Researchers at NUH harness the pinpoint precision of
blood-based biomarkers for the early detection and treatment of
hepatocellular carcinoma, one of the world’s deadliest cancers.
Issue 6 | September 2024
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Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, is the third-leading cause of cancer-related death worldwide — yet its detection remains challenging. Predominantly caused by chronic liver conditions such as severe scarring (cirrhosis), fatty liver disease and hepatitis B, HCC often presents no symptoms in its early stages. This frequently leads to late-stage diagnoses, in which the prognosis is grim, with fewer than 20 per cent of patients surviving beyond five years.
While hepatitis B is currently the leading cause of HCC in Singapore, Dr Daniel Huang, Consultant at the Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital (NUH), and his team have shed light on an emerging trend. Fatty liver disease is rapidly becoming a significant contributor to HCC, with Southeast Asia experiencing the highest prevalence. “In Singapore, the incidence of fatty liver-related liver cancer is projected to increase by 100 per cent between 2020 and 2030,” says Dr Huang.
Current detection methods are struggling to keep pace with the evolving landscape of HCC aetiology — underscoring the urgent need for a shift in screening strategies. To this end, Dr Huang and his team are developing blood-based biomarkers that offer a more effective, personalised approach to screening, which could ultimately improve outcomes for those at risk.
Personalised care for early detection
Personalisation is at the core of the team’s approach. “The traditional focus on cirrhosis as the primary indicator for HCC screening is increasingly inadequate, especially given the rising incidence of HCC linked to fatty liver disease,” says Dr Huang. “Nearly 40 per cent of HCC cases associated with fatty liver occur in the absence of cirrhosis — this means many patients are at risk of being overlooked.”
To address this, Dr Huang is turning to blood-based biomarkers, which refine the screening process by enabling the stratification of patients based on their risk level for developing liver cancer. “Specific molecular signatures in the blood that risk stratify people with fatty liver disease into those with a high risk of developing liver cancer and those without will help to save lives and healthcare costs” says Dr Huang. “This will allow us to identify high-risk individuals more precisely, facilitating earlier intervention and potentially curative treatments.”
The shortcomings of the current screening process extend beyond an over-reliance on cirrhosis. The limited visibility provided by ultrasound imaging, particularly in patients with fatty liver disease, has prompted Dr Huang’s team to explore the use of simplified MRI, which has proven more accurate and cost-effective.
In addition to improving the screening process, Dr Huang’s team has also uncovered substantial risks of HCC among individuals who do not meet the current hepatitis B treatment criteria. By expanding the eligibility for antiviral treatment, his team demonstrated a 70 per cent reduction in HCC risk — this work contributed to an expansion of the World Health Organisation’s guidelines on hepatitis B treatment in 2024.
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