Liver cancer is the 4th most common cancer among men in Singapore, accounting for 7.4% of cancers diagnosed between 2015-2019, according to data from the Singapore Cancer Registry 2019 report. This article looks at how liver cancer is diagnosed, and options for liver cancer treatment in Singapore.

Diagnosis of Liver Cancer

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 primary 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. A positron emission tomography (PET) scan may also be used.

PET scan: This procedure is done to locate malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

Treatment of Liver Cancer in Singapore

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.

Worried About Cancer Treatment Costs in Singapore?

With the possibility of having to pay upwards of $100,000 per year for treatment of late stage cancer in Singapore, it is no surprise that many people may be concerned about the financial impact of getting cancer. Cancer insurance is a cost-effective way of protecting yourself financially in case cancer strikes. Learn more about how cancer insurance can shield you from the impact of cancer treatment costs in our article here.