Liver Cancer

Hepatitis B carriers who have blood relatives diagnosed with liver cancer have a higher risk of developing liver cancer themselves. They should be evaluated and seen regularly by a liver doctor (hepatologists).

There are many hepatitis viruses, such as hepatitis A virus, which are spread by eating contaminated food. The hepatitis A virus causes short term liver damage, after which the liver will repair itself and no further damage is done. It has not been associated with liver cancer. There are also many other viruses which do not specifically attack the liver, but can cause mild short-term liver infection, such as the dengue virus.

Hepatopancreatobiliary (HPB) Surgeons are general surgeons who subspecialize in the surgery of the Liver (hepato-), Pancreas (pancreato-), Bile ducts and gallbladder (biliary). As these group of organs form an intricate system, surgery in this area is highly complex and hence requires specialized training and experience.

Gastroenterologists are medical specialists who diagnose and treat diseases of the gastrointestinal tract e.g. stomach, intestines including the liver (Hepatologist). While they do not perform surgery for these conditions, their expertise lies in the medical treatment of these diseases e.g. anti-viral medication for hepatitis B infection.

Yes, if the tumour is early, surgery offers the best chance of cure, either with removal of the tumour (liver resection) or liver transplantation. Unfortunately, while some may be diagnosed at advanced stages, these patients can still benefit from good control of the disease with the various treatments, e.g. locoregional, systemic or radiation therapy.

The term “traditional” or “herbal” remedies or medicine can represent thousands of compounds, many of which are not well known. Unfortunately, most are not rigorously tested or well regulated by the companies that produce them. Some are likely safe but many more may be very harmful. More importantly, there is no current evidence of any of these “remedies” work for liver cancer. It is recommended that patients considering these alternative forms of medication discuss this with their liver doctor.

It may be wise to ask your father's doctors again what was discovered. When a patient has colon cancer and this colon cancer can and may spread to the liver at a later stage, the patient is still suffering from colon cancer and not from liver cancer per se. The cancer cells that are in the liver will behave like colon cancer cells. It is not a new cancer, but rather an advanced stage of colon cancer in which spread has occurred to other organs.

When it comes to treating liver cancer, surgery is often the best option if amenable as it provides the only chance of cure and/or best long-term outcomes in survival and quality of life. If surgery is not possible, non-surgical treatments are still available and can serve as complementary or supporting therapies. In cases when cure is possbile, a liver resecton (tumour resection) or a liver transplant will be recommended. Treatment strategies will be tailored accordingly to each patient’s condition, preferences and decisions made together with the patient during a multidisciplinary discussion. Liver cancer surgery may be considered in the following scenarios:

• Early-stage liver cancer: If the cancer is detected at an early stage and the patient still has good liver function, surgery is usually the best option.
• Localized tumours: Surgery will be considered if the tumours are localized and have not spread to other parts of the body surrounding the liver.
• Acceptable overall health: The patient should be in acceptable overall health and have adequate liver volume and function to tolerate the surgery and recover well.
• No response to other treatments: If the patient has not responded adequately to non-surgical treatments such as locoregional therapy e.g., ablation or embolisation (TACE or SIRT); or systemic treatment e.g immunotherapy, chemotherapy may be recommended and/or used in combination.

Liver cancer surgery, like any major surgical procedure, carries certain risks, which vary depending on the type of surgery, the individual's overall health, and more. Risks associated with liver cancer surgery include:

• Bleeding: The liver has a rich blood supply, and surgery may lead to bleeding but most of the bleeding will be well controlled. In rare cause, excessive bleeding might then require additional procedures to control it.
• Infection: As with any surgical procedure, there is a risk of developing an infection at the wounds or within the abdomen.
• Blood Clots: Surgery and decreased mobility afterwards can increase the risk of blood clots forming. Pre-, intra and post-operative measures will be instituted to minimise these risks.
• Liver Failure: In extensive surgeries, there is a risk of insufficient liver function leading to liver decompensation and failure, especially if the remaining liver tissue cannot regenerate sufficiently.
• Bile Leakage: Surgery on the liver can sometimes lead to the leakage of bile, which is fluid produced by the liver.
• Damage to Nearby Organs or Structures: Given the liver's proximity to other organs and blood vessels, there is a risk of injuring nearby structures during surgery.
• Adverse Reaction to Anaesthesia: Some people might experience complications related to anaesthesia, such as allergic reactions.
• Delayed Recovery: Recovery from liver cancer surgery in the minority of cases be lengthy and challenging, and some people might experience slow wound healing or prolonged recovery periods. Minimally invasive liver surgery can ameliorate many of these short-term issues.

Liver cancer surgery is a major operation and can take several weeks for full recovery. To ensure a smoother recovery, be sure to follow these advice:

• Follow Medical Guidance: Adhere to post-surgery instructions regarding medication, wound care, diet, and activity levels.
• Pain Management & Monitoring: Take prescribed pain relief, watch for signs of infection, and know when to seek medical attention.
• Gradual Activity Resumption: Slowly reintroduce daily activities and follow the advice of your liver cancer doctor.
• Healthy Lifestyle: Maintain a balanced diet, stay hydrated, engage in light exercise, and avoid alcohol and smoking.
• Attend Follow-up Appointments: Attend your scheduled follow-ups to monitor your recovery progress.

Enhanced Recovery Programme

Patients undergoing major surgery have been shown to benefit from measures and prehabilitation prior to and early after surgery to improve their physical condition and better tolerate and recover from the surgery. This multimodal perioperative care pathway starts a few weeks prior and immediately after the surgery, designed to achieve early recovery for patients undergoing major surgery and minimise complications. These include:

• Excerises to improve strength and mobility – physiotherapy, prehabilitation
• Lung excerises- deep breahting and incentive spirometry
• Diet optimisation – nutritional supplements to boost immune system and provide an optimal diet to boost physiological reserves especially in patients who has loss of weight and appetite
• Others e.g., - Preoperative smoking and alcohol cessation, medications review, Anti-thrombotic prophylaxis
• Post-operative- Early mobilisation, early oral intake, nutritional supplementation, nausea and vomiting (PONV) prophylaxis, judicious fluid and pain management etc.

Surgical Associates has a comprehensive enhanced recovery programme and our team works closely with other specialists, nurses and allied health professionals (e.g. physiotherapist, dieitician ) for a tailored programme to cater to each individual patient’s needs and condition.