The hepatobiliary unit at the Hospital Selayang, which is now the national tertiary referral centre for liver diseases, receives about 150 patients with liver cancer every year. Beware liver cancer!

TO a large extent, liver cancer is a silent disease. and when signs and symptoms appear, it may be too late for doctors to offer any form of curative treatment for the cancer.

That means, when you show up at your doctor?s office with symptoms like a bloated abdomen, jaundice, drastic weight loss, and a feeling of heaviness in your upper abdomen, even though there may be treatments to get the cancer under control, your chances of a cure might be limited.

Since its relocation to Hospital Selayang in 1999, the hepatobiliary unit has evolved into a national tertiary referral centre specialised in the management of critically ill patients with acute and chronic liver diseases.

Unfortunately, in Malaysia, this is the norm rather than the exception.

?Patients still come late to us,? says Mr R. Krishnan, head of hepatobiliary surgery at Hospital Selayang. the unit, which is now the national tertiary referral centre for liver diseases, receives about 150 patients with liver cancer every year.

?Right now, for the bulk of our patients, there is little we could offer,? says Mr Krishnan. It?s only in less than 25% of cases that we could offer some sort of treatment for their cancer,? he notes.

However, hope is not lost. Liver cancer might be a silent disease, but its risk factors and causes are rather well documented. the trick is to minimise your risk factors, monitor your liver regularly if you have any of the conditions that may lead to liver cancer, and follow the timeless health advice: live a healthy lifestyle.

Know the causes and risk factors

While more recent data is yet to be published, going by the numbers provided in the National Cancer Registry in 2006, liver cancer was then already ranked the sixth most common cancer among Malaysians. it was the fifth most common cancer among males and ninth most common cancer among females in Peninsular Malaysia.

There are two types of liver cancer. Cancers of the liver caused by malignant changes in liver cells are called primary liver cancers (hepatocellular carcinoma). Cancers in the liver that are caused by the spread and retention of cancer cells from elsewhere are called secondary liver cancers.

Mr R. Krishnan … Patients still come late to us.

?Most of the time, (primary) liver cancer occurs in people with some underlying liver problem,? says Ministry of Health national head of surgical services Datuk Mr Harjit Singh, who is also former head of hepatobiliary surgery at Hospital Selayang.

A lot of them have hepatitis B or C infections, alcoholic liver disease, fatty liver, or any kind of liver disease that can lead to cirrhosis (the formation of scar tissue in the liver). However, the problem is that most people take these things for granted.

?They don?t go for any form of check-ups or screening tests,? says Mr Harjit. ?By the time they present with pain or symptoms, the disease is already (at) an advanced (stage).?

According to a consensus paper on the management of hepatocellular carcinoma (primary liver cancer) in Asia that Mr Harjit co-authored, the risk factors for developing liver cancer in Asia include heavy exposure to aflatoxin (toxins produced by a type of fungus), algal hepatotoxins (liver toxins) in contaminated water, betel nut chewing, diabetes mellitus, and alcohol abuse leading to liver cirrhosis.

However, the main known cause for liver cancer in Asia is chronic hepatitis B virus infection. ?In Malaysia, it is hepatitis B. But (liver cancer due to) hepatitis C is picking up,? says Mr Krishnan.

That said, these remain as risk factors. There is no guarantee that you will develop liver cancer if you have these conditions. Nevertheless, you have a greater chance of developing it compared to those who don?t.

Datuk Mr Harjit Singh … Most of the time, primary liver cancer occurs in people with some underlying liver disease

Care, monitor, and don?t work it too hard

So, how do you prevent liver cancer? you can start by taking steps to prevent or minimise the risk factors and have your liver checked if you have any underlying liver disease.

Getting yourself immunised against hepatitis B is a start. Malaysians who are born after 1989 would have already been immunised as a child under the National Immunisation Schedule, but those born before that will have to obtain their immunisation from their local healthcare providers. There is still no vaccine for hepatitis C.

As both viruses are transmitted through the exposure to infectious blood or body fluids, avoiding and managing situations that may lead to its transmission ? like unprotected sex, needle sharing, and transmission from mother to child during delivery ? can help prevent one from getting infected.

That is why even for procedures that involve needles like tattoo drawings, body piercings, and even acupuncture, it is important to make sure that the needles used are disposable ones meant for single use, Mr Harjit explains.

Pregnant mothers with hepatitis B can also be given appropriate treatment to prevent the child from being infected as well.

On top of that, those with a family history of liver disease or liver cancer should also get themselves screened regularly through medical checkups.

People who have underlying liver disease must, essentially, follow up with their family physician or their regular GP and get their screening tests done at least every six months, says Mr Harjit.

Even people who are healthy should at least get themselves tested for diseases such as hepatitis B and C, especially when they have reached the age of 30.

?We have almost 2.5 million hepatitis B carriers in this country. A significant proportion of them are at a risk of developing chronic liver disease,? Mr Harjit adds.

A healthy diet and regular exercise also plays a role in preventing liver cancer as well. at the very least, it could minimise one of the risk factors ? fatty liver ? that is usually associated with excessive consumption of alcohol and the metabolic syndrome (brought about by unhealthy diets and physical inactivity). this will, in turn, minimise your risk of developing liver cancer.

Work with your regular doctors

As the hepatobiliary unit in Hospital Selayang is a tertiary care centre, the patients they receive are mostly referrals from primary care doctors. But both Mr Krishnan and Datuk Mr Harjit emphasises that you don?t have to go to a liver specialist for a normal checkup.

?Ideally, the message is that people should be seen by their primary care doctors,? says Mr Harjit. ?If their doctors find any liver problems, like liver masses or tumours, they can refer the patients to us,? he adds.

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