What Is Acid Reflux and Heartburn?

Heartburn is a burning feeling in the chest caused by stomach acid travelling up towards the throat (acid reflux). If it keeps happening, it’s called Acid Reflux Disease, or Gastroesophageal Reflux Disease (GERD), which affects about 1 in every 10 patients in Singapore.

Suffering from heartburn or acid reflux? Heartburn is a burning feeling in the chest caused by stomach acid travelling up towards the throat (acid reflux). Acid Reflux Disease, or Gastroesophageal Reflux Disease (GERD) affects about 1 in every 10 patients in Singapore. Here are most of the common questions asked:

What are the common symptoms of Acid Reflux?

Suffering from heartburn or acid reflux? Heartburn is a burning feeling in the chest caused by stomach acid travelling up towards the throat (acid reflux). Acid Reflux Disease, or Gastroesophageal Reflux Disease (GERD) affects about 1 in every 10 patients in Singapore. Here are most of the common questions asked:

• Heartburn. Also called acid indigestion, heartburn is a burning pain or discomfort that moves up from your stomach to the middle of your abdomen and chest. This pain can also move into your throat.
• Regurgitation. A sour or bitter-tasting acid backing up into your throat or mouth.
• Dyspepsia. Difficulty swallowing or a sensation of food being stuck in your throat.
• Other symptoms: Chronic hiccups, Nausea, Weight Loss, Wheezing (dry cough), Chronic Sore Throat or Bloating.

Treatment Options For Acid Reflux

In mild cases, medication may be sufficient to treat GERD and it’s symptoms. In more severe cases, Dr. Kenneth Koo Yih Meng may suggest surgery, done via minimally invasive techniques, which Dr. Kenneth Koo Yih Meng is very proficient with.

Over-the-counter medications

The options include:

• Antacids that neutralize stomach acid. Antacids, such as Mylanta, Rolaids and Tums, may provide quick relief. But antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or sometimes kidney problems.
• Medications to reduce acid production. These medications — known as H-2-receptor blockers — include cimetidine (Tagamet HB), famotidine (Pepcid AC) and nizatidine (Axid AR). H-2-receptor blockers don’t act as quickly as antacids, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Stronger versions are available by prescription.
• Medications that block acid production and heal the esophagus. These medications — known as proton pump inhibitors — are stronger acid blockers than H-2-receptor blockers and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole
  (Prilosec OTC, Zegerid OTC).

Prescription medications

Prescription-strength treatments for GERD include:

1. Prescription-strength H-2-receptor blockers. These include prescription-strength famotidine (Pepcid) and nizatidine. These medications are generally well-tolerated but long-term use may be associated with a slight increase in risk of vitamin B-12 deficiency and bone fractures.
2. Prescription-strength proton pump inhibitors. These include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant). Although generally well-tolerated, these medications might cause diarrhea, headache, nausea and vitamin B-12 deficiency. Chronic use might increase the risk of hip fracture.
3. Medication to strengthen the lower esophageal sphincter. Baclofen may ease GERD by decreasing the frequency of relaxations of the lower esophageal sphincter. Side effects might include fatigue or nausea.
4. Prescription-strength H-2-receptor blockers. These include prescription-strength famotidine (Pepcid) and nizatidine. These medications are generally well-tolerated but long-term use may be associated with a slight increase in risk of vitamin B-12 deficiency and bone fractures.

Symptoms Of Acid Reflux Conditions Treated By Our Gastroenterologist

Suffering from heartburn or acid reflux? Heartburn is a burning feeling in the chest caused by stomach acid travelling up towards the throat (acid reflux). Acid Reflux Disease, or Gastroesophageal Reflux Disease (GERD) affects about 1 in every 10 patients in Singapore. Here are most of the common questions asked:

• Abdominal Bloating & Pain
• Irritable Bowel Syndrome (IBS)
• Polyps (Abnormal Growths)

What are the common symptoms of Acid Reflux?

Suffering from heartburn or acid reflux? Heartburn is a burning feeling in the chest caused by stomach acid travelling up towards the throat (acid reflux). Acid Reflux Disease, or Gastroesophageal Reflux Disease (GERD) affects about 1 in every 10 patients in Singapore. Here are most of the common questions asked:

• Heartburn. Also called acid indigestion, heartburn is a burning pain or discomfort that moves up from your stomach to the middle of your abdomen and chest. This paincan also move into your throat.
• Regurgitation. A sour or bitter-tasting acid backing up into your throat or mouth.

What are the common symptoms of Acid Reflux?

