Dr C.K. Leow
Liver, Pancreas, Colon and General Surgery

Liver Cancer, Hepatitis and You

Liver cancer is also known as hepatocellular carcinoma (HCC) or hepatoma. It is a common cancer in Asia and kills one million people per year. In Singapore, it is the 5th most common cancer in men. The reason why liver cancer is common among Asians is because the chronic hepatitis B virus (HBV) infection rate in the Asian population is very high when compared to the Western population. In addition to chronic HBV infection, there is the health problem of chronic hepatitis C virus (HCV) infection too. People who are chronically infected with HBV and / or HCV are at greatly increased risk of developing liver cancer.


It will be surprising to most people to know that at the time of diagnosis the majority of patients with HCC will have no or minimal symptoms. Not uncommonly the liver cancer is discovered by an abnormal blood test or an abnormal ultrasound scan of the liver during a routine health screening programme. Some of the symptoms of liver cancer include vague discomfort in the right upper part of the abdomen, discomfort in the pit of the stomach, intermittent diarrhea, feeling tired, weight loss, presence of a lump in the abdomen, increasing size of the abdomen and jaundice.


The diagnosis is made by a blood test and a scan of the liver. The blood test measures the level of the tumour marker alpha-fetoprotein (AFP). The scan is a CT scan of the liver. It is important to remember that not all patients with HCC will have abnormal levels of AFP. It is possible to have a large liver cancer and yet the AFP level is normal.


Depending on the extent of the liver cancer and the underlying condition of the liver, the treatment can be curative or palliative.

Curative Treatment

The only method to cure liver cancer is by surgery. The aim of the operation is to completely remove the cancer from the liver. As most patients with liver cancer will also have liver cirrhosis (hardening of the liver), liver surgery can be more challenging. Although a liver operation is a very major operation, it can be safely performed by an appropriately trained liver surgeon. The average hospital stay for a patient who is undergoing a liver operation is 7 – 10 days.

(The alternative to surgical removal of the cancer is a liver transplant. However, only a small number of patients with HCC are suitable candidate for liver transplant.)

Palliative Treatment

Palliative treatment attempts to control and slow down the cancer growth, it is not possible to cure. There are several types of palliative treatments and include chemotherapy, trans-arterial chemoembolization, local ablation treatment with heat or cold and internal irradiation treatment.

All the palliative treatments, with the exception of the irradiation method, have to be repeated at regular intervals. The frequency of repeat treatment will depend on the type of treatment used. In general, palliative treatment needs to be given indefinitely.


Liver cancer tends to affect individuals who are chronically infected with the hepatitis B and / or C virus. It is very important for these carriers to have regular medical monitoring on their liver. By regular monitoring it is hoped that the liver cancer can be detected at an earlier stage. This will then make surgery for the liver cancer more likely and thus increase your chance of being cured.