Liver Cancer

What Is Liver Cancer?

Liver cancer is a cancer of the liver cells called hepatocytes, which make up 80% of the liver. It can manifest as multiple nodules within the organ. Liver cancer ranks as the third most common cancer globally but it is notably more common in Asian countries due to relatively high rates of hepatitis B infection, a significant risk factor. In Singapore, liver cancer is the 4th most common cancer among Singaporean males.

Types of Liver Cancer

Liver cancer is categorised as either primary or secondary, depending on the origin of the cancerous cells.

Primary Liver Cancer

This type of liver cancer begins within the liver tissue and can manifest in various types, with hepatocellular carcinoma (HCC) being the most common. Hepatocellular carcinoma (HCC), also known as hepatoma, is particularly common among people aged 50 and above, especially those with cirrhosis.

Metastatic or Secondary Liver Cancer

The second type of liver cancer refers to cancer that has spread to the liver from another part of the body. The most common type of metastatic liver tumour is metastatic colorectal cancer, which begins in the colon or rectum and spreads to the liver through the bloodstream.

Stages of Liver Cancer

The staging system commonly used for liver cancer is the TNM staging system. This system is used to stage cancer based on the size and extent of the T (tumour), N (node) and M (metastasis).

Stage I (T1, N0, M0)

At this stage, the tumour is localised within the liver and is small in size, without any involvement of nearby lymph nodes.

Stage II (T2, N0, M0)

In stage II liver cancer, the tumour has grown into blood vessels but remains confined within the liver without spreading cancer cells to nearby lymph nodes or distant sites.

Stage III (T3 or T4, N0 or N1, M0)

At this stage, several tumours or at least one large tumour has either grown extensively within the liver (T3 or T4) or cancer cells have spread to lymph nodes near the liver (N1) but have not metastasized to distant organs.

Stage IV (Any T, Any N, M1)

Stage IV liver cancer indicates advanced disease where the cancer cells have spread to other parts of the body, such as the lungs or bones (M1).

What Are the Risk Factors of Liver Cancer?

Several risk factors can influence liver cancer, including:

Chronic Viral Hepatitis

The most common risk factor for liver cancer is chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). HBV and HCV can be transmitted through blood transfusions, sharing contaminated needles during drug use, unprotected sexual contact, or from mother to child during childbirth.

Liver Cirrhosis

Cirrhosis is when liver cells are scarred due to long-term liver damage and inflammation. Some people who develop liver cancer already have underlying cirrhosis.

Non-Alcoholic Fatty Liver Disease (NAFLD)

This disease occurs due to the buildup of fat in the liver, which can result in inflammation, liver damage, and potentially liver cancer.


People with a family history of liver cancer may face a higher risk of developing liver cancer.

Type 2 Diabetes

Individuals with Type 2 diabetes have a higher risk of developing liver cancer due to higher insulin levels or liver damage resulting from diabetes.


Smoking can cause various cancers, including liver cancer. This risk escalates when combined with heavy alcohol consumption.

Signs and Symptoms of Liver Cancer

There are often no symptoms during the early stages of liver cancer but as the cancer progresses, various symptoms may begin to show, including:

  • Fatigue
  • Nausea or vomiting
  • Unexplained weight loss
  • A lump in the right side of the abdomen
  • Abdominal pain
  • Right shoulder pain
  • Jaundice (yellowing of the skin and the whites of the eyes)
  • Itching

How Is Liver Cancer Diagnosed?

Initially, your doctor will assess your medical history and symptoms and conduct a physical examination. If liver cancer is suspected, additional tests will be ordered to confirm the diagnosis. These diagnostic tests include:

Imaging Scans

Imaging techniques such as ultrasound, CT scans and MRI are used for visualising the liver and detecting abnormalities like tumours or lesions.


A liver biopsy involves the removal of a small amount of liver tissue using a laparoscope. Tissue samples are analysed to confirm the presence of cancer cells and determine the type and extent of the cancer.

Blood Tests

These measure the level of alpha-fetoprotein (AFP), a protein produced by the liver that is connected to primary liver cancer. Blood tests are also done to assess the health of the liver, blood clotting abilities, tumour markers, hepatitis B or C infections, genetic issues, and any abnormalities in liver function.

Treatments for Liver Cancer

Your doctor may recommend treatment options based on the cancer stage, as well as your age, overall health, and individual preferences. Treatments for liver cancer typically include:


Surgery is the common approach for localised liver cancer. Surgical procedures, such as hepatectomy and liver transplantation, aim to remove cancerous tissue and provide a chance for long-term survival.

Localised Therapies

These techniques are often used for small liver tumours that are not suitable for surgery or for patients who are not candidates for surgery due to health reasons. Radiofrequency ablation (RFA) is a type of local therapy that uses high-frequency electrical currents to destroy cancer cells.

Systemic Therapies

Systemic therapies for liver cancer target cancer cells throughout the body, often through medications administered orally or intravenously, aiming to control or shrink tumours in the liver and potentially elsewhere.

Can Liver Cancer Be Prevented?

Liver cancer may not be completely prevented but there are steps that one can take to lower the risk of developing this condition. These include:

Seeking Treatment for Hepatitis B and C Infections

Consult a doctor for appropriate medication and preventive strategies for hepatitis B or C.

Vaccination Against Hepatitis B Virus

The hepatitis B vaccine reduces the risk of developing liver cancer, especially for those at higher risk of exposure.

Smoking Cessation and Alcohol Moderation

These can reduce risks for liver cancer as excessive smoking and alcohol consumption can contribute to liver damage.

Weight Management

Maintain a healthy weight to reduce the risk of obesity-related conditions, including fatty liver disease and liver cancer.

Maintaining an Active Lifestyle

Aerobic exercises such as brisk walking, jogging, cycling, swimming, and dancing increase blood flow to the liver, which helps in detoxifying the body and removing harmful substances.

Consuming a Healthy, Balanced Diet

Fruits, vegetables, whole grains, and lean proteins provide essential nutrients and antioxidants that support liver function and reduce cancer risk.

Practising Safe Sex

The use of condoms during sex helps reduce the transmission of hepatitis B and C, both of which can increase the risk of liver cancer.

Frequently Asked Questions (FAQs)

Who should be screened for liver cancer?

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What is the prognosis/survival rate for liver cancer?

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Could liver cancer come back after treatment?

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Dr Kieron Lim Image

Meet Our Liver Cancer Specialist

Dr Kieron Lim

MBBS, University of LondonMember, Royal College of Physicians (UK)Fellow, Academy of Medicine (Gastroenterology) SingaporeFellow, Royal College of Physicians (Edinburgh)

Dr Kieron Lim is a senior gastroenterologist with over 30 years of experience treating patients with gastrointestinal conditions, including liver cancer. As the former head of the Division of Gastroenterology and Hepatology at the National University Hospital; and current Medical Director of the Liver Transplant Programme at Mount Elizabeth Hospital, he is skilled in managing complex liver cases. Dr Lim specialises in using endoscopic procedures to diagnose liver cancer accurately and coordinating the best possible care for each patient.