Liver Cancer Treatment and Diagnosis in Singapore
What are the Liver Cancer Treatments in Singapore?
Depending on your specific medical condition, different treatments may be prescribed for patients with liver cancer (hepatocellular carcinoma), biliary (bile-duct) cancer (cholangiocarcinoma), or other associated cancers of the gall-bladder, and surrounding organs. The types of treatments recommended normally depend on the stage of the cancer, extent of metastasis (i.e spreading to other organs) and the patient’s health condition. Your medical oncologist may prescribe different hepatobiliary treatment regimes such as surgery, tumour ablation, chemotherapy, targeted cancer therapy, and radiotherapy.
Hepatobiliary Cancer Treatment: Surgery
Surgery is the treatment of choice for patients with early stage liver cancer because it has a high probability of treating hepatobiliary cancer, especially if only parts of the liver are affected with cancer.
For more severe cases where a greater part of the liver is cancerous, a liver transplant may be recommended. A liver transplant is a type of surgery where the liver is removed and replaced with a healthy, donated liver. Transplant surgery may only be considered if the cancer is contained within the liver, if a donor liver is available, and if the medical team believes the cancer is likely to be eliminated by surgery. Anti-rejection drugs (immunosuppressants) are used to prevent organ rejection after the liver transplant.
Hepatobiliary Cancer Treatment: Radiation Therapy
In radiation therapy, high-energy rays are used to destroy cancer cells and prevent them from growing. External radiotherapy uses a machine outside the body to direct radiation towards cancer cells. This type of treatment is not commonly used to treat liver cancer because the liver cannot tolerate high doses of radiation.
Another method is internal radiation, where radioactive substances are implanted to the cancer infected area through the hepatic artery—a blood vessel that carries blood to the liver.
Hepatobiliary Cancer Treatment: Chemotherapy
Chemotherapy uses anti-cancer drugs to kill hepatic cancer cells and prevent them from dividing and growing. Chemotherapy can also help control symptoms by shrinking the cancer or slowing its growth. The drugs are usually given to patients as injections into veins, although they can sometimes be given as tablets.
Chemotherapy may also be given as part of a treatment called chemoembolization. This involves the injection of chemotherapy drugs directly into the liver cancer, together with a gel or tiny plastic beads to block blood flow to the cancer.
Hepatobiliary Cancer Treatment: Targeted Therapy
Targeted therapy uses drugs that prevent the growth and spread of cancer by interfering with specific molecules involved in cancer development. This drug targets liver, gall-bladder, or bile-duct cancer cells by stopping them from growing their own blood vessels. Since cancer cells need blood supply to receive nutrients and oxygen, this may limit the cancerous cell’s ability to grow.
Hepatobiliary Cancer Treatment: Tumour Ablation
Tumour ablation is a specific regimen that destroys primary liver cancer cells using either heat or alcohol. During the procedure, a computed tomography (CT) helps doctors by guiding a needle into the liver. A local anaesthetic is given to patients at the beginning of the procedure to alleviate pain.
There are 2 types of tumour ablation treatments, Radio Frequency Ablation (RFA) and Percutaneous Ethanol Injection (PEI).
- RFA treatment uses laser light or radio waves passed through the needle to destroy cancer cells by heating them to a very high temperature.
- PEI treatment uses alcohol injected through the needle into the cancer to destroy the cancer cells.
Are there any Side Effects of Hepatobiliary Cancer Treatment?
Side Effects of Hepatobiliary Cancer Treatment: Surgery
Experiencing pain is a common side effect of surgery, however discomfort can be managed with prescribed medication and the use of anesthesia.
Side Effects of Hepatobiliary Cancer Treatment: Radiation Therapy
The side effects of radiation therapy include nausea and vomiting, diarrhea, tiredness, hair loss, and skin changes.
Side Effects of Hepatobiliary Cancer Treatment: Chemotherapy
The side effects of chemotherapy commonly include the following:
- Nausea and vomiting
- Diarrhea
- Constipation
- Tiredness
- Pain
- Loss of appetite
- Hair loss
- Skin and nail changes
- Numbness and tingling
- Swelling
Side Effects of Hepatobiliary Cancer Treatment: Targeted Therapy
The side effects of targeted therapy may include nausea and vomiting, diarrhea, constipation, swelling of hands and feet, rash and other skin changes, and vision problems.
