Liver Cancer 101 – Risk Factors, Symptoms, Treatment Options & Prevention

Liver cancer

Cancer, the dreaded word nobody wants to hear from their doctor. Liver cancer especially, is one of the big silent killers as symptoms rarely surface until the cancer is at a later stage.

Liver cancer is the third most common cause of cancer-related deaths. It is also one of the most fatal cancers, with five-year relative survival rates of less than 15%, even in developed countries.

Hepatocellular carcinoma (HCC) is the most common form of liver cancer and is responsible for about 90% of the primary malignant (ability to spread and destroy tissues) liver cancers seen in adults.

Risk factors for liver cancer include

  • Chronic infection with hepatitis B virus (HBV) and/or hepatitis C virus (HCV)
  • Consumption of food contaminated with aflatoxin B (naturally occurring toxins produced by many species of fungus that can be found in tree nuts, peanuts and other oil seeds)
  • Alcohol-related cirrhosis (scarring of liver due to long-term liver damage)
  • Non-alcoholic fatty liver disease associated with obesity

You can prevent liver cancer by reducing your exposure to the risk factors

  • Avoid and treat hepatitis infections
  • Cut down on your alcohol and tobacco usage
  • Maintain a healthy weight as obesity can lead to fatty liver disease and diabetes, which have been linked to liver cancer
  • Stay away from cancer-causing substances such as aflatoxins (most commonly found in tree nuts, peanuts, and other oil seeds)

Liver cancer symptoms

Most people do not experience any symptoms in the early stages of liver cancer. When the symptoms manifest, they may include:

  • A hard lump on the right side just below the rib cage
  • Discomfort in the upper abdomen on the right side
  • Pain around the right shoulder blade
  • Unexplainable weight loss
  • Yellow-green colour on the skin and eyes (jaundice)
  • Unusual tiredness
  • Nausea
  • Ongoing lack of appetite

Treatment Options

There are five standard treatments used to treat liver cancer:

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Percutaneous ethanol injection
  • Targeted therapy

Unfortunately, liver cancer is notoriously difficult to treat and the standard treatments are often ineffective. It also does not respond well to conventional chemotherapy, so options for advanced liver cancer patients are limited.

Chances of recovery and treatment options depend on the factors below:

  • The stage of the cancer (tumour size, whether it affects part/all of the liver, or has spread to other places in the body)
  • How well the liver is working
  • Your general health, including whether there is cirrhosis of the liver

Surgery is perhaps the best chance to cure patients with liver cancer. If the cancer is found at an early stage and the rest of the liver is healthy, surgery with or without liver transplantation may be curative.

However, only about 15% of patients are operable as liver cancer is often detected at the later stages. It is rare for someone with inoperable liver cancer to live beyond a year after diagnosis.

Sorafenib – Your Best Chance for Survival

Sorafenib is the only oral anti-cancer drug approved in Malaysia, and the only one demonstrated to significantly improve overall survival in patients with HCC.

It delivers targeted therapy, which works differently from standard chemotherapy. Chemotherapy stops or slows the growth of cancer cells but it can also harm healthy cells that divide quickly. Targeted therapy works by honing in on the cancer cells and starving the tumour, while leaving normal cells relatively unharmed.

It is one of the newer classes of cancer therapies that work by targeting and blocking signalling proteins in cells to stop the generation of tumour cells as well as cuts off the blood supply to tumours.

Sorafenib Side Effects

As each person’s reaction to cancer treatment is different, with some experiencing very few side effects and others experiencing more, the possible side effects of sorafenib are generally mild and may go away during the course of treatment as the patient’s body adjusts to the medicine.

Most of these side effects can be managed with lifestyle adjustments, topical therapy or if necessary, medication. They may include hand or foot skin reaction, changes to the skin, fatiguehigher blood pressure, diarrhoea, mouth sores or ulcers, nausea, thinning of the hair and/or joint pains.

Sorafenib Donation through the NexPAP Programme

The NexPAP Patient Assistance Programme is a joint initiative by Bayer HealthCare and the Malaysian Liver Foundation that offers donation sorafenib to patients diagnosed with inoperable liver cancer (HCC) who satisfy eligibility criteria, after they have had two months’ treatment with the drug.

To qualify for this programme, you:

  • need to be a Malaysian citizen/Permanent Resident
  • satisfy the low income level criteria (subject to Malaysian Liver Foundation approval)
  • be able to purchase the first two months’ treatment of sorafenib

How it works

Upon qualification, Bayer HealthCare provides donation sorafenib for up to the following 12 calendar months to you.

The programme then continues when you buy the next two months’ supply, followed by the Bayer HealthCare donation – for as long as medically required as determined by the prescribing physician, and you continue to meet the eligibility criteria.

How to apply for the NexPAP programme

At their prescribing doctor’s recommendation, liver cancer patients can apply to the Malaysian Liver Foundation for the NexPAP Patient Assistance Programme. For more information, contact the foundation at 03-7842 6101.


Have you battled with cancer and came out victorious? Share your inspiring stories in the comments below or on our Facebook page.


Edited by: The HealthWorks Team
Adapted from “Coping with Liver Cancer” by Professor Datuk Dr Nor Shahidah Khairullah, Malaysian Liver Foundation Chief Executive Officer and Medical Director

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