Hepatocellular Carcinoma

2024/05/20

What is Hepatocellular Carcinoma?

Hepatocellular Carcinoma (HCC) is a cancer arising from liver cells (hepatocytes).

In terms of cancer deaths in Singapore, HCC was ranked third amongst men and fourth amongst women during the period of 2011-2015.

Symptoms

HCC Symptoms

Most patients with HCC do not have any symptoms especially in the early stage of the disease. In the later stages, patients may develop jaundice, confusion, bleeding tendencies or fluid in their abdomen known as ascites.

What are the risk factors associated with HCC?

The most common risk factor for HCC in Singapore is being a Hepatitis B virus carrier. Other risk factors include any cause of liver cirrhosis including non-alcoholic fatty liver disease, chronic alcohol dependence, chronic hepatitis C virus infection, autoimmune hepatitis and primary biliary cirrhosis. There is also increasing evidence that obesity and diabetes may be risk factors for cirrhosis.

Is there a way for earlier detection of HCC in the absence of symptoms?

It is possible to detect HCC early in the absence of symptoms. Patients with risk factors for HCC should undergo screening every six months using ultrasound of the liver and by undergoing a liver tumour blood test (alpha-fetoprotein).

Ultrasound of the liver

Diagnosis

Diagnosis of HCC can usually be made using CT or MRI scans. In a small proportion of cases, a liver biopsy may be needed to establish a diagnosis.

CT or MRI scans

Treatment (provided by NUH)

There are now several curative treatment modalities for HCC in selected patients. These include radiofrequency ablation (RFA), surgery and liver transplantation. There are also a host of other treatment modalities used in more advanced stages of HCC including transarterial chemoembolisation (TACE), Yttrium-90 radioembolisation (Y-90), stereotactic body radiation therapy and molecular targeted therapies such as sorafenib, regorafenib and levantinib as well as immunotherapy. In addition, there are numerous clinical trials available for patients with advanced stage HCC.

Surgical Resection

Surgery is suitable for patients with early stage HCC and well preserved liver function who would tolerate a proportion of their liver being removed.

Liver Transplantation

Patients transplanted for early to intermediate stage HCC have five year survival rates exceeding 73%. Liver transplantation not only provides a cure for HCC but also for the underlying liver disease.

Radiofrequency Ablation (RFA)

RFA is suitable for patients with small to intermediate size HCCs. A small electrode needle is inserted into the tumour through a small puncture in the skin. An electric current passed through the electrode allows complete ablation of the tumour.

Radiofrequency Ablation (RFA)

Transarterial Chemoembolisation (TACE)

TACE is a minimally invasive procedure performed by experienced radiologists under X-ray imaging. An injection at the groin or wrist is administered to allow the insertion of a small-calibre tube into the blood vessel(s) supplying the liver cancer cells, to deliver chemotherapeutic medication to the cells. Thereafter, these blood vessel(s) supplying the liver cancer will be blocked to deprive the cancer cells of blood supply and induce its death.

Transarterial Chemoembolisation (TACE)

Yttrium-90 Radioembolisation (Y-90)

Y-90 is a technique whereby radioactive beads are deployed into the tumour via a blood vessel. The radioactive beads emit low-energy radioactivity that kills the tumour.

Molecular targeted therapy

Many targeted therapeutic agents such sorafenib, regorafenib and levantinib are available for patients with advanced stage HCC to prolong their lives.

Immunotherapy

This group of medications will assist our body immune system to target and control HCC tumour cells.

Follow-up after treatment

Patients treated for HCC are followed-up on a regular basis for surveillance of any tumour recurrence.

When to seek medical advice

You should seek medical advice if you have:

1) A family history of liver cancer

2) Liver cirrhosis

3) Chronic hepatitis B

4) Any chronic liver disease (e.g. fatty liver disease, hepatitis C)

5) An elevated alpha-feto protein (tumour marker)