Dr Kieron Lim
Senior Gastroenterologist & Hepatologist in Singapore
MBBS, University of London, Member, Royal College of Physicians (UK), Fellow, Academy of Medicine (Gastroenterology) Singapore, Fellow, Royal College of Physicians (Edinburgh)
Liver cancer remains a significant health concern in Singapore, ranking among the top five causes of cancer-related deaths in both men and women. Despite its seriousness, liver cancer often causes few or no symptoms in its early stages, making timely diagnosis especially important. Early detection can expand the range of treatment options available and improve clinical outcomes.
Understanding liver cancer and seeking specialist evaluation when needed are important first steps towards appropriate treatment and long-term management.
What Is Liver Cancer?
Liver cancer develops when cells within the liver undergo abnormal changes and begin to grow uncontrollably, forming a tumour. Most primary liver cancers arise from hepatocytes, the main functional cells that make up around 80% of the liver. As the tumour grows, it can impair the liver's ability to carry out essential functions such as filtering toxins, producing proteins and regulating metabolism.
Liver cancer is categorised as either primary or secondary, depending on the origin of the cancerous cells.
Hepatocellular Carcinoma (HCC) or Primary Liver Cancer
This type of liver cancer begins within the liver tissue and can manifest in various types, with hepatocellular carcinoma (HCC) being the most common. Hepatocellular carcinoma (HCC), also known as hepatoma, is particularly common among people aged 50 and above, especially those with cirrhosis.
Metastatic or Secondary Liver Cancer
The second type of liver cancer refers to cancer that has spread to the liver from another part of the body. The most common type of metastatic liver tumour is metastatic colorectal cancer, which begins in the colon or rectum and spreads to the liver through the bloodstream.
What Are the Signs and Symptoms of Liver Cancer?
There are often no symptoms during the early stages of liver cancer, but as the cancer progresses, various symptoms may begin to show, including:
- Fatigue
- Unexplained weight loss
- Abdominal pain
- Nausea or vomiting
- A lump in the right side of the abdomen
- Right shoulder pain
- Jaundice (yellowing of the skin and the whites of the eyes)
What Are the Causes and Risk Factors of Liver Cancer?
Liver cancer develops when cells in the liver undergo genetic mutations that disrupt the normal control of cell growth and division. Instead of growing and dying in a regulated way, these abnormal cells multiply uncontrollably and may form a malignant tumour.
Although the mechanism of mutation is understood, the exact triggers for these genetic changes are not always clear.
Several risk factors can influence liver cancer, including:
Chronic Viral Hepatitis
The most common risk factor for liver cancer is chronic viral infection. Typical examples are the hepatitis B virus (HBV) or hepatitis C virus (HCV). HBV and HCV can be transmitted through blood transfusions, sharing contaminated needles during drug use, unprotected sexual contact or from mother to child during childbirth.
Liver Cirrhosis
Cirrhosis is when liver cells are scarred due to long-term liver damage and inflammation. Some people who develop liver cancer already have underlying cirrhosis.
Non-Alcoholic Fatty Liver Disease (NAFLD)
This disease occurs due to the buildup of fat in the liver, which can result in inflammation, liver damage and potentially liver cancer.
Genetics
People with a family history of liver cancer may face a higher risk of developing liver cancer.
Type 2 Diabetes
Individuals with Type 2 diabetes have a higher risk of developing liver cancer due to higher insulin levels or liver damage resulting from diabetes.
Smoking
Smoking can cause various cancers, including liver cancer. This risk escalates when combined with heavy alcohol consumption.
When Should I See a Liver Cancer Specialist?
Although many liver conditions are not cancerous, it is important not to ignore persistent symptoms or assume they will resolve on their own. If you are experiencing the ongoing symptoms listed above, or these risk factors apply to you, you could have a higher risk of developing liver cancer. A specialist assessment can help determine whether further investigation is needed.
Book an AppointmentHow Do Doctors Diagnose Liver Cancer?
