focusing them on the tumor inside the patient's body and releasing temperatures exceeding 60 degrees Celsius to kill cancer cells.

Transarterial chemoembolization (TACE)

Special oils and medications are injected into the hepatic artery through a catheter, blocking the blood vessel and causing the tumor to die naturally due to the lack of nutrient supply. It is usually used in conjunction with chemotherapy and radiation therapy. Common side effects include infection, nausea, vomiting, and gastrointestinal discomfort. TACE is suitable for patients with tumors in both lobes of the liver but not spread to other organs; or patients with tumors in only one lobe but who cannot undergo surgery due to poor liver function; or cases where the tumor is larger than five centimeters and is not suitable for radiofrequency ablation.

Y-90 Internal Radiotherapy

Using microspheres containing radioactive isotopes, which are placed into the liver via a catheter, the radioactive material can be directly and concentrated to target the liver tumor, with minimal impact on surrounding organs. Side effects are significantly reduced compared to traditional radiotherapy, and the therapeutic effect is also more ideal. This method is suitable for liver cancer cases that cannot be surgically removed or treated locally, bringing new hope to patients with mid-to-late-stage liver cancer who have limited treatment options.

Targeted therapy

Currently used targeted therapies for liver cancer treatment include sorafenib and lenvatinib, which are suitable for liver cancer patients who cannot undergo resection surgery, ablation therapy, or transarterial chemoembolization.

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