HCC is actually cancer of the liver. Individuals with cirrhosis are at risk of developing liver cancer or HCC. In our Singapore context, the most common cause of cirrhosis, and hence risk of HCC, is chronic hepatitis B.

In chronic hepatitis B, the infected liver cells undergo death and regeneration. Sometimes, during cell regeneration, the process gets out of control and the abnormal liver cells continue to divide at a rapid pace and without stopping. This is the beginning of HCC.

Although HCC begins in the liver, if left untreated, it can spread via the bloodstream to other parts of the body. The most common areas of spread are to the lungs. When spread occurs outside the liver, it is known as HCC secondaries (or metastases) and signifies a very advanced stage of disease.

How common is HCC?

HCC occurs more commonly in males and those above the age of 40 years. In addition to cirrhosis, other factors may add on to the risk of developing HCC. These factors include smoking, using steroids for bodybuilding and exposure to aflatoxin that is found in mouldy peanuts and cereals. There are more than 300 new cases of HCC diagnosed each year in Singapore.

How do I know if I have HCC?

Early stage HCC has no symptoms. That is to say, you will not know that you are having HCC! By the time HCC produces symptoms, it is often at an advanced stage. These symptoms include pain in the upper abdomen, loss of appetite and weight and swelling of the abdomen and legs.

How do doctors diagnose HCC?

Since early stage HCC has no symptoms, doctors can only diagnose them in patients who go for regular medical check-up and through screening of individuals at risk of developing HCC, such as those with chronic hepatitis B. Early stage HCC is most often diagnosed through an ultrasound examination. Blood tests may still remain normal.

If the cancer marker for HCC (ie alpha-foetoprotein, or AFP) measured in a blood test is very high and the individual has features suggestive of a cancerous growth in the liver on ultrasound or CT scan, then the diagnosis of HCC is certain. Sometimes the AFP may be normal or the scans may be ambiguous, then the doctor may need to do other special X-ray tests (e.g. hepatic angiogram) or to take a small piece of the growth for examination under the microscope (liver biopsy)

Is HCC treatable?

Early stage HCC can be cured by surgery or liver transplantation. Unfortunately, most liver cancers in Singapore are diagnosed at a late stage due to lack of regular screening of individuals at risk.

Although late stage HCC may not be curable because surgery or liver transplantation is not possible, there are several other types of treatment that may retard the growth and spread of the cancer and hence prolong life. These treatments include injection of alcohol into the HCC, using radiofrequency waves to burn the HCC, injecting cancer drugs into the HCC or injecting cancer drugs into the bloodstream. There is still no suitable oral medication for treatment of HCC.

What is the doctor’s advice for me with regards to HCC?

Prevention is better than cure. Everyone should avail themselves of hepatitis B vaccination as a successful vaccination will remove the most common cause of HCC in Singapore.

Individuals who are already at risk (e.g. patients with chronic hepatitis B) should visit a doctor regularly for ultrasound scans and blood tests as part of screening for early stage HCC. They should not wait for symptoms to appear before consulting the doctor. They should also avoid adding on to the risk of developing HCC, e.g. smoking.

The most important point to remember is that early stage HCC that is curable has no symptom. Hence, just because you feel well does not mean all is well!