Understanding Stage 4 Liver Cancer: Symptoms, Treatments, and Prognosis

Liver cancer remains a pressing global health issue, and in Singapore, it is the fourth most common cancer affecting men. While early detection can improve outcomes, many cases are diagnosed only at an advanced stage. Stage 4 liver cancer, in particular, presents unique challenges as the disease has already progressed significantly. eases, how they are diagnosed and treated, and what you should know to protect your liver.

What Is Stage 4 Liver Cancer?

Stage 4 liver cancer, also known as advanced or metastatic liver cancer, indicates that the cancer has spread beyond the liver to other parts of the body, such as the lungs or bones. In medical terms, this stage is defined as Any T, Any N, M1 according to the TNM staging system, where:

• T (Tumour): Describes the size and extent of the primary tumour in the liver
• N (Nodes): Indicates whether cancer has spread to nearby lymph nodes
• M (Metastasis): Reflects whether the cancer has reached distant organs or lymph nodes

Stage 4 liver cancer is further divided into two categories: Stage 4A and Stage 4B. Stage 4A involves cancer that has spread to nearby lymph nodes but not to distant organs, while Stage 4B involves cancer that has spread to distant organs.

Symptoms of Stage 4 Liver Cancer

In its early stages, liver cancer may not present noticeable symptoms. However, as the disease progresses to Stage 4, individuals might experience:

• Fatigue

  : Persistent tiredness not alleviated by rest

• Unexplained Weight Loss

  : Significant weight loss without changes in diet or exercise

• Abdominal Pain

  : Discomfort or pain, especially in the upper right side of the abdomen

• Jaundice

  : Yellowing of the skin and the whites of the eyes

• Nausea or Vomiting

  : Frequent feelings of nausea or episodes of vomiting

• Abdominal Swelling

  : Accumulation of fluid in the abdomen, leading to bloating

• Right Shoulder Pain

  : Referred pain due to liver enlargement

• Itching

  : Generalised itching due to bile salt accumulation

• Loss of Appetite

  : Reduced desire to eat

• Unexplained Fever

  : Fever without an apparent cause

Treatment Options for Stage 4 Liver Cancer

Managing Stage 4 liver cancer requires a multidisciplinary approach. Since the cancer has spread beyond the liver, treatment typically focuses on controlling disease progression, alleviating symptoms, and improving quality of life. The main treatment strategies include:

Prognosis of Stage 4 Liver Cancer

The outlook for Stage 4 liver cancer is typically serious, as the disease has already spread beyond the liver to other parts of the body. However, prognosis can vary significantly depending on several key factors, including the patient's overall health, liver function, and how well the cancer responds to treatment.

In Singapore, the overall 5-year relative survival rate for liver cancer is more than 20%, which is among the best in the world, second only to Japan. However, for Stage 4 liver cancer, the median survival is typically less than six months. Some patients can live longer than expected with proper treatment, but the prognosis remains generally poor.

Dr Kieron Lim: Expertise in Liver Cancer Management

Dr Kieron Lim is a Senior Consultant in Gastroenterology and Hepatology based in Singapore. With over 30 years of experience in managing complex liver conditions, including liver cancer, Dr Lim provides comprehensive care that spans diagnosis, treatment, and post-treatment support. He is the current Medical Director of the Liver Transplant Programme at Mount Elizabeth Hospital. He has previously served as the Head of the Division of Gastroenterology and Hepatology at the National University Hospital (NUH).

Preventive Measures and Regular Screening

Preventing liver cancer involves addressing key risk factors and adopting lifestyle changes. Some of the most significant risk factors include chronic infections with hepatitis B or C, excessive alcohol intake, and non-alcoholic fatty liver disease (NAFLD). By addressing these underlying issues, individuals can significantly lower their risk of developing liver cancer.

Preventive Measures

Various preventive measures can be taken to reduce the risks of developing liver cancer. These include:

• Vaccination Against Hepatitis B: This is a crucial preventive measure, especially for those born before the national vaccination program was implemented in Singapore.
• Limiting Alcohol Consumption: Reducing alcohol intake can significantly lower the risk of liver disease and cancer.
• Maintaining a Healthy Lifestyle: This includes regular exercise, a balanced diet, and maintaining a healthy weight to reduce the risk of NAFLD.
• Controlling Diabetes and Metabolic Syndrome: Managing these conditions can help prevent NAFLD and related liver complications.
• Practising Safe Behaviours: Avoid sharing needles and practise safe sex to prevent hepatitis B and C transmission.

Regular Screening

Regular screenings are essential for early detection of liver cancer, particularly for those at higher risk. Recommended screening tests include:

• Serum Alpha-Fetoprotein (AFP) Level: This blood test can indicate liver cancer and should be done every 3 to 6 months for high-risk individuals.
• Ultrasound of the Liver: This imaging test should be performed every 6 to 12 months to detect liver abnormalities early.