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Understanding Hepatoma

Overview of Hong Kong

Incidence and Survival Rates of Hepatoma

The liver is one of the body’s most vital organs, responsible for producing proteins, storing vitamins and minerals, and facilitating red blood cell metabolism, among other critical functions. However, the liver is also prone to developing cancer cells, which pose a significant threat to life.

Liver cancer ranks as the fifth most common cancer in Hong Kong. In 2022, there were 1,612 new cases of liver cancer, accounting for 4.6% of all new cancer cases in the city. The crude incidence rate was 22 new cases per 100,000 people in Hong Kong. Additionally, liver cancer is the third most fatal cancer locally, causing 1,412 deaths in 2022, which represents 9.6% of all cancer-related deaths. Men are predominantly affected by liver cancer, with a male-to-female incidence ratio of approximately 2.7 to 1 in 2022.

Treating liver cancer is relatively challenging, primarily because patients are often diagnosed at intermediate or advanced stages, which significantly impacts cure rates. Data show that the overall five-year relative survival rate for liver cancer patients is 29.5%. Therefore, prevention is better than cure. The public is advised to receive the hepatitis B vaccine, and individuals who are hepatitis B carriers should undergo regular follow-ups to detect liver tumors early.

For primary hepatoma, tumours originate from mutations in the DNA of liver cells, causing uncontrolled cell growth. Chronic hepatitis infections cause some genetic mutations, while the causes of others remain unclear and warrant further study. However, the medical community generally recognises the following factors as having a higher risk of cancer:

  • Hepatitis B Virus: This is the cause of over half of hepatoma cases worldwide, with individuals carrying this virus being about 100 times more likely to develop hepatoma than others.
  • Liver Cirrhosis: This disease can develop approximately 20 years after having hepatitis B and also increases the risk of hepatoma, typically after about 30 years.
  • Hepatitis C: Patients with chronic hepatitis B and C have a 150 times higher likelihood of developing hepatoma, and this is more common in Europe and America.
  • Alcohol Abuse: Chronic and excessive alcohol consumption can lead to liver cirrhosis, which may then develop into hepatoma, doubling the risk of hepatoma.
  • Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Fatty Liver: These conditions, which may arise from obesity, diabetes, or other metabolic disorders, can harm the liver and lead to cirrhosis or hepatoma.
  • Consumption of Toxic Foods: Foods like peanuts and grains can contain aflatoxin, which has been proven to cause hepatoma.
  • Long-term Exposure to Pollutants: Prolonged contact with substances like polyvinyl chloride can damage liver health.

Symptoms of Hepatoma

Common Liver Cancer Symptoms: Warning Signs of Dull Pain in Upper Right Abdomen and Weight Loss

The liver can regenerate; even when a significant portion loses functionality, it can still operate normally. While this benefits the body, hepatoma patients may not exhibit noticeable symptoms. Early-stage hepatoma typically shows no apparent signs, and discomfort only arises when the tumour grows to a specific size. Related symptoms include pain in the upper right abdomen, shoulder pain, loss of appetite, sudden weight loss, nausea, a lump in the upper abdomen, jaundice (yellowing of the skin and eyes), dark urine, pale stools, and abdominal swelling. If any of these symptoms persist or worsen, it is crucial to seek medical attention promptly.

Common Diagnostic Methods

Liver Cancer Diagnosis Methods: Ultrasound and AFP Tumor Marker Tests

If a doctor suspects a patient has hepatoma, various methods will be employed for further examination. General diagnostic approaches include:

  • Biopsy: The patient undergoes local anaesthesia, after which the doctor inserts a thin needle into the right abdomen to extract a small tissue sample from the liver, which is then sent to a laboratory for analysis to determine the type of tumour.
  • Serum Alpha-Fetoprotein Test: The alpha-fetoprotein level in the blood is a cancer marker; when hepatoma cells proliferate, this level increases significantly.
  • Abdominal Ultrasound: The doctor uses ultrasound to obtain images of the liver’s structure to locate and size the tumour.
  • CT Scan: The doctor takes X-ray images of the liver from various angles to obtain more detailed pictures, analysing the tumour’s location and size. The patient may need to drink a special contrast agent to enhance the visibility of the organs during the scan.
  • Angiography: Similar to the methods above, a contrast agent is injected into the patient’s blood vessels, and X-rays are used to observe the flow of blood containing the contrast agent, helping to pinpoint the exact location of cancer cells and the blood vessels supplying them.

After conducting these examinations, the doctor assesses the stage of hepatoma based on factors such as the location, size, and extent of the cancer cells’ spread. Generally, hepatoma can be classified into stages I through IV:

StageDescription
IAThe tumour diameter does not exceed 2 cm and has not yet invaded blood vessels or spread to nearby lymph nodes.
IBTumour diameter exceeds 2 cm but has not yet invaded blood vessels or spread to nearby lymph nodes.
IIA single tumour larger than 2 cm has invaded blood vessels, or multiple tumours not exceeding 5 cm in diameter, with neither spreading to lymph nodes nor other tissues.
IIIAMultiple tumours, with at least one larger than 5 cm, but still not spread to lymph nodes or other distant tissues.
IIIBAt least one tumour of any size has invaded the prominent hepatic veins but has not spread to lymph nodes or other distant tissues.
IVAOne or more tumours of any size have spread to nearby lymph nodes but have not further spread to other distant tissues.
IVBOne or more tumours of any size may not have invaded lymph nodes but have spread to other locations, such as the bones or lungs.