Side Effects of Hepatobiliary Cancer Treatment: Ablation Therapy
The side effects of ablation therapy are varied and may include:
- Abdominal pain
- Infection in the liver
- Fever
What do I need to do if I have Hepatobiliary Cancer?
If you suspect that you or your loved one have liver or bile-duct cancer, it is advisable to get the support you need. Early detection, diagnosis, and treatment of liver cancer is key to treating the disease.
Regardless of what stage your hepatobiliary cancer may be, you should schedule an appointment to see an oncologist specialising in hepatobiliary cancer as soon as possible. With the speed of developments in hepatobiliary cancer diagnosis and treatment, novel emerging treatment options could be explored by your medical oncologist.
Our liver cancer specialists at OncoCare specialise in treating late stage and advanced stages of hepatobiliary cancer, as well as earlier stages of the disease in Singapore.
Oncologists at OncoCare with Clinical Interests in Hepatobiliary Cancers
OncoCare is the leading liver cancer care provider. Our oncologists have extensive experience in diagnosing and treating all types of hepatobiliary cancers, including liver, pancreatic, and bile duct cancer as well as other cancers such as breast, cervical, ovarian, lung, and colon cancer. We offer a comprehensive range of services and treatments, including surgery, chemotherapy, radiation therapy, and targeted therapy.
Dr Akhil Chopra
Senior Consultant, Medical Oncologist
MBBS (Delhi) – American Board Certified (Int Med) – American Board Certified (Hematology) –
American Board Certified (Med Oncology)
Before joining OncoCare Cancer Centre at Mount Elizabeth Hospital, Singapore, Dr Akhil Chopra was a Senior Consultant in Medical Oncology at Johns Hopkins Singapore, Tan Tock Seng Hospital and Adjunct Associate Professor at Lee Kong Chian School of Medicine.
Dr Chopra has experience treating multiple cancer types including breast cancer, lung cancer, cancers of stomach, colon, rectum, liver, prostate, kidney, testicular and bladder, gynaecological cancers such as ovarian and uterine/cervical cancers; as well as lymphomas and chronic leukaemia/multiple myeloma. Besides his clinical and research work, he has been involved in teaching medical students from the Lee Kong Chian School of Medicine as well as medical residents and students from Johns Hopkins University, Baltimore in USA.
- Graduated from Delhi in 2001
- American Board Certified, Internal Medicine
- American Board Certified, Medical Oncology
- American Board Certified, Hematology
- Fellowship Training at Hahnemann University Hospital/Drexel University College of Medicine in Philadelphia, USA
Cancer Specialities: breast cancer, lung cancer, cancers of stomach, colon, rectum, liver, prostate, kidney, testicular and bladder, gynaecological cancers such as ovarian and uterine/cervical cancers
Dr Benjamin Chuah
Senior Consultant, Medical Oncologist
MBBCH, BAO (Ireland) – MRCP (United Kingdom) – FRCP (Edinburgh) – FRCP (Medical Oncology)
Prior to entering private practice, Dr Benjamin Chuah was actively involved in post-graduate teaching as well as research. He was the principal or co-investigator in international trials involving the use of novel and targeted therapy drugs for colorectal and pancreatic cancer. His research work includes small cell gallbladder cancer with paraneoplastic hyponatremia and has led to several 1st author publications in high impact medical and oncology journals including Gastroenterology, GUT and Annals of Oncology.
Dr Chuah has also held the position of Director for Postgraduate Medical Education (Medical Oncology) and was a Core Faculty member for the Residency Program (Internal Medicine). He was awarded the National University Hospital Postgraduate Teaching Excellence Award in 2011. In addition, he was awarded the NUH Innovative Grant for research in warfarin pharmacogenomics and honoured with the inaugural Kobayashi Foundation Award for work done on serial changes in the expression of breast cancer-related proteins in response to neoadjuvant chemotherapy.