Suffering from heartburn or acid reflux? Heartburn is a burning feeling in the chest caused by stomach acid travelling up towards the throat (acid reflux). Acid Reflux Disease, or Gastroesophageal Reflux Disease (GERD) affects about 1 in every 10 patients in Singapore. Here are most of the common questions asked:

Chemotherapy

Chemotherapy is the use of anti-cancer drugs to destroy cancer cells or stop them from dividing. It can help to control symptoms by shrinking the cancer and
slowing its progression. Chemotherapy drugs are usually given as injections into the vein (intravenously), although they can sometimes be given as tablets.

Chemotherapy may also be administered as part of a treatment called chemoembolisation. Chemoembolisation involves the injection of chemotherapy drugs directly
into the cancer in the liver, together with a gel or tiny plastic beads to block blood flow to the cancer (embolisation).

Not everyone is suitable for chemotherapy as it can only be given if the liver function is good enough.

Immunotherapy

An important part of the immune system is the ability to recognise foreign from normal cells. Immunotherapy isa relatively new form of therapy where
patients receivea medication targeted at a receptor called the Program death protein 1(PD1) or programmed death ligand 1(PD- L1). These are known as
checkpoint inhibitors. These drugs stimulate the immune cells called T lymphocytes to attack the cancer cells. A couple of immunotherapy drugs
(both PD1 inhibitors) have been shown to be useful in liver cancer and more clinical trials are underway.

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells or keep them from growing. External radiotherapy uses a machine outside the body the deliver
radiation towards the cancer. Such treatment is not often used to treat HCC because the liver cannot take very high doses of radiation. It may however
be used to relieve pain, for example, in patients whose cancer has spread to the bone. Alternatively, internal radiation uses a radioactive substance
delivered selectively to the cancer via a major blood vessel that carries blood to the liver (hepatic artery).

What is Liver Cancer?

Primary liver cancer is a disease in which malignant (cancer) cells arise from tissues in the liver. The different types of primary liver cancer are
usually named after the types of cells from which it is thought the cancer has developed. Hepatocellular carcinoma (HCC) or hepatoma arises from the main cells
of the liver called hepatocytes and accounts for about 85% of primary liver cancers. A less common type of primary liver cancer originates from cells that line
the bile duct called cholangiocytes and is therefore called cholangiocarcinoma or bile duct cancer.

The liver is also the seat of another type of cancer called secondary (or metastatic) liver cancer. In this condition, the main cancer originates elsewhere
in the body and secondary deposits are formed in the liver. A common example is colorectal cancer spreading to the liver via the bloodstream.

What are the risk factors for Liver Cancer?

The three main risk factors for developing HCC (the most common primary liver cancer) are chronic hepatitis B infection, chronic hepatitis C infection and
excessive alcohol consumption. The risk of an individual with chronic hepatitis B infection developing HCC is 100-fold that of an uninfected individual.

Other less common risk factors include aflatoxin (a poison found in mouldy peanuts, wheat, soya and grain), inherited conditions (e.g. haemochromatosis,
alpha-1 anti-trypsin deficiency) and any cause of cirrhosis (scarring throughout the liver) like autoimmune hepatitis or primary biliary cirrhosis. Many
liver cancers can be prevented by public health measures that reduce exposure to these known risk factors.

Common symptoms of Liver Cancer

Patients who develop HCC usually have no symptoms other than those related to their chronic liver disease. With worsening symptoms of the existing chronic
liver disease like abdominal distension with fluid (ascites), encephalopathy (altered mental state), jaundice, or gastro- instestinal tract bleeding may
heighten the suspicion of development of HCC. Besides that, some patients may have mild to moderate upper abdominal pain, weight loss, early satiety,
lethargy, anorexia or a palpable mass in the upper abdomen.

• abdominal distension with fluid (ascites)
• encephalopathy (altered mental state)
• jaundice
• weight loss
• early satiety
• lethargy
• anorexia

Liver Cancer Screening

Screening can help doctors find and treat HCC early, when the cancer is localised and more easily removed by surgery. This may in turn improve the
chance of survival. Those with chronic hepatitis B infection and liver scarring (cirrhosis) due to hepatitis C or other causes are at increased risk and
should be screened for liver cancer.

1. A blood test for alpha-fetoprotein (AFP) every 3-6 months
2. An ultrasound scan of the liver every 6-12 months

Diagnosis For Liver Cancer

The following tests and procedures may be performed to diagnose HCC and to show the stage of the cancer:

Physical examination

Physical examination for general signs of health. An examination of the abdomen will also be performed to check for hard lumps or ascites.

Blood Tests

Blood tests to check general health, liver function and the amount of AFP. The amount of AFP in the blood can be higher in people with HCC.

Liver Ultrasound Scan

A liver ultrasound scan that uses sound waves to produce a picture of the liver. This is a painless test and usually takes several minutes to perform.
The picture may reveal a liver tumour.

