The Basics of by wulinqing


                              Dr Reuben Wong Kong Min, Registrar, Department of Gastroenterology & Hepatology

                                                                 Liver cancer is the third most common
                                                                 cancer among men in Singapore. Between
                                                                 1998 and 2002, it accounted for 8.1% of
                                                                 all cancers diagnosed in Singapore. Liver
                                                                 cancer tends to occur more commonly in
                                                                 men as compared to women (3.4 males
                                                                 is to 1 female) and it has a higher
                                                                 incidence among the ethnic Chinese,
                                                                 followed by Malays, then Indians.

                The Basics of
                             Liver Cancer
                                      Types of liver cancer
                                      There are two major types of liver cancers, namely Hepatocellular Carcinomas (HCC) and
                                      Cholangiocarcinomas. HCCs arise from the liver cells themselves and account for 84% of all
                                      liver cancers. Cholangiocarcinomas, which arise from the bile duct cells, account for 6% of
                                      liver cancers.

                                      Am I at risk of getting liver cancer?
                                      Anyone can potentially get liver cancer, but what is important is identifying if you are at risk
                                      of getting the disease.

                                      *   Chronic Hepatitis B and C patients have a high risk. It is estimated that two-thirds of liver
                                          cancers arise in patients with chronic viral hepatitis.
                                      *   Patients with liver cirrhosis - a condition in which there is hardening and damage to the
                                          liver. Liver cirrhosis is commonly due to viral hepatitis infections and chronic alcohol
                                          ingestion, but can also occur from a variety of other medical conditions.
                                      *   External chemicals such as alfatoxins (a compound found on mouldy nuts and grains),
                                          certain industrial organic chemicals, tobacco and oral estrogen compounds can also
                                          damage the liver and predispose to liver cancer.

                                      What are the symptoms of liver cancer that I should look
                                      out for?
                                      As with most other cancers, liver cancers in its early stages rarely produce symptoms. As the
                                      cancer cells multiply, some symptoms may emerge:

                                      *   Upper abdominal pain (as the tumour stretches the liver capsule)
                                      *   Bruising of the skin and difficulty in blood clotting after a cut
                                      *   Yellowing of the skin and whites of the eyes (jaundice)
                                      *   Abdominal swelling (from fluid in the abdomen)
                                      *   General symptoms such as weight loss and tiredness

                                      By the time the above symptoms occur, the cancer is usually at an advanced stage.

04 Lifeline Oct - Dec 2006

  Diagnosis of liver cancer                                                  Early detection of liver cancer
  The diagnosis of liver cancer involves an ultrasound scan and/or a         Through screening and surveillance, liver cancer can be detected early
  Computerised Tomography (CT) scan, which allows the doctors to 'look'      while it is potentially curable. This usually involves the use of regular
  inside the liver and surrounding tissue using ultrasound waves or x-       ultrasound scans and taking blood samples for a tumour marker known
  rays and visualise the size and number of tumour masses present.           as Alpha-Feto Protein (AFP). An elevated AFP does not always indicate
                                                                             liver cancer, but in the correct clinical setting, it helps alert your doctor
  Unlike some other cancers, it is not always necessary to take a specimen   if further tests are needed.
  of tumour tissue for examination, but in ambiguous cases, the doctor
  may advise a biopsy.                                                       Do I need to be screened for liver cancer?
  How can we treat liver cancer?                                             Not everyone needs to be screened for liver cancer.
  The goal of treatment is to kill or remove as much of the cancerous        Patients with a high risk profile, such as chronic Hepatitis B and C
  cells possible, and can be achieved by a number of ways:                   patients and individuals with liver cirrhosis, should be regularly reviewed
                                                                             by a doctor and have scheduled ultrasound scans and blood tests.
  1. Surgery
     Parts of the liver with tumour can be removed, leaving good liver       Can I do anything to protect myself from
     tissue behind that will later regenerate. In some cases, the doctor     getting liver cancer?
     may advise on a liver transplant.