- Graduated from Trinity College, University of Dublin, Ireland in 1998
- MRCP (UK), Royal Colleges of Physicians of the United Kingdom, 2002
- Awarded the Professor’s Prize in Physic (Surgery) 1998, Arthur Ball Prize (2nd place) 1998, NUH Innovative Grant 2007, the Kobayashi Foundation Award 2010 and NUH Postgraduate Teaching Excellence Award 2011
- Director of Post Graduate Medical Education (Medical Oncology) and Core Faculty for the Residency Program (internal Medicine) at National University Hospital
Cancer Specialities: Gastrointestinal Cancers including oesophageal, gastric, biliary tract, pancreatic, liver (hepatocellular carcinoma), neuroendocrine cancers and colorectal cancers
Dr Thomas Soh
Senior Consultant, Medical Oncologist
MBBS (Singapore) – MRCP (United Kingdom)
Dr Soh believes in the delivery of quality healthcare, and was the lead and co-lead in several healthcare improvement projects. He has received multiple awards for his involvement in the Clinical Practice Improvement Programmes which he implemented at NUH. Between 2013-2015, he served as Honorary Secretary of the Executive Committee, Singapore Society of Oncology.
He is actively involved in both research and education in cancer medicine. His research focuses on colorectal cancer, chemotherapy drugs Regorafenib, FOLFIRI regimen (irinotecan, 5-fluorouracil and folinic acid). He was the principal investigator in several multi-centre gastrointestinal cancer clinical trials and his research has led to over 10 publications in high impact medical and oncology journals.
- Graduated from the National University of Singapore in 2003
- Obtained Membership of the Royal College of Physician (United Kingdom) in 2007
- Awarded Teaching Excellence Award in 2014, NCIS
- Awarded NUH UMC Undergraduate Teaching Best Tutor Award in 2015
- Research funding from the National Medical Research Council (NMRC), Singapore, being awarded the Clinical Investigator Salary Support Program (CISSP) award 3 times
- Research work was published in more than 10 publications relating to hepatocellular carcinoma, colorectal cancer, pancreatic cancer and other gastrointestinal cancers.
- Sub-specialty oncology interest in gastrointestinal (oesophageal, stomach, colon and rectal cancers) and hepatobiliary cancers (liver, pancreas, bile duct and gallbladder cancers)
Cancer Specialities: Gastrointestinal (oesophageal, gastric, colon and rectal cancer) and Hepatobiliary Cancer (liver, pancreas, bile duct and gallbladder cancers)
What is Hepatobiliary Cancer?
Definition of Hepatobiliary Cancer
Hepatobiliary cancers are cancers that appear in the liver, gallbladder, bile ducts or bile. They normally occur as tumours on these organs. Also known as hepatocellular carcinomas (HCC), liver cancer affects about one million people globally each year.
What are the Signs and Symptoms of Hepatobiliary Cancer?
The most common symptoms of hepatobiliary cancer are:
Many people do not show any signs or symptoms of hepatobiliary cancer, especially in the early stages of primary liver cancer.
When signs and symptoms appear, they normally include:
- Weight loss
- Loss of appetite
- Upper abdominal pain
- Nausea and vomiting
- General weakness and fatigue
- Abdominal swelling
- Yellow discoloration of skin and eyes (jaundice)
- White, chalky stool
Screening for Hepatobiliary Cancer
Screening is normally used to diagnose cancer before patients experience any signs or symptoms. The goal of cancer screening is to:
- Lower the number of people who lose their lives from hepatobiliary cancer
- Lower the number of people who develop hepatobiliary cancer
People with conditions like Hepatitis B, Hepatitis C, or Liver Cirrhosis may be at an increased risk for liver cancer and are advised to consider screening.
Hepatobiliary cancer screening tests include:
Screening options for hepatobiliary cancer include testing your blood for a substance called alpha-fetoprotein (AFP), which may be produced by cancer cells, or having imaging tests like an ultrasound, computed tomography (CT or CAT) scan, or magnetic resonance imaging (MRI).
How Hepatobiliary Cancer is Diagnosed
Cancer doctors normally use a battery of tests to diagnose cancer. Your oncologist may also conduct tests to understand whether hepatobiliary cancer has spread to other organs in the body. For most types of cancer, a biopsy is the only definite way for a liver cancer specialist to know whether an area of the body has cancer. Biopsies are done under general anaesthesia, and involves your cancer specialist taking a small sample of tissue for testing in a laboratory.