Although a diagnosis of HCC can be made based on the amount of AFP in the blood and on dedicated CT or MRI scans, a liver biopsy may sometimes be needed
to be sure of the diagnosis. If the cancer has not already spread and if there is a chance it can be removed, then a biopsy might not be performed.

This is due to the small risk of the cancer spreading along the path of the needle when the biopsy needle is removed.

In this situation, the diagnosis is confirmed after an operation to remove the tumour.

Liver Cancer Treatments

The type of treatment for patients with HCC will depend on its stage (that is, its size and whether it has spread beyond its original site) and the
patient’s general health. The main treatments used are surgery, tumour ablation, chemotherapy, targeted cancer therapy and radiotherapy.

Surgery

Surgery is potentially curative and is therefore the treatment of choice for patients with early stage HCC. If
only certain parts of the liver are
affected by cancer and the rest of the liver is healthy, then surgery may be possible to remove the affected part or parts. This type of surgery is called
a liver resection. Another form of surgery is a liver transplant. This involves the removal of the entire liver and replacement with a healthy donated liver.
Such a major operation maybe performed when the cancer is in the liver only and a donated liver is available. If surgery is not possible, then other treatments
may be offered to help control the cancer, thereby reducing symptoms and improving quality of life.

Tumour Ablation

Tumour ablation aims to destroy primary liver cancer cells using either heat (radiofrequency ablation; RFA) or alcohol (percutaneous ethanol injection; PEI). This procedure is usually done in the scanning department so that ultrasound or computerised tomography (CT) can help the doctor to guide a needle through the skin and into the cancer within the liver. A local anaesthetic will be given. RFA treatment uses laser light or radio waves passed through the needleto 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. Tumour ablation may sometimes be repeated if the tumour grows again.

Chemotherapy

Chemotherapy is the use of anti-cancer drugs to destroy cancer cells or stop them from dividing. It can help to control symptoms by shrinking the cancer and slowing its progression. Chemotherapy drugs are usually given as injections into the vein (intravenously), although they can sometimes be given as tablets.

Chemotherapy may also be administered as part of a treatment called chemoembolisation. Chemoembolisation involves the injection of chemotherapy drugs directly into the cancer in the liver, together with a gel or tiny plastic beads to block blood flow to the cancer (embolisation).

Not everyone is suitable for chemotherapy as it can only be given if the liver function is good enough.

Immunotherapy

An important part of the immune system is the ability to recognise foreign from normal cells. Immunotherapy isa relatively new form of therapy where patients receivea medication targeted at a receptor called the Program death protein 1(PD1) or programmed death ligand 1(PD- L1). These are known as checkpoint inhibitors. These drugs stimulate the immune cells called T lymphocytes to attack the cancer cells. A couple of immunotherapy drugs (both PD1 inhibitors) have been shown to be useful in liver cancer and more clinical trials are underway.

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells or keep them from growing. External radiotherapy uses a machine outside the body the deliver radiation towards the cancer. Such treatment is not often used to treat HCC because the liver cannot take very high doses of radiation. It may however be used to relieve pain, for example, in patients whose cancer has spread to the bone. Alternatively, internal radiation uses a radioactive substance delivered selectively to the cancer via a major blood vessel that carries blood to the liver (hepatic artery).

What is Liver Cancer?

Primary liver cancer is a disease in which malignant (cancer) cells arise from tissues in the liver. The different types of primary liver cancer are
usually named after the types of cells from which it is thought the cancer has developed. Hepatocellular carcinoma (HCC) or hepatoma arises from the main cells
of the liver called hepatocytes and accounts for about 85% of primary liver cancers. A less common type of primary liver cancer originates from cells that line
the bile duct called cholangiocytes and is therefore called cholangiocarcinoma or bile duct cancer.

The liver is also the seat of another type of cancer called secondary (or metastatic) liver cancer. In this condition, the main cancer originates elsewhere
in the body and secondary deposits are formed in the liver. A common example is colorectal cancer spreading to the liver via the bloodstream.

What are the risk factors for Liver Cancer?

The three main risk factors for developing HCC (the most common primary liver cancer) are chronic hepatitis B infection, chronic hepatitis C infection and
excessive alcohol consumption. The risk of an individual with chronic hepatitis B infection developing HCC is 100-fold that of an uninfected individual.

Other less common risk factors include aflatoxin (a poison found in mouldy peanuts, wheat, soya and grain), inherited conditions (e.g. haemochromatosis,
alpha-1 anti-trypsin deficiency) and any cause of cirrhosis (scarring throughout the liver) like autoimmune hepatitis or primary biliary cirrhosis. Many
liver cancers can be prevented by public health measures that reduce exposure to these known risk factors.

