Liver cancer is a malignant tumor that starts in the liver cells, and the most common type is hepatocellular carcinoma. In Hong Kong, because of the relatively high proportion of hepatitis B carriers, liver cancer has long ranked among the most common cancers and leading causes of cancer death. The liver is called a 'silent organ' — early liver cancer almost never causes symptoms, and by the time abdominal pain or jaundice appears, the disease is often already at an intermediate or advanced stage.
That is exactly why regular monitoring for high-risk groups is so important. Liver cancer found early has a chance of being cured with surgery or ablation. Even for intermediate or advanced disease, recent advances in targeted therapy and immunotherapy have greatly improved treatment prospects.
Causes and Risk Factors
Chronic hepatitis B and hepatitis C infections are the main causes of liver cancer. Long-term infection leads to repeated liver inflammation and fibrosis, which eventually progresses to cirrhosis and liver cancer. Cirrhosis itself is the most important precancerous condition — whether it is caused by viral hepatitis, long-term heavy alcohol use, or fatty liver disease (metabolic-associated fatty liver disease), patients with cirrhosis are at high risk for liver cancer.
Other risk factors include: aflatoxin (from moldy food), long-term heavy drinking, fatty liver related to obesity and diabetes, a family history of liver cancer, and being male or older. It is worth emphasizing that hepatitis B vaccination and antiviral treatment for hepatitis C (which can now be cured) are both effective ways to prevent liver cancer.
Common Symptoms and Warning Signs
Early liver cancer usually causes no symptoms at all — this is the most dangerous feature of the disease. As the tumor grows, possible symptoms include: pain or a dull, bloated feeling in the upper right abdomen, loss of appetite, nausea, unexplained weight loss, and easy fatigue.
Later-stage signs include: yellowing of the skin and whites of the eyes (jaundice), fluid buildup in the abdomen (ascites), itchy skin, and tea-colored urine. If you already have cirrhosis and your symptoms suddenly worsen (such as more ascites or confusion), seek medical care immediately. High-risk groups should not wait for symptoms to appear — they need to take the initiative with regular check-ups.
Diagnosis and Staging Concepts
Diagnosis of liver cancer combines blood tests and imaging: alpha-fetoprotein (AFP) is a commonly used tumor marker, along with ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) to evaluate the tumor. Liver cancer can sometimes be diagnosed based on typical imaging features alone, without necessarily needing a biopsy. For patients with hepatitis B or cirrhosis, ultrasound and AFP testing are generally recommended every six months.
In addition to tumor size, number, and whether it has spread, staging must also assess liver function (such as the Child-Pugh grade), because the remaining liver function directly determines which treatments can be tolerated. This is the biggest difference between liver cancer staging and that of other cancers.
Overview of Treatment Options
Curative treatments for early liver cancer include: surgical resection (for those with good liver function), radiofrequency or microwave ablation (for small tumors), and liver transplantation (for those who meet specific criteria, which can address both the tumor and cirrhosis). For intermediate-stage disease, treatment mainly consists of local therapies such as transarterial chemoembolization (TACE) or radioembolization.
Drug treatment for advanced liver cancer has advanced rapidly in recent years: immunotherapy combined with anti-angiogenic targeted therapy has become the mainstream first-line regimen, clearly extending survival compared with traditional targeted drugs (such as sorafenib). Liver function status is always a core consideration when choosing a regimen.
Clinical Trials: One More Treatment Option
Liver cancer is one of the most active areas for research into combined immunotherapy and targeted therapy, with new combinations, new drugs, and strategies combining local therapy with drugs continually being tested in clinical trials. For patients who do not respond well to standard treatment, clinical trials are often a shortcut to accessing the latest therapies.
The CancerLink platform can match patients with recruiting liver cancer clinical studies in Hong Kong based on cancer type, stage, and genetic mutations. Once successfully matched and enrolled, study-related treatment costs are fully covered. Learning about your options gives you one more choice.
If you are a hepatitis B carrier or have cirrhosis, be sure to develop a habit of regular monitoring — an ultrasound every six months may be the most important line of defense between you and early liver cancer. Patients who have already been diagnosed should not lose hope either; liver cancer treatment is advancing faster than you might imagine.