  2. Tumour ablation                                                         Yes! There are simple measures you can adopt:
     In this procedure, no invasive surgery is needed. The tumour tissue
     is either burnt off using radio-waves or killed with ethanol injected   *    Protect yourself from Hepatitis B and C.
     through a needle in the tumour.                                         *    Avoid excessive alcohol and contact with chemicals that can cause
                                                                                  liver damage and hardening.
  3. Chemo-embolisation                                                      *    Boost your body's natural immune system with a healthy lifestyle
     In this procedure, the blood supply to the tumour is blocked off by          and diet.
     injecting small coated micro-spheres, delivering a chemotherapy         References:
     agent direct to the tumour.                                             1. Trends in Cancer Incidence in Singapore 1968-2002. Singapore Cancer Registry Report no 6.
                                                                             2. AASLD Practice Guidelines: Management of Hepatocellular Carcinomas. Heptology 2005 42(5).
  4. Systemic chemotherapy
     Chemotherapy drugs are injected through veins to kill the cancer        Read about a clinical breakthrough that brings hope to patients with
     cells in the body.                                                      liver failure on Page 8.
  5. Radiotherapy
     Radiotherapy is given either in the form of radiation directed at the
     tumour mass, or using radio-isotopes, which preferentially home in
     and destroy tumour cells.

Contact us
For more information or appointments, please contact:

Clinic                          Contact Details                Our Doctors (specialising in liver cancer)

University Digestive Centre     Tel : 6772 2505                From Department of Gastroenterology & Hepatology:
Kent Ridge Wing 2, Level 4      Fax : 6774 1075                A/Prof Lim Seng Gee, Chief & Senior Consultant
                                email :         Dr Dede Sutedja, Senior Consultant
                                                               Dr Lee Yin Mei, Consultant
                                                               Dr Dan Yock Young, Consultant
                                                               Dr Desmond Wai, Visiting Consultant

                                                                                                                                                Lifeline Oct - Dec 2006     05

                Medical Services
                For Women And Children In The Heartlands
                From 18 October, specialist obstetric and gynaecology as well as paediatric medical
                services are available at the newly opened Jurong Medical Centre by the National
                Healthcare Group.

                      Jurong Medical Centre
                   Clinic for Women & Children
                              (Level 2)
                          60 Jurong West Central 3                      Services for Women                                          Services for Newborns,
                             Singapore 648346                      by Department of Obstetrics &                                     Children & Teenagers
                        Appointment Line: 6551 7888                      Gynaecology, NUH                                   by The Children's Medical Institute, NUH
                         Enquiries Line: 6551 7733
                              Fax: 6551 7738                     * Antenatal scans and antenatal package                    * Medical consultation for common paediatric
                                                                    for pregnant mums                                         conditions including:
                                                                 * Wellness package for women                                 - asthma            - vomiting
                              Operating Hours:                   * Simple day surgery procedure such as                       - eczema            - diarrhoea
                         8.30am - 5.30pm (Mon - Fri)                termination of pregnancy and                              - allergic rhinitis - tummy ache
                           8.30am -12.30pm (Sat)                    evacuation of uterus, marsupialization                  * Vaccination
                                                                    of bartholin cyst, incision and drainage.               * Nutritional assessment of babies

                Saturday                                                    Faster, Safer And Improved
                Clinic                                                      Accuracy Treatment
                                                                            For LASIK Patients
                Sessions                                                          The new Excimer
                                                                              Laser system MEL80
                for ENT Consultations                                       is now available at our
                                                                               NUH LASIK Centre.
                                                                            The advanced features

                t      o provide greater convenience and accessible
                       services to our patients, our ENT - Head
                       and Neck Surgery Clinic at Kent
                Ridge Wing 2 has started providing clinic sessions on
                Saturday mornings (9am - 12.30pm), since September.
                                                                                   of this new laser
                                                                                system increase the
                                                                            accuracy of results and
                                                                             allow for faster visual
                Areas of our specialised services include:
                • Allergy & Rhinology
                • Hearing & Language Intervention
                • Head & Neck Surgery
                • Sleep & Snoring
                • Voice & Swallowing
                • Paediatric ENT
                                                                             b        eing the first refractive surgery centre in Singapore to be equipped
                                                                                      with this new laser system, we are able to provide a more comprehensive
                                                                                      and higher quality LASIK services for our patients. An expanded range
                                                                             of treatment modalities is now available, including standard, tissue-saving,
                                                                             aspheric, wavefront and topography-guided treatment as well as near vision
                                                                             correction. We are now able to provide greater customisation to cater to the
                                                                             needs of the individual and differing characteristics of each eye.
                 For appointments,
                                                                             For more information or appointments, please call NUH LASIK
                     please call
                                                                             Centre at 6772 2020 or visit our website at
                    6772 2002.
                                                                             * OCBC is currently offering its Visa card and MasterCard holders 0% instalment payment plans (6 months or 12 months)
                                                                             for LASIK procedures done at NUH.

06 Lifeline Oct - Dec 2006

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