Diagnosis begins with a consultation, during which your doctor will review your symptoms, medical history and individual risk factors before recommending the most appropriate investigations. If liver cancer is suspected, additional tests will be ordered to confirm the diagnosis. These diagnostic tests include:
Medical history and physical examination
Blood Tests
These measure the level of alpha-fetoprotein (AFP), a protein produced by the liver that is connected to primary liver cancer. Blood tests are also done to assess the health of the liver, blood clotting abilities, tumour markers, hepatitis B or C infections, genetic issues and any abnormalities in liver function.
Ultrasound
Ultrasound is usually employed as a preliminary screening tool in people with known risk factors such as chronic hepatitis or liver cirrhosis. This method may be able to detect abnormal growths, but cannot immediately diagnose cancer.
CT scan
For liver cancer diagnosis, doctors usually perform a contrast-enhanced multiphase CT scan to better assess the tumour. CT scans can help evaluate the size, shape and number of liver tumours, and detect involvement of nearby lymph nodes.
MRI
MRI is particularly useful when CT findings are inconclusive or when smaller lesions are suspected that CT may miss.
PET-CT scan
PET-CT scans may be used in selected cases, particularly for cancer staging or to identify whether the cancer has spread beyond the liver, which CT or MRI alone may not always detect.
Biopsies
A liver biopsy involves the removal of a small amount of liver tissue. This procedure may be performed when imaging findings are inconclusive or when confirmation is required.
If liver cancer is diagnosed, doctors then use staging to determine how far the cancer has progressed and what treatment options may be suitable.
What Are the Stages of Liver Cancer?
When carrying out cancer staging, doctors use information from blood tests, imaging scans and biopsy results to assess the tumour, check whether nearby lymph nodes are involved and identify whether the cancer has spread to other parts of the body.
The staging system commonly used for liver cancer is the TNM system, which assesses:
- T (Tumour): the size and extent of the liver tumour
- N (Nodes): whether nearby lymph nodes are affected
- M (Metastasis): whether the cancer has spread to distant organs
Stage I (T1, N0, M0)
At stage I liver cancer, the tumour is localised within the liver and is small in size, without any involvement of nearby lymph nodes.
Stage II (T2, N0, M0)
In stage II liver cancer, the tumour has grown into blood vessels but remains confined within the liver without spreading cancer cells to nearby lymph nodes or distant sites.
Stage III (T3 or T4, N0 or N1, M0)
At stage III liver cancer, several tumours or at least one large tumour have either grown extensively within the liver (T3 or T4) or cancer cells have spread to lymph nodes near the liver (N1) but have not metastasised to distant organs.
Stage IV (Any T, Any N, M1)
Stage 4 liver cancer indicates advanced disease where the cancer cells have spread to other parts of the body, such as the lungs or bones (M1).
What Are the Treatment Options for Liver Cancer?
Liver cancer treatment is tailored to each individual. Your doctor will recommend the most appropriate option based on the cancer stage, liver function, tumour size and location, whether the cancer has spread and your overall health. In some cases, a combination of treatments may be recommended.
Treatments for liver cancer typically include:
Liver Cancer Surgery
Surgery is often considered for localised liver cancer, with the goal of removing cancerous tissue and improving long-term outcomes. A gastroenterologist may refer patients to a surgeon for further evaluation and determine whether surgery is appropriate. Common surgical options include:
- Liver Resection (Hepatectomy) – This procedure involves removing part of the liver containing the tumour. It is typically suitable for patients with hepatocellular carcinoma (HCC) who do not have severe underlying liver disease, such as advanced cirrhosis.
- Liver Transplantation – This may be considered for patients with early-stage tumours that meet specific criteria, such as a single small tumour or a limited number of small tumours, with no spread beyond the liver or involvement of blood vessels.
Localised Therapies
These techniques are often used for small liver tumours that are not suitable for liver cancer surgery or for patients who are not candidates for surgery due to health reasons. Radiofrequency ablation (RFA) is a type of local therapy that uses high-frequency electrical currents to destroy cancer cells.