Common symptoms of Liver Cancer

Patients who develop HCC usually have no symptoms other than those related to their chronic liver disease. With worsening symptoms of the existing chronic
liver disease like abdominal distension with fluid (ascites), encephalopathy (altered mental state), jaundice, or gastro- instestinal tract bleeding may
heighten the suspicion of development of HCC. Besides that, some patients may have mild to moderate upper abdominal pain, weight loss, early satiety,
lethargy, anorexia or a palpable mass in the upper abdomen.

• abdominal distension with fluid (ascites)
• encephalopathy (altered mental state)
• jaundice
• weight loss
• early satiety
• lethargy
• anorexia

Liver Cancer Screening

Screening can help doctors find and treat HCC early, when the cancer is localised and more easily removed by surgery. This may in turn improve the
chance of survival. Those with chronic hepatitis B infection and liver scarring (cirrhosis) due to hepatitis C or other causes are at increased risk and
should be screened for liver cancer.

1. A blood test for alpha-fetoprotein (AFP) every 3-6 months
2. An ultrasound scan of the liver every 6-12 months

Diagnosis For Liver Cancer

The following tests and procedures may be performed to diagnose HCC and to show the stage of the cancer:

Physical examination

Physical examination for general signs of health. An examination of the abdomen will also be performed to check for hard lumps or ascites.

Blood Tests

Blood tests to check general health, liver function and the amount of AFP. The amount of AFP in the blood can be higher in people with HCC.

Liver Ultrasound Scan

A liver ultrasound scan that uses sound waves to produce a picture of the liver. This is a painless test and usually takes several minutes to perform.
The picture may reveal a liver tumour.

Although a diagnosis of HCC can be made based on the amount of AFP in the blood and on dedicated CT or MRI scans, a liver biopsy may sometimes be needed
to be sure of the diagnosis. If the cancer has not already spread and if there is a chance it can be removed, then a biopsy might not be performed.

This is due to the small risk of the cancer spreading along the path of the needle when the biopsy needle is removed.

In this situation, the diagnosis is confirmed after an operation to remove the tumour.

Liver Cancer Treatments

The type of treatment for patients with HCC will depend on its stage (that is, its size and whether it has spread beyond its original site) and the
patient’s general health. The main treatments used are surgery, tumour ablation, chemotherapy, targeted cancer therapy and radiotherapy.

Surgery

Surgery is potentially curative and is therefore the treatment of choice for patients with early stage HCC. If
only certain parts of the liver are
affected by cancer and the rest of the liver is healthy, then surgery may be possible to remove the affected part or parts. This type of surgery is called
a liver resection. Another form of surgery is a liver transplant. This involves the removal of the entire liver and replacement with a healthy donated liver.
Such a major operation maybe performed when the cancer is in the liver only and a donated liver is available. If surgery is not possible, then other treatments
may be offered to help control the cancer, thereby reducing symptoms and improving quality of life.

Tumour Ablation

Tumour ablation aims to destroy primary liver cancer cells using either heat (radiofrequency ablation; RFA) or alcohol (percutaneous ethanol injection; PEI).
This procedure is usually done in the scanning department so that ultrasound or computerised tomography (CT) can help the doctor to guide a needle through the
skin and into the cancer within the liver. A local anaesthetic will be given. RFA treatment uses laser light or radio waves passed through the needleto 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.
Tumour ablation may sometimes be repeated if the tumour grows again.

Chemotherapy

Chemotherapy is the use of anti-cancer drugs to destroy cancer cells or stop them from dividing. It can help to control symptoms by shrinking the cancer and
slowing its progression. Chemotherapy drugs are usually given as injections into the vein (intravenously), although they can sometimes be given as tablets.

Chemotherapy may also be administered as part of a treatment called chemoembolisation. Chemoembolisation involves the injection of chemotherapy drugs directly
into the cancer in the liver, together with a gel or tiny plastic beads to block blood flow to the cancer (embolisation).

Not everyone is suitable for chemotherapy as it can only be given if the liver function is good enough.

Immunotherapy

An important part of the immune system is the ability to recognise foreign from normal cells. Immunotherapy isa relatively new form of therapy where
patients receivea medication targeted at a receptor called the Program death protein 1(PD1) or programmed death ligand 1(PD- L1). These are known as
checkpoint inhibitors. These drugs stimulate the immune cells called T lymphocytes to attack the cancer cells. A couple of immunotherapy drugs
(both PD1 inhibitors) have been shown to be useful in liver cancer and more clinical trials are underway.

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells or keep them from growing. External radiotherapy uses a machine outside the body the deliver
radiation towards the cancer. Such treatment is not often used to treat HCC because the liver cannot take very high doses of radiation. It may however
be used to relieve pain, for example, in patients whose cancer has spread to the bone. Alternatively, internal radiation uses a radioactive substance
delivered selectively to the cancer via a major blood vessel that carries blood to the liver (hepatic artery).