A hepatobiliary doctor may consider the following factors when choosing a diagnostic test:
- Patient’s signs and symptoms
- Age and medical condition
- Results of earlier medical tests
Tests to diagnose hepatobiliary cancer include:
- Physical examination: Your doctor will look for an abnormal buildup of fluid in the abdomen and for signs of jaundice, including yellowing of the skin and eyes. He or she may also feel the abdomen to check for lumps, swelling, or other changes in the liver, spleen, and nearby organs.
- Blood tests: Your cancer specialist will do a blood test to look for a substance called AFP. Higher levels of AFP are found in patients who have hepatobiliary cancer. Doctors will also test the patient’s blood to see if there are any signs of Hepatitis B or Hepatitis C.
- Ultrasound: An ultrasound uses sound waves to create a picture of the organs inside the body, using a small amount of radiation.
- Computed tomography (CT or CAT) scan: A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer combines these images to show any abnormalities or tumors.
- Magnetic resonance imaging (MRI): An MRI uses magnetic fields to produce detailed images of the body. MRI can be used to measure the tumor’s size.
- Angiogram: An angiogram is an x-ray image of blood vessels.
- Laparoscopy: Laparoscopy is a test that allows doctors to see the inside of the body with a tube called a laparoscope.
- Biopsy: A biopsy is when a small amount of tissue in the liver is removed for examination by the liver cancer specialist under a microscope.
What are the Causes and Risk Factors of Hepatobiliary Cancer?
The following factors may increase the risk of primary liver cancer:
Chronic infection with HBV or HCV: Chronic infection with the Hepatitis B virus (HBV) or Hepatitis C virus (HCV) increases the risk of liver cancer.
Cirrhosis: This irreversible condition causes scar tissue to form in the liver which increases the chance of developing liver cancer.
Certain inherited liver diseases: These include hemochromatosis and Wilson’s disease.
Diabetes: Diabetes is a disease that affects the body’s ability to produce or use insulin. Diabetics are more likely to develop liver cancer than those without diabetes
Nonalcoholic fatty liver disease: An accumulation of fat in the liver increases the risk of liver cancer.
Exposure to aflatoxins: Aflatoxins are poisons produced by molds that grow on crops that are stored poorly.
Excessive alcohol consumption: Consuming more than the recommended amount increases your risk of getting liver cancer.
What are the Types of Hepatobiliary Cancer?
Primary liver cancer begins in the tissue of the liver. There are two main types of primary liver cancer: hepatocellular carcinoma and cholangiocarcinoma (cancer of the bile duct).
Secondary metastatic liver cancer occurs when the cancer spreads to the liver from other parts of the body.
What are the Stages of Hepatobiliary Cancer?
Before deciding the stage of hepatobiliary cancer, liver cancer specialists consider:
- Overall functioning and health condition of liver
- Severity of liver cancer symptoms
- Whether or not the liver cancer has spread to other organs
The above factors, combined with results from diagnostic imaging tests, will help doctors assign the stage of hepatobiliary cancer.
Stage 1 Liver Cancer
There are two sub-stages for Stage 1 liver cancer:
- Stage 1A occurs with a single tumour that is 2 cm or less in size, which may or may not have grown into surrounding blood vessels
- Stage 1B occurs with larger tumours above 2 cm which have not affected the blood vessels
Stage 2 Liver Cancer
In Stage 2 liver cancer, the solitary tumour has started to grow into the blood vessels that permeate the liver organ.
Stage 3 Liver Cancer
Stage 3 liver cancer is normally subdivided into 2 further stages:
- Stage 3A: Here, there is more than one tumour and they’ve reached a size of more than 5cm in diameter
- Stage 3B: At this stage, the cancer has grown into one of the main blood vessels supplying to or carrying blood away from the liver
Stage 4 Liver Cancer
Like the earlier stage, there are two sub-stages here:
- Stage 4A: At this stage, the cancer may be of any size. Often patients also have multiple tumours which may have grown into the blood vessels or other organs. It may also have spread to the lymph nodes.
- Stage 4B: Similar to stage 4A, with the exception that the cancer of any size with multiple tumours may have spread to other parts of the body (eg the lungs, bones or other surrounding bones).
TNM Staging System
Depending on your liver cancer specialist, a different staging system may be used to describe the progression of your hepatobiliary cancer. This is called the TNM staging system:
- T describes the size of the tumour
- N describes whether there are cancer cells in the lymph nodes
- M describes whether the cancer has spread to a different part of the body (M is an acronym for metastasis)