Systemic Therapies
Systemic therapies for liver cancer target cancer cells throughout the body, often through medications administered orally or intravenously, aiming to control or shrink tumours in the liver and potentially elsewhere.
Following treatment, regular follow-up appointments and imaging are important to monitor recovery, assess treatment response and detect any recurrence at an early stage.
Can Liver Cancer Be Prevented?
Liver cancer may not be completely prevented, but there are steps that one can take to lower the risk of developing this condition. These include:
Seeking Treatment for Hepatitis B and C Infections
Consult a doctor for appropriate medication and preventive strategies for hepatitis B or C.
Vaccination Against Hepatitis B Virus
The hepatitis B vaccine reduces the risk of developing liver cancer, especially for those at higher risk of exposure.
Smoking Cessation and Alcohol Moderation
These can reduce risks for liver cancer as excessive smoking and alcohol consumption can contribute to liver damage.
Weight Management
Maintain a healthy weight to reduce the risk of obesity-related conditions, including fatty liver disease and liver cancer.
Maintaining an Active Lifestyle
Aerobic exercises such as brisk walking, jogging, cycling, swimming and dancing increase blood flow to the liver, which helps in detoxifying the body and removing harmful substances.
Consuming a Healthy, Balanced Diet
Fruits, vegetables, whole grains and lean proteins provide essential nutrients and antioxidants that support liver function and reduce cancer risk.
Practising Safe Sex
The use of condoms during sex helps reduce the transmission of hepatitis B and C, both of which can increase the risk of liver cancer.
Liver Cancer Treatment and Diagnosis at Kieron Lim Gastroenterology
Liver cancer requires timely diagnosis and an individualised treatment plan based on the stage of the disease, liver function and overall health. Early specialist assessment can help identify the most appropriate treatment approach and improve long-term outcomes.
At Kieron Lim Gastroenterology, we provide comprehensive evaluation for patients with suspected or confirmed liver cancer. From assessing symptoms and risk factors to arranging appropriate investigations and staging, we develop personalised management plans to help patients understand their diagnosis, explore suitable treatment options and receive timely care based on their individual condition.
Care is led by Dr Kieron Lim, our senior consultant gastroenterologist and hepatologist, who has extensive experience managing liver diseases, including liver cancer. He provides thorough assessment, coordinates the diagnostic process and works closely with other specialists to ensure patients receive appropriate treatment and ongoing care.
If you are experiencing symptoms of liver cancer, have risk factors or require further evaluation of a liver condition, contact our clinic today to arrange a consultation.
Frequently Asked Questions (FAQs) About Liver Cancer
Who should be screened for liver cancer?
Can liver cancer be detected before symptoms develop?
What is the prognosis/survival rate for liver cancer?
Could liver cancer come back after treatment?
How often should I follow up after liver cancer treatment?
Meet Our Liver Transplant Doctor
Dr Kieron Lim
Senior Consultant Gastroenterologist & Hepatologist
MBBS, University of London
Member, Royal College of Physicians (UK)
Fellow, Academy of Medicine (Gastroenterology) Singapore
Fellow, Royal College of Physicians (Edinburgh)
Dr Kieron Lim is a senior consultant gastroenterologist and hepatologist with over 30 years of experience treating patients with gastrointestinal conditions, including liver cancer. As the former head of the Division of Gastroenterology and Hepatology at the National University Hospital and current Medical Director of the Liver Transplant Programme at Mount Elizabeth Hospital, he is skilled in managing complex liver cases. Dr Lim specialises in using endoscopic procedures to diagnose liver cancer accurately and coordinating the best possible care for each patient.
Contact Us
Whatsapp: +65 9726 0495 | Telephone: +65 6836 0080
Fax: +65 6836 0090 | Emergency: +65 6533 0088
Email: enquiries@kieronlimgastro.sg