What is Liver Cancer?

Primary liver cancer is a disease in which malignant (cancer) cells arise from tissues in the liver. The different types of primary liver cancer are
usually named after the types of cells from which it is thought the cancer has developed. Hepatocellular carcinoma (HCC) or hepatoma arises from the main cells
of the liver called hepatocytes and accounts for about 85% of primary liver cancers. A less common type of primary liver cancer originates from cells that line
the bile duct called cholangiocytes and is therefore called cholangiocarcinoma or bile duct cancer.

The liver is also the seat of another type of cancer called secondary (or metastatic) liver cancer. In this condition, the main cancer originates elsewhere
in the body and secondary deposits are formed in the liver. A common example is colorectal cancer spreading to the liver via the bloodstream.

What are the risk factors for Liver Cancer?

The three main risk factors for developing HCC (the most common primary liver cancer) are chronic hepatitis B infection, chronic hepatitis C infection and
excessive alcohol consumption. The risk of an individual with chronic hepatitis B infection developing HCC is 100-fold that of an uninfected individual.

Other less common risk factors include aflatoxin (a poison found in mouldy peanuts, wheat, soya and grain), inherited conditions (e.g. haemochromatosis,
alpha-1 anti-trypsin deficiency) and any cause of cirrhosis (scarring throughout the liver) like autoimmune hepatitis or primary biliary cirrhosis. Many
liver cancers can be prevented by public health measures that reduce exposure to these known risk factors.

Common symptoms of Liver Cancer

Patients who develop HCC usually have no symptoms other than those related to their chronic liver disease. With worsening symptoms of the existing chronic
liver disease like abdominal distension with fluid (ascites), encephalopathy (altered mental state), jaundice, or gastro- instestinal tract bleeding may
heighten the suspicion of development of HCC. Besides that, some patients may have mild to moderate upper abdominal pain, weight loss, early satiety,
lethargy, anorexia or a palpable mass in the upper abdomen.

• abdominal distension with fluid (ascites)
• encephalopathy (altered mental state)
• jaundice
• weight loss
• early satiety
• lethargy
• anorexia

Liver Cancer Screening

Screening can help doctors find and treat HCC early, when the cancer is localised and more easily removed by surgery. This may in turn improve the chance of survival. Those with chronic hepatitis B infection and liver scarring (cirrhosis) due to hepatitis C or other causes are at increased risk and should be screened for liver cancer.

1. A blood test for alpha-fetoprotein (AFP) every 3-6 months
2. An ultrasound scan of the liver every 6-12 months
3. Medication to strengthen the lower esophageal sphincter. Baclofen may ease GERD by decreasing the frequency of relaxations of the lower esophageal sphincter. Side effects might include fatigue or nausea.
4. Prescription-strength H-2-receptor blockers. These include prescription-strength famotidine (Pepcid) and nizatidine. These medications are generally well-tolerated but long-term use may be associated with a slight increase in risk of vitamin B-12 deficiency and bone fractures.

Diagnosis For Liver Cancer

The following tests and procedures may be performed to diagnose HCC and to show the stage of the cancer:

Physical examination

Physical examination for general signs of health. An examination of the abdomen will also be performed to check for hard lumps or ascites.

Blood Tests

Blood tests to check general health, liver function and the amount of AFP. The amount of AFP in the blood can be higher in people with HCC.

Liver Ultrasound Scan

A liver ultrasound scan that uses sound waves to produce a picture of the liver. This is a painless test and usually takes several minutes to perform.
The picture may reveal a liver tumour.

Although a diagnosis of HCC can be made based on the amount of AFP in the blood and on dedicated CT or MRI scans, a liver biopsy may sometimes be needed
to be sure of the diagnosis. If the cancer has not already spread and if there is a chance it can be removed, then a biopsy might not be performed.

This is due to the small risk of the cancer spreading along the path of the needle when the biopsy needle is removed.

In this situation, the diagnosis is confirmed after an operation to remove the tumour.

Liver Cancer Treatments

The type of treatment for patients with HCC will depend on its stage (that is, its size and whether it has spread beyond its original site) and the
patient’s general health. The main treatments used are surgery, tumour ablation, chemotherapy, targeted cancer therapy and radiotherapy.

Surgery

Surgery is potentially curative and is therefore the treatment of choice for patients with early stage HCC. If
only certain parts of the liver are
affected by cancer and the rest of the liver is healthy, then surgery may be possible to remove the affected part or parts. This type of surgery is called
a liver resection. Another form of surgery is a liver transplant. This involves the removal of the entire liver and replacement with a healthy donated liver.
Such a major operation maybe performed when the cancer is in the liver only and a donated liver is available. If surgery is not possible, then other treatments
may be offered to help control the cancer, thereby reducing symptoms and improving quality of life.

