Cancer begins when healthy cells change and grow out of control, forming a mass called a tumor.

A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. Cancer that begins in the liver is known as primary liver cancer.


Liver Cancer Treatment In Malaysia



 

Types of primary liver cancer in adults

There are a number of types of primary liver cancer that occur in adults.

  • Hepatocellular carcinoma - Approximately 75% of liver cancers are HCC
  • Cholangiocarcinoma - Approximately 10-20% of liver cancers develop In the bile duct of the liver
  • Angiosarcomas – About 1% of liver cancers start in the blood vessels of the liver and grows very quickly

Risk Factors and Prevention

The following factors can raise a person’s risk of developing HCC.

Cirrhosis
Cirrhosis develops when liver cells are damaged and replaced by scar tissue. Most cirrhosis can be caused by alcohol abuse, hepatitis virus infection, and hemochromatosis.
Viral hepatitis
The 2 common types are hepatitis B and hepatitis C. Viral hepatitis is the largest risk factor for liver cancer worldwide.
Hepatitis C has become much more common than hepatitis B because there is no vaccine to prevent hepatitis C.
Gender
Men are more likely than women to develop liver cancer.
Environmental factors
Some environmental factors may increase the risk of liver cancer, such as eating food contaminated with aflatoxin.

Risk factors are cumulative and having more than 1 risk factor increases the risk of developing liver cancer.

 

Symptoms and Signs

Patients with HCC may experience no symptoms, particularly when the tumor is detected early as part of a screening program. When symptoms or signs do occur, they include:

  • Pain in the right upper abdominal area, near the right shoulder blade
  • Unexplained weight loss
  • A hard lump under the ribs at the right upper abdominal area
  • Weakness or fatigue

Some symptoms experienced by people with HCC may be caused by cirrhosis rather than the tumor.

 

Diagnosis

Blood tests
AFP levels in the blood are elevated in about 50% to 70% of people who have HCC.

Computed tomography (CT) scans
HCC can be diagnosed based on features specific to liver cancer that are seen on a CT scan.

Magnetic resonance imaging (MRI)
An MRI scan uses magnetic fields to produce detailed images of the body.

Biopsy
A biopsy is the removal of a small amount of tissue for examination under a microscope.
When the AFP blood test, CT scan, or MRI strongly indicates HCC, and other test results that are typical of HCC, a biopsy may not be needed.

Molecular testing of the tumor
These laboratory tests will identify specific genes, proteins, and other factors unique to liver cancer.


Results of these tests will help determine your treatment options.

 

Stages

The Barcelona Clinic Liver Cancer (BCLC) system categorizes HCC based on characteristics of the tumor, liver function, performance status, and cancer-related symptoms.

BCLC stage groupings include:

 
Early stage

The tumor is smaller than 5 cm. Liver function varies, and portal vein pressure may or may not be increased.
Patients with early-stage disease may be candidates for a liver transplant, surgery, or radiofrequency ablation (RFA).

 
Intermediate stage

The tumor may be large or there may be multiple tumors. Regional therapies, such as trans-arterial chemoembolization maybe recommended for these patients with intermediate stage HCC.

Advanced stage

The tumor has invaded the portal vein or spread to other parts of the body, such as the lymph nodes, lungs, and bones.
Targeted therapy or immunotherapy maybe recommended for these patients.

 

Types of Treatment

 

Treatments to eliminate and potentially cure HCC

These treatments are recommended for early stage cancer. These treatments include surgery, radiofrequency ablation, percutaneous ethanol injection, and radiation therapy.

Treatments to extend survival of patients and improve quality of life

While these treatments will most likely not eliminate the cancer, they have been shown to improve symptoms, quality of life and survival.

Chemoembolization and radio embolization

During chemoembolization, chemotherapy drugs are injected into the hepatic artery, and the flow of blood through the artery is blocked for a short time so the chemotherapy stays in the tumor longer.

Blocking the blood supply to the tumor also destroys cancer cells. During radio embolization, the specialist places radioactive beads into the artery that supplies the tumor with blood. The beads deliver radiation therapy directly into the tumor when they become trapped in the small blood vessels of the tumor.

Targeted therapy

Targeted therapy is drug treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, our Oncologist may run tests to identify the genes, proteins, and other factors in your tumor.

This will help out oncologist better match you with the most effective treatment whenever possible.


For HCC, anti-angiogenesis drugs are the most common type of targeted therapy. Anti-angiogenesis therapies focused on stopping angiogenesis, which is the process of making new blood vessels.

Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor.

The first anti-angiogenesis therapy is believed to work through this process and used to treat advanced HCC that cannot be completely removed with surgery. In 2017, the U.S. Food and Drug Administration (FDA) approved the use of a second oral targeted therapy for previously treated HCC.

In 2018, a 3rd anti-angiogenesis oral targeted therapy was approved by the FDA as first-line treatment for inoperable HCC.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer.

The PD-1 pathway is critical in the immune system’s ability to control cancer growth. PD-1 and PD-L1 antibodies block this pathway and can stop the growth of HCC.

In 2017, the FDA approved an immune checkpoint inhibitor for the treatment of HCC, following the use of a targeted therapy.

In 2020, the FDA subsequently approved the use of a combination of immune checkpoint inhibitors that work to block the PDL-1 pathway that would otherwise allow the cancer to hide from the immune system.

Other immunotherapy drugs are still being studied in clinical trials.

Patients and their families have opportunities to talk about the way they are feeling with our oncologists, nurses, counselors, or join our psychosocial program and support group at Onco Life Centre.

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