Primary Treatment Methods

Liver Cancer Treatment Methods: Surgical Resection and Embolization Therapy Options

Once doctors clearly understand the patient’s condition, they can select the most appropriate treatment method. Compared to other types of cancer, hepatoma treatment methods are relatively diverse and can be broadly categorised as follows:

  • Surgical Resection: This is the most direct method for addressing cancer cells, involving the removal of the tumour along with nearby damaged tissue. This approach is suitable for patients whose tumours affect only one lobe of the liver and whose liver function remains normal. According to Hospital Authority data, the 3-year and 5-year survival rates for patients undergoing surgery are 62% and 50%, respectively.
  • Alcohol Injection: Once the tumour’s location is confirmed, the doctor injects high-concentration alcohol (up to 95%) directly into the tumour site. This concentrated alcohol dehydrates the cancer cells, effectively destroying them. This method is only applicable for tumours not exceeding 3 cm in diameter or no more than three tumours, and the alcohol only kills the central part of the tumour, so that multiple treatments may be necessary.
  • Radiofrequency Ablation: The doctor heats the area near the tumour to over 60 degrees Celsius, causing the tumour tissue to necrose.
  • Liver Transplant: This method is generally suitable for patients with severely impaired liver function, provided their tumours are not 5 cm in diameter. If the tumour is too large, it indicates that cancer cells may have spread to other areas, and performing a transplant might allow the cancer cells to proliferate in the new liver, leading to recurrence.
  • Transarterial Chemoembolization (TACE): If the doctor identifies the blood vessels supplying nutrients to the tumour, drugs can be infused through the patient’s arterial catheter and block that vessel, preventing the tumour from growing further or even causing it to die, without affecting surrounding healthy tissue. This method is suitable for tumours that have spread to both lobes of the liver but have not metastasised to other organs.
  • Radiation Therapy: One of the main radiation treatments for hepatoma is radioembolisation, which involves injecting radioactive microspheres through the patient’s blood vessels into the hepatic artery of the tumour, delivering short-range radiation to kill cancer cells while minimising damage to normal liver function.
  • Targeted Therapy: Sorafenib is currently the only FDA-approved targeted drug for hepatoma patients, reducing blood flow within tumours. However, patients should be aware that sorafenib can produce toxic effects, potentially leading to skin conditions, hypertension, gastrointestinal discomfort, and other side effects.

Healthy Living

Post-Liver Cancer Surgery Care: Liver Function Maintenance and Recurrence Monitoring

The patient’s condition should significantly improve after completing the treatment plan under the doctor’s guidance. However, patients should pay close attention to their daily details during recovery to ensure optimal treatment effectiveness. For example, patients can increase their intake of foods rich in protein and vitamins, such as milk, eggs, fruits, and vegetables, while limiting animal fats. Additionally, patients should steer clear of tobacco and alcohol; those with smoking or drinking habits should quit promptly. Most importantly, regular follow-up appointments are essential, and any unusual symptoms should be reported to a doctor for professional advice.

Prevention Methods

Hepatoma Prevention

Addressing the risk factors mentioned above, the following measures can help prevent future hepatoma:

  • Refusing to smoke or quitting smoking and moderating alcohol consumption.
  • If family members have hepatitis B, they should undergo blood tests early and ensure vaccination against hepatitis B.
  • Practising safe sex and avoiding sharing needles to prevent transmission of hepatitis B or C through bodily fluids.
  • Properly storing food to prevent mould or spoilage, which can produce aflatoxin.

Frequently Asked Questions

Hepatoma FAQs

What is the difference between hepatoma and cholangiocarcinoma?

Hepatoma refers to cancer cells growing in the liver, which can be subdivided into various types, including primary hepatoma and intrahepatic cholangiocarcinoma. Intrahepatic cholangiocarcinoma is a type of cholangiocarcinoma, while another type, hilar cholangiocarcinoma, grows at the junction of the liver’s bile ducts.

Are peanuts and grains that contain aflatoxin completely unsuitable for consumption?

Many crops can potentially contain aflatoxin, including peanuts, corn, and tree nuts, and it is not feasible to eliminate aflatoxin from food. However, storing food in a cool, dry place can prevent it from moulding and becoming contaminated with aflatoxin. If you are at high risk for liver disease, it is advisable to avoid foods that may contain aflatoxin.

What should I do if I notice early signs of hepatoma?

Some symptoms of hepatoma, such as loss of appetite, nausea, and jaundice, are not unique to hepatoma and may be caused by other health issues. Therefore, if you notice these symptoms, pay attention but do not panic; if the symptoms persist or worsen, seek medical attention promptly.

What should I pay attention to after being diagnosed with hepatoma?

First, try to maintain a positive and calm mindset, following your doctor’s instructions for treatment while understanding that the side effects after treatment are typical. Excessive anxiety will not contribute positively to your condition. Communicate with family, friends, or social workers to help them understand your needs.

Second, while undergoing treatment, maintain good personal habits, including moderate exercise and avoiding tobacco and alcohol, to improve your immunity and reduce the risk of cancer recurrence.

Is the recurrence rate for hepatoma high?

The recurrence rate largely depends on the individual patient. As mentioned above, if a patient has hepatitis B or C or is at high risk for hepatitis, or has a long history of smoking, drinking, or consuming aflatoxin, even after recovering from hepatoma, they still face a higher risk of recurrence. Therefore, maintaining healthy lifestyle habits and regular follow-up appointments is crucial for monitoring recovery or recurrence.

*Sources: 

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▣ The information on this website has been reviewed by the HEAL Medical Team and is regularly updated according to the most recent clinical evidence. All content is provided for general informational purposes only and should not replace professional medical advice. Please consult your doctor or another qualified healthcare professional for personalized medical guidance.

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