Tumour Ablation

Tumour ablation aims to destroy primary liver cancer cells using either heat (radiofrequency ablation; RFA) or alcohol (percutaneous ethanol injection; PEI).
This procedure is usually done in the scanning department so that ultrasound or computerised tomography (CT) can help the doctor to guide a needle through the
skin and into the cancer within the liver. A local anaesthetic will be given. RFA treatment uses laser light or radio waves passed through the needleto 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.
Tumour ablation may sometimes be repeated if the tumour grows again.

Chemotherapy

Chemotherapy is the use of anti-cancer drugs to destroy cancer cells or stop them from dividing. It can help to control symptoms by shrinking the cancer and
slowing its progression. Chemotherapy drugs are usually given as injections into the vein (intravenously), although they can sometimes be given as tablets.

Chemotherapy may also be administered as part of a treatment called chemoembolisation. Chemoembolisation involves the injection of chemotherapy drugs directly
into the cancer in the liver, together with a gel or tiny plastic beads to block blood flow to the cancer (embolisation).

Not everyone is suitable for chemotherapy as it can only be given if the liver function is good enough.

Immunotherapy

An important part of the immune system is the ability to recognise foreign from normal cells. Immunotherapy isa relatively new form of therapy where
patients receivea medication targeted at a receptor called the Program death protein 1(PD1) or programmed death ligand 1(PD- L1). These are known as
checkpoint inhibitors. These drugs stimulate the immune cells called T lymphocytes to attack the cancer cells. A couple of immunotherapy drugs
(both PD1 inhibitors) have been shown to be useful in liver cancer and more clinical trials are underway.

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells or keep them from growing. External radiotherapy uses a machine outside the body the deliver
radiation towards the cancer. Such treatment is not often used to treat HCC because the liver cannot take very high doses of radiation. It may however
be used to relieve pain, for example, in patients whose cancer has spread to the bone. Alternatively, internal radiation uses a radioactive substance
delivered selectively to the cancer via a major blood vessel that carries blood to the liver (hepatic artery).

What is Liver Cancer?

Primary liver cancer is a disease in which malignant (cancer) cells arise from tissues in the liver. The different types of primary liver cancer are
usually named after the types of cells from which it is thought the cancer has developed. Hepatocellular carcinoma (HCC) or hepatoma arises from the main cells
of the liver called hepatocytes and accounts for about 85% of primary liver cancers. A less common type of primary liver cancer originates from cells that line
the bile duct called cholangiocytes and is therefore called cholangiocarcinoma or bile duct cancer.

The liver is also the seat of another type of cancer called secondary (or metastatic) liver cancer. In this condition, the main cancer originates elsewhere
in the body and secondary deposits are formed in the liver. A common example is colorectal cancer spreading to the liver via the bloodstream.

What are the risk factors for Liver Cancer?

The three main risk factors for developing HCC (the most common primary liver cancer) are chronic hepatitis B infection, chronic hepatitis C infection and
excessive alcohol consumption. The risk of an individual with chronic hepatitis B infection developing HCC is 100-fold that of an uninfected individual.

Other less common risk factors include aflatoxin (a poison found in mouldy peanuts, wheat, soya and grain), inherited conditions (e.g. haemochromatosis,
alpha-1 anti-trypsin deficiency) and any cause of cirrhosis (scarring throughout the liver) like autoimmune hepatitis or primary biliary cirrhosis. Many
liver cancers can be prevented by public health measures that reduce exposure to these known risk factors.

Common symptoms of Liver Cancer

Patients who develop HCC usually have no symptoms other than those related to their chronic liver disease. With worsening symptoms of the existing chronic
liver disease like abdominal distension with fluid (ascites), encephalopathy (altered mental state), jaundice, or gastro- instestinal tract bleeding may
heighten the suspicion of development of HCC. Besides that, some patients may have mild to moderate upper abdominal pain, weight loss, early satiety,
lethargy, anorexia or a palpable mass in the upper abdomen.

• abdominal distension with fluid (ascites)
• encephalopathy (altered mental state)
• jaundice
• weight loss
• early satiety
• lethargy
• anorexia

Liver Cancer Screening

Screening can help doctors find and treat HCC early, when the cancer is localised and more easily removed by surgery. This may in turn improve the
chance of survival. Those with chronic hepatitis B infection and liver scarring (cirrhosis) due to hepatitis C or other causes are at increased risk and
should be screened for liver cancer.

1. A blood test for alpha-fetoprotein (AFP) every 3-6 months
2. An ultrasound scan of the liver every 6-12 months

Diagnosis For Liver Cancer

The following tests and procedures may be performed to diagnose HCC and to show the stage of the cancer:

Physical examination

Physical examination for general signs of health. An examination of the abdomen will also be performed to check for hard lumps or ascites.

