Hello everyone. Welcome to our Homage series again. Today we're going to talk about some of the myths that we've heard about liver cancer, and the facts that Dr. Ian is here with us that he's going to share with us. So Dr. Ian is a general surgeon who specialises in liver, pancreas and biliary system. So, hi Dr. Ian.
Hi.
So today we're going to have three myths that I've read. Perhaps if you can help me or help us understand. So the first one is, first, does ethnicity play a high probability in liver cancer?
Ethnicity does have some role in causing liver cancer. So, we're talking about in the Malaysian population. Chinese are probably more likely to get liver cancer. That being because they are more prone to getting hepatitis B, most of them are- a lot of chronic hepatitis B carrier among the Chinese less, so in the Malay population and Indian population. Those are usually caused by other causes that lead to liver cancer. Yes, ethnicity does play some role in causing liver cancer.
Okay, so people with hepatitis has got a higher chance of being diagnosed of this liver cancer is that right?
Patients with hepatitis B and C, they have a higher chance of being diagnosed with liver cancer. So, there are other causes that can lead to liver cancer, things like chronic alcohol use. There are other other causes as well, newer things like what you call fatty liver disease that also can lead somewhat probably to liver cancer and there are smaller, smaller causes as well which we don't see commonly in Malaysia.
Okay, so that means is like Hepatitis B and C, mainly found within the Chinese will have higher tendency of getting diagnosed with liver cancer. And then with excessive alcohol but this is very general, there's a high tendency as well and fatty liver.
Yes. Yeah. Hepatitis B more so in Chinese. C, not so much in Chinese just B, it's, it's a how you say, hereditary diseases. It's been infected, or showing- basically passed over from parent to child, and have that kind of disease population in Malaysia, especially in the Chinese.
I see. Okay. Then the second question that I have is, is liver cancer the hardest cancer to cure?
It is one of- one of the hardest. It's not the hardest. Generally, the cancers, with liver, pancreas, the bile ducts, those are all- even gastric cancers, they're all difficult cancers to cure. Yeah, so it's not the hardest but it is one of the hardest.
Okay. Why is that?
Why is that. Good question. I guess, one it's not the most common- the most common cancer. So I guess in terms of research, in terms of knowledge on this cancer it's probably, it's still growing. It's not as vast as maybe even more common cancers like breast cancer or colon cancer or lung cancer, per se. And for some other reason we, as I say because we haven't studied it very well. So, treatment although it's wide sometimes we don't know even after treatment why it comes back, so quickly. In that sense, and also because maybe sometimes, a lot of times these patients, they present very late. So, the options for treatment is a little bit less, a bit harder to treat this patient and sometimes they are probably not very treatable when they first present, because of the advanced stage of the disease at that point of time.
I see. Is it because also the symptoms, is quite general such as weight loss- sudden weight loss. And, yeah, and maybe you know you feel uneasy.
Yeah. Actually- actually most most cancers. I mean, especially in the abdomen, they can come pretty vague. It does come as simple discomfort or, you know, once you- once you start getting things like weight loss, loss of appetite, usually quite significant already. So, yeah because of this vague symptom some, some, I guess, not just some most Malaysians have- I mean nobody really likes to see the doctor. Whatever's said and done. So people treat it as maybe just a simple gastric pain. You know just go buy some medication and self-treat. Or sometimes they see doctors and it's not picked up. They don't have a suspicion that it may be something else. So after left alone to fester for a while it might grow, and by the time it's actually caught, when it's giving these other symptoms like loss of weight, or maybe more severe pain, or if they turn a little bit yellow or what we call jaundice. Those - at that point it may be a bit too late, it may be a bit too advance. Yeah. So that's why it's a little bit harder to treat them.
Okay, one last question. So liver cancer I understand that sometimes it's just extraction of that growth in the liver or yeah. So does that mean that one can live with half a liver?
So, like I said, there are actually many treatment options for liver cancer. The ones that we deem more towards cure. It's about surgery liver resection. We can also give what we call ablation basically to burn the tumour, and another option which we are doing a little bit more in Malaysia now is liver transplant. But you're asking about basically specifically liver resection or removing the liver. So, yes. The amazing thing about the liver is it can regenerate it and grow, grow back after it's been injured or it's being removed. In a person with a normal liver capacity which means there's no liver injury or what we call cirrhosis, the person can actually probably live with just a mere 30% of their liver. Right, but if someone has liver cirrhosis or a previous liver injury, chronic liver injury. They can live with about 50% of the volume of the liver. It usually tends to regenerate and try to grow, and take over the whole function of the liver by itself.
So am I right to conclude that so, if someone is diagnosed with liver cancer. But because it's so hard to cure, given the illness, very little research to be done. So, I have only that few options to remove the tumour. And even