Guide To Liver Cancer In Singapore

The liver is the largest internal organ in the body. It sits on the upper right side of the abdomen and carries out functions that are vital for life, such as producing essential proteins, processing nutrients, and detoxification. Liver cancer in Singapore is a common cancer among men. It is also a common disease throughout Southeast Asia, China, Japan and Korea.

Cancer in the liver is “primary” when it starts in the liver. On the other hand, if the cancer is referred to as ‘secondary’, it means that it had spread (metastasised) to the liver from another area of the body (such as the lung, colon or breast). Cancer that spreads to the liver is more common than cancer that begins in the liver cells. Types of liver cancer include:

• Hepatocellular Carcinoma (HCC) or hepatoma, is the most common type of primary liver cancer. It begins in the main cell type in the liver, the hepatocytes.
• Intrahepatic Cholangiocarcinoma, or Bile Duct Cancer, begins in the cells lining the bile ducts (which link the liver to the bowel and gall bladder).
• Angiosarcoma and Hemangiosarcoma, are cancers which start in the blood vessels of the liver.
• Hepatoblastoma is a very rare type of cancer that develops in children, usually those younger than 4 years old.
• Secondary cancers of the liver are named and treated based on its primary site (i.e. where it started). For instance, cancer that started in the lung and spread to the liver is called metastatic lung cancer, not liver cancer. Treatment given will also be as for lung cancer.

Learn More: Liver, Pancreas And Gallbladder Conditions In Singapore >>

Liver Cancer Singapore Statistics

The latest Singapore Cancer Registry (2022 Annual report) indicates that liver cancer in Singapore is the 5^th most common cancer among men, accounting for 7.1% of cancers diagnosed (2018-2022). It is not a top 10 most common cancers for women. Only 11.4% of liver cancers in males were diagnosed at Stage I during the period 2003 – 2007. This improved to 36.1% for the period 2018 – 2022. The Cancer Registry did not provide corresponding statistics for females.

Liver cancer is the 3rd most common cause of cancer deaths in men for 2018-2022, responsible for 12.3% of all cancer deaths. In women, it is the 5^th most common type of cancer resulting in death (5.8%).

Causes Of Liver Cancer & Risk Factors

HCC (the most common type of liver cancer in adults), typically develops in patients who suffer from chronic liver disease. This may in turn by caused by hepatitis virus infection, or liver cirrhosis.

Risk factors are behaviors, conditions, or substances that can make you more likely to develop a disease. The following are risk factors of liver cancer that you should watch out for:

• Sex – men are more likely than women to develop HCC.
• Being overweight or obese.
• Having a long-term hepatitis B virus or hepatitis C virus infection.
• Smoking cigarettes.
• Excessive alcohol consumption.
• Having cirrhosis (scarring of the liver, which can also be caused by hepatitis and alcohol use).
• Having nonalcoholic fatty liver disease (extra fat in the liver that is not caused by alcohol).
• History of type 1 or 2 diabetes.
• Having inherited conditions such as hemochromatosis, a condition where the body takes up and stores more iron than it needs, or Wilson’s disease.
• Eating foods that have aflatoxin (a fungus that can grow on foods, such as grains and nuts that have not been stored properly).

Having these risk factors doesn’t mean you will certainly develop liver cancer, but these factors do increase your risk of developing it. If you are worried about your risk factors or symptoms, consult with your doctor for advice.

Symptoms Of Liver Cancer

Most people do not present symptoms in the early stages of liver cancer. Symptoms do appear, however, as the cancer grows or becomes advanced. The following are the possible symptoms of liver cancer as the cancer progresses:

• An abdominal mass or lump on the right side just below the rib cage.
• Discomfort or pain in the upper abdomen on the right side.
• Swollen abdomen caused by fluid build-up (ascites).
• Pain near the right shoulder blade or in the back.
• Jaundice (yellowing of the skin and whites of the eyes).
• Easy bruising or bleeding.
• Unusual tiredness or weakness (fatigue).
• Nausea and Vomiting.
• Loss of appetite or feelings of fullness after eating a small meal.
• Unexplained weight loss.
• Pale, chalky bowel movements and dark urine.
• Fever.

Rare Symptoms

Some liver cancers secrete hormones that can cause additional symptoms. These may include low blood sugar (hypoglycemia)  that can result in lightheadedness and fainting, especially in people who fasted; breast enlargement (gynecomastia); testicular atrophy; and a high red blood cell count.

Screening And Prevention

Tests that examine the liver and the blood are used to detect liver cancer. Diagnostic tests for liver cancer may include one or more of the following:

• Physical exam and health history: A physical exam of the body will be done to assess a patient’s health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, family history, past illnesses, and treatments will also be taken.
• Blood tests: Blood tests may expose liver function abnormalities. These liver function tests measure the amounts of certain substances released into the blood by the liver. An above-normal amount of a substance may be a sign of liver cancer.
• Imaging tests: Your doctor may order imaging tests, such as an ultrasound, CT scan, and MRI.
• Alpha-fetoprotein (AFP) tumor marker test: Tumor markers are released into the blood by organs, tissues, or tumor cells in the body. An increased level of AFP in the blood may be a sign of liver cancer. Other cancers and some non-cancer-related conditions, including cirrhosis and hepatitis, may also increase AFP levels.
• Biopsy: During a biopsy, cells or tissues are removed so they can be viewed under a microscope by a pathologist to check for signs of cancer. After liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body. The process of determining the size and location of the cancer and whether it has spread is called staging. Some of the diagnostic procedures used to diagnose liver cancer, such as CT scan and MRI, may be used in the staging process. In addition, a positron emission tomography (PET) scan may also be used.