Blood Tests

Blood tests to check general health, liver function and the amount of AFP. The amount of AFP in the blood can be higher in people with HCC.

Liver Ultrasound Scan

A liver ultrasound scan that uses sound waves to produce a picture of the liver. This is a painless test and usually takes several minutes to perform.
The picture may reveal a liver tumour.

Although a diagnosis of HCC can be made based on the amount of AFP in the blood and on dedicated CT or MRI scans, a liver biopsy may sometimes be needed
to be sure of the diagnosis. If the cancer has not already spread and if there is a chance it can be removed, then a biopsy might not be performed.

This is due to the small risk of the cancer spreading along the path of the needle when the biopsy needle is removed.

In this situation, the diagnosis is confirmed after an operation to remove the tumour.

Liver Cancer Treatments

The type of treatment for patients with HCC will depend on its stage (that is, its size and whether it has spread beyond its original site) and the
patient’s general health. The main treatments used are surgery, tumour ablation, chemotherapy, targeted cancer therapy and radiotherapy.

Surgery

Surgery is potentially curative and is therefore the treatment of choice for patients with early stage HCC. If
only certain parts of the liver are
affected by cancer and the rest of the liver is healthy, then surgery may be possible to remove the affected part or parts. This type of surgery is called
a liver resection. Another form of surgery is a liver transplant. This involves the removal of the entire liver and replacement with a healthy donated liver.
Such a major operation maybe performed when the cancer is in the liver only and a donated liver is available. If surgery is not possible, then other treatments
may be offered to help control the cancer, thereby reducing symptoms and improving quality of life.

Tumour Ablation

Tumour ablation aims to destroy primary liver cancer cells using either heat (radiofrequency ablation; RFA) or alcohol (percutaneous ethanol injection; PEI).
This procedure is usually done in the scanning department so that ultrasound or computerised tomography (CT) can help the doctor to guide a needle through the
skin and into the cancer within the liver. A local anaesthetic will be given. RFA treatment uses laser light or radio waves passed through the needleto 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.
Tumour ablation may sometimes be repeated if the tumour grows again.

Chemotherapy

Chemotherapy is the use of anti-cancer drugs to destroy cancer cells or stop them from dividing. It can help to control symptoms by shrinking the cancer and
slowing its progression. Chemotherapy drugs are usually given as injections into the vein (intravenously), although they can sometimes be given as tablets.

Chemotherapy may also be administered as part of a treatment called chemoembolisation. Chemoembolisation involves the injection of chemotherapy drugs directly
into the cancer in the liver, together with a gel or tiny plastic beads to block blood flow to the cancer (embolisation).

Not everyone is suitable for chemotherapy as it can only be given if the liver function is good enough.

Immunotherapy

An important part of the immune system is the ability to recognise foreign from normal cells. Immunotherapy isa relatively new form of therapy where
patients receivea medication targeted at a receptor called the Program death protein 1(PD1) or programmed death ligand 1(PD- L1). These are known as
checkpoint inhibitors. These drugs stimulate the immune cells called T lymphocytes to attack the cancer cells. A couple of immunotherapy drugs
(both PD1 inhibitors) have been shown to be useful in liver cancer and more clinical trials are underway.

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells or keep them from growing. External radiotherapy uses a machine outside the body the deliver
radiation towards the cancer. Such treatment is not often used to treat HCC because the liver cannot take very high doses of radiation. It may however
be used to relieve pain, for example, in patients whose cancer has spread to the bone. Alternatively, internal radiation uses a radioactive substance
delivered selectively to the cancer via a major blood vessel that carries blood to the liver (hepatic artery).

What is Liver Cancer?

Primary liver cancer is a disease in which malignant (cancer) cells arise from tissues in the liver. The different types of primary liver cancer are usually named after the types of cells from which it is thought the cancer has developed. Hepatocellular carcinoma (HCC) or hepatoma arises from the main cells
of the liver called hepatocytes and accounts for about 85% of primary liver cancers. A less common type of primary liver cancer originates from cells that line
the bile duct called cholangiocytes and is therefore called cholangiocarcinoma or bile duct cancer.

The liver is also the seat of another type of cancer called secondary (or metastatic) liver cancer. In this condition, the main cancer originates elsewhere
in the body and secondary deposits are formed in the liver. A common example is colorectal cancer spreading to the liver via the bloodstream.

What are the risk factors for Liver Cancer?

The three main risk factors for developing HCC (the most common primary liver cancer) are chronic hepatitis B infection, chronic hepatitis C infection and
excessive alcohol consumption. The risk of an individual with chronic hepatitis B infection developing HCC is 100-fold that of an uninfected individual.

