Treatment of liver cancer

Professor Pierce Chow Photo: Courtesy

Professor Pierce Chow is a Senior Consultant and Co-Director (Surgical) of the Comprehensive Liver Cancer Clinic at the National Cancer Centre Singapore; Senior Consultant Surgeon in HPB (Hepatic-Pancreatic-Biliary) and Transplant Surgery at the Singapore General Hospital; Professor and Course Director at Duke-NUS Medical School Singapore. He is specialised in the treatment of liver cancer and has carried out extensive research on hepatocellular carcinoma (HCC).

A few days ago, he visited Bangladesh and was kind enough to share a few words about the treatment of liver-centric diseases, alongside some good advice on how to maintain healthier lifestyles to prevent such diseases.



What are the main causes of liver cancer?

First of all, there are two categories of liver cancer —primary liver cancer and secondary liver cancer. Primary liver cancer arises from the liver cells itself. It is the result of chronic liver injury such as chronic viral hepatitis B, or hepatitis C. It can be caused by fatty liver, which is related to diabetes, and cirrhosis caused by excessive drinking of alcohol. These are potential risk factors.

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. HCC occurs most often in people who are carriers of hepatitis B, or hepatitis C infection.

Secondary liver cancer arises from cancer that originates outside the liver. Most often, it is either colorectal, lung, or breast cancer, which ultimately spreads to other organs like the liver. Treatment of this type of cancer is dependent on the primary organ from where the cancer spreads.

Other rare causes of liver cancer are those related to hereditary diseases.



Has there been any recent breakthroughs in the treatment?

There have been some interesting breakthroughs in the last couple of years. Liver cancer is a challenging illness to fight against, as the majority of its patients are in Asia, mostly the poor, and until recently there was very little interest from the pharmaceutical industry.

Appropriate treatment of HCC is dependent on the stage at which the cancer is diagnosed. Surgery is potentially curative in early stage HCC. There have also been breakthroughs in the treatment of intermediate and advanced stages of the cancer.

In the intermediate stage, yttrium-90, a radioactive nuclide coated on tiny spheres, is introduced via a catheter, which takes it from the artery to the tumour.  This has the potential of downstaging it thus making it possible for surgical resection.

Liver cancer is often diagnosed in the intermediary stage, as there are no conspicuous symptoms in the earlier stages. Vague symptoms, like loss of appetite and malaise, exist.

In the advanced stage, there is systematic therapy, as the cancer cells can potentially be in many parts of the body. The cancer has spread in the bloodstreams, making leeway to the entire body. Immunotherapy is a very promising new therapy.



How is liver cancer approached from a doctor's perspective?

Liver cancer is one of most prevailing forms of cancer in the world today. Its preventive measures need to be taken seriously with treatment if necessary. It is seen from a multi-disciplinary approach — involving medical and radiation oncologist, nuclear medicine physician, surgeon, and interventional radiologist.



How viable is the idea of liver transplant?

Liver transplants are done when the liver is not functioning well, and the best outcome occurs when it is carried out for HCC in the early stage. The rate of survival for both resection and transplant is the same in early stage HCC. Surgery is however only possible if the liver functioning is good. Otherwise, transplant is an option.



What are the dietary and lifestyle habits we should follow/avoid to maintain a healthy liver?

Alcohol, which causes cirrhosis, should be avoided. Hepatitis B and C are transmitted in multiple ways — sexual intercourse, sharing needles, sharing toothbrushes, etc. Hepatitis B is genetic in some cases as well, and that is called vertical transmission.

If the mother is a carrier of hepatitis B, the child must be vaccinated at birth. There should be strict diet regulation and exercise to reduce the risk of fatty liver. It also helps to avert the risk of diabetes. High carbohydrate intake increases the chances of having fatty liver.

Fitness should always be a high priority, and for that, proper diet plan should be implemented with regular exercise. Given that time for exercise is short for many, the focus on diet should be at the 80 percent threshold, and the rest for exercise.



What preventive measures can be taken?

When it comes to primary liver cancer, it is best to avoid the risk factors stated above. This is the primary prevention.

The secondary prevention is that known carriers of hepatitis B must receive treatment and go for regular blood screening and imaging every six months.

Those diagnosed with hepatitis B are more prone to liver cancer, and screening must involve two modalities — ultrasound and alpha-fetoprotein. Two of them should be should be used in case there is a negative chance of false reading. Crosschecking should be done.