Liver cancer is the fourth most common cancer suffered by men, although it is not as common in women. However, it is the third-biggest cause of cancer death in men, and the fourth in women.
The problem with liver cancer is
that each tumour is unique.
Even within the same person, different
parts of a tumour can have a
different genetic make-up, making
it tough for doctors to find a treatment
plan that works against the
And it does not help that this cancer,
although not uncommon, is not
yet well understood.
Part of the reason is that 80 per
cent of cases are found in the
Asia-Pacific, rather than in the
West where the most cutting-edge
research is done, said Professor
Pierce Chow, who is from the surgical
oncology division at the National Cancer
Centre Singapore (NCCS).
He added: “Liver cancer, for the
longest time, was really the cancer
of poor people in the Third World.”
The lack of research in this area
means that existing treatment for it
The standard drug used for patients
with this disease, called Sorafenib,
does not work on many people.
Surgery to remove the tumour
is often a stop gap measure, as 95
per cent of cancers recur within
But doctors in Singapore are trying
to change this by learning more
about the different sub-types of liver
cancer, which could pave the
way towards more personalised
Prof Chow and his team, for instance,
are collecting the tumours
cut out of patients during surgery
and analysing them in detail.
If his patients return because
their cancer has recurred, he could
already know which existing drugs
work against their particular tumour.
Currently, explained Associate
Professor Dan Yock Young, who is
from the National University
Hospital’s gastroenterology and
hepatology division, treating liver
cancer can be a little like flying
Unlike other cancers, biopsies are
not often done since any sample
might not be representative of the
“It’s almost like we are treating a
black and white shadow, while others
have moved on to colour televisions,”
Prof Dan said.
“We want to put them into
sub-classifications, so that we have
a better idea in terms of predicting
the overall outcome.”
Currently, treatment options include
liver transplantation and surgery
to remove part of the liver.
Doctors have also developed a
technique known as transarterial
chemoembolisation – in which
chemotherapydrugs are injected into
the liver and block the blood supply
to the tumour, after which it can
be burned off.
If these do not work, there are
oral chemotherapy medications.
In Singapore, liver cancer is the
fourth most common cancer in
men, and the third most likely to
kill. Some 2,264 cases of this cancer
were reported between 2010 and
It is also the fourth most common
cause of cancer death in women, although
it does not make an appearance
in the list of common female
Liver cancer is traditionally associated
with the hepatitis B virus,
which is estimated to have infected
between 5 and 10 per cent of the
population in East Asia.
Carriers of the virus, said Dr
Cheah Yee Lee, a general surgeon
at Gleneagles Hospital, are a hundred
times more likely to get liver
cancer compared to those who are
In Singapore, all those born after
1985 have been vaccinated against
hepatitis B – although that still
means a good proportion of the population
Rising obesity numbers also
mean that non-alcoholic fatty liver
disease has become a new culprit.
When fat accumulates in the liver,
Dr Cheah explained, the liver can become
inflamed or hardened, which
could eventually lead to cancer.
This can complicate treatment
further, because doctors might
deem it unsafe to put further stress
on the liver when the organ is already
not doing well.
“Liver cancer differs from other
cancers in this regard – the treatment
and prognosis of liver cancer
is also dependent on the underlying
liver disease and function,” Dr
Those who want to reduce their
chances of this cancer can do so by
leading a healthy lifestyle, which
makes them less likely to get fatty
This includes not smoking and, interestingly
enough, drinking more
“Avoid oily foods that add on to
metabolic stress,” Prof Dan said.
“We think that fish and vegetables
For further enquiries on liver
cancer, please call the National
Cancer Centre Singapore helpline on
6225-5655 or e-mail it at
You can also contact the National
University Cancer Institute,
Singapore on 6773-7888 or e-mail it