Other less common risk factors include aflatoxin (a poison found in mouldy peanuts, wheat, soya and grain), inherited conditions (e.g. haemochromatosis,
alpha-1 anti-trypsin deficiency) and any cause of cirrhosis (scarring throughout the liver) like autoimmune hepatitis or primary biliary cirrhosis. Many
liver cancers can be prevented by public health measures that reduce exposure to these known risk factors.

Common symptoms of Liver Cancer

Patients who develop HCC usually have no symptoms other than those related to their chronic liver disease. With worsening symptoms of the existing chronic
liver disease like abdominal distension with fluid (ascites), encephalopathy (altered mental state), jaundice, or gastro- instestinal tract bleeding may
heighten the suspicion of development of HCC. Besides that, some patients may have mild to moderate upper abdominal pain, weight loss, early satiety,
lethargy, anorexia or a palpable mass in the upper abdomen.

• abdominal distension with fluid (ascites)
• encephalopathy (altered mental state)
• jaundice
• weight loss
• early satiety
• lethargy
• anorexia

Liver Cancer Screening

Screening can help doctors find and treat HCC early, when the cancer is localised and more easily removed by surgery. This may in turn improve the
chance of survival. Those with chronic hepatitis B infection and liver scarring (cirrhosis) due to hepatitis C or other causes are at increased risk and
should be screened for liver cancer.

1. A blood test for alpha-fetoprotein (AFP) every 3-6 months
2. An ultrasound scan of the liver every 6-12 months

Diagnosis For Liver Cancer

The following tests and procedures may be performed to diagnose HCC and to show the stage of the cancer:

Physical examination

Physical examination for general signs of health. An examination of the abdomen will also be performed to check for hard lumps or ascites.

Blood Tests

Blood tests to check general health, liver function and the amount of AFP. The amount of AFP in the blood can be higher in people with HCC.

Liver Ultrasound Scan

A liver ultrasound scan that uses sound waves to produce a picture of the liver. This is a painless test and usually takes several minutes to perform.
The picture may reveal a liver tumour.

Although a diagnosis of HCC can be made based on the amount of AFP in the blood and on dedicated CT or MRI scans, a liver biopsy may sometimes be needed
to be sure of the diagnosis. If the cancer has not already spread and if there is a chance it can be removed, then a biopsy might not be performed.

This is due to the small risk of the cancer spreading along the path of the needle when the biopsy needle is removed.

In this situation, the diagnosis is confirmed after an operation to remove the tumour.

Liver Cancer Treatments

The type of treatment for patients with HCC will depend on its stage (that is, its size and whether it has spread beyond its original site) and the
patient’s general health. The main treatments used are surgery, tumour ablation, chemotherapy, targeted cancer therapy and radiotherapy.

Surgery

Surgery is potentially curative and is therefore the treatment of choice for patients with early stage HCC. If
only certain parts of the liver are
affected by cancer and the rest of the liver is healthy, then surgery may be possible to remove the affected part or parts. This type of surgery is called
a liver resection. Another form of surgery is a liver transplant. This involves the removal of the entire liver and replacement with a healthy donated liver.
Such a major operation maybe performed when the cancer is in the liver only and a donated liver is available. If surgery is not possible, then other treatments
may be offered to help control the cancer, thereby reducing symptoms and improving quality of life.

Chemotherapy

Chemotherapy is the use of anti-cancer drugs to destroy cancer cells or stop them from dividing. It can help to control symptoms by shrinking the cancer and
slowing its progression. Chemotherapy drugs are usually given as injections into the vein (intravenously), although they can sometimes be given as tablets.

Chemotherapy may also be administered as part of a treatment called chemoembolisation. Chemoembolisation involves the injection of chemotherapy drugs directly
into the cancer in the liver, together with a gel or tiny plastic beads to block blood flow to the cancer (embolisation).

Not everyone is suitable for chemotherapy as it can only be given if the liver function is good enough.

Immunotherapy

An important part of the immune system is the ability to recognise foreign from normal cells. Immunotherapy isa relatively new form of therapy where
patients receivea medication targeted at a receptor called the Program death protein 1(PD1) or programmed death ligand 1(PD- L1). These are known as
checkpoint inhibitors. These drugs stimulate the immune cells called T lymphocytes to attack the cancer cells. A couple of immunotherapy drugs
(both PD1 inhibitors) have been shown to be useful in liver cancer and more clinical trials are underway.

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells or keep them from growing. External radiotherapy uses a machine outside the body the deliver
radiation towards the cancer. Such treatment is not often used to treat HCC because the liver cannot take very high doses of radiation. It may however
be used to relieve pain, for example, in patients whose cancer has spread to the bone. Alternatively, internal radiation uses a radioactive substance
delivered selectively to the cancer via a major blood vessel that carries blood to the liver (hepatic artery).