Liver Cancer Screening

The following tests and procedures may be performed to screen for, or to diagnose liver cancer:

• Physical examination: The doctor checks the abdomen hard masses, fluid accumulation, and other signs of liver disease.
• Blood tests: An alpha-fetoprotein (AFP) tumour marker blood test may be carried out. AFP in the blood can be elevated for people with liver cancer.
• Liver ultrasound: Ultrasound scan of the liver may reveal the presence of a tumour.
• Computed tomography (CT) or magnetic resonance imaging (MRI): The medical imaging scans help doctors to visualise the three-dimensional picture of the liver and the surrounding organs. It can reveal the position and size of a tumour, and if it has spread beyond the liver.
• Liver biopsy: A tissue sample is removed via a biopsy needle and examined under a microscope. It is not be a procedure of choice as it may result in bleeding and increases risk of spreading the tumour.

Liver Cancer Treatments

Treatments for primary liver cancer depend on the stage of the disease as well as the age, overall health, and personal preferences of the patient. Often a combination of therapies is used for a better outcome.

The main treatment options include:

• Tumor ablation

Radiofrequency ablation uses electric current to heat and destroy cancer cells.

• Radiation therapy

This treatment uses high-powered energy from sources such as X-rays and protons to destroy cancer cells and shrink tumors.

• Chemotherapy

Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. If your liver cancer has spread or you have secondary cancer, chemotherapy may be given through a vein to treat the whole body. This form of treatment also affects healthy cells.

• Surgery

In partial hepatectomy (surgery to remove the part of the liver where cancer is discovered) a wedge of tissue, an entire lobe, or a larger part of the liver, along with some of the healthy tissue around it is removed. The remaining liver tissue takes over the functions of the liver and may regrow.

• Liver transplant

In a liver transplant, the entire liver is surgically removed and replaced with a healthy donated liver. A liver transplant may be done when the disease is in the liver only and a donated liver can be found. If the patient has to wait for a donated liver, another treatment is given as needed.

• Embolisation therapy

Embolisation therapy is the use of substances to block or decrease the flow of blood through the hepatic artery to the tumor. When the tumor does not get the oxygen and nutrients it needs, it will not continue to grow.

There are two main types of embolisation therapy:

• Transarterial embolisation (TAE): A small incision (cut) is made in the inner thigh and a catheter (thin, flexible tube) is inserted and threaded up into the hepatic artery. Once the catheter is in place, a substance that blocks the hepatic artery and stops blood flow to the tumor is injected.
• Transarterial chemoembolisation (TACE): This procedure is like TAE except an anticancer drug is also given.

Cost Of Liver Cancer Treatments And Screenings

The estimated cost in Singapore for liver cancer blood test and medical imaging is:

• AFP Tumour Marker Blood test – S$20.
• Ultrasound (Liver) – S$120-S$140.
• MRI (Abdomen) – S$1,300-S$1,400.
• CT Scan (Multiphasic Liver) – S$800 – S$1,100.

With regards to the cost of treatment, MOH recommends the following range of fees for surgeons as of 1 Jan 2025 (excluding anaesthetist, facilities and consumables fees):

• Liver Transplant, Donation (Live Donor) (TOSP: SF701L): S$18,800 – S$26,500.
• Liver Transplant, Recipient (TOSP: SF702L): S$22,400 – S$33,600.
• Liver, Various Lesions, Lobectomy (3 – 4 Segments) (TOSP: SF812L): S$17,400 – S$24,800.

Survival Rate

The 5-year Age-Standardised Relative Survival Rate (ASRS) for liver cancer for 2018 – 2022 is low, at 26.8% for males. However, there has been substantial improvement over years. The ASRS for 1998- 2002 was just 9.5%. The Cancer Registry did not provide corresponding statistics for females.

Contact Us For An Appointment

If you have concerns about your liver health or are experiencing symptoms, we can help with getting an appointment to see a liver specialist. Contact us via the button below.

.

FAQs

What are the symptoms of liver cancer?

Liver cancer often does not have symptoms in the early stage. Most of its are similar to those of other health conditions. Symptoms might include:

Upper abdominal pain .

• Abdominal swelling.
• Nausea and vomiting.
• Jaundice.
• Pale stools.
• Unintended weight loss. 

What causes liver cancer?

Causes of primary liver cancer include:

• Chronic hepatitis B or hepatitis C infection
• Liver cirrhosis due to excessive alcohol consumption.
• Inherited liver conditions, non-alcoholic fatty liver disease, and exposure to certain chemicals or toxins.

What are the risks from liver resection surgery?

Liver resection surgery may result in complications. Severe complications are rare. They include the possibility of liver failure, liver abscess & infection, bleeding, blood clots, bile leakage and pneumonia.

Related Content

Cost Of Liver Cancer Screening & Treatment In Singapore

Liver Cancer Screening In Singapore: What You Need To Know

How To Find The Best Liver Surgeon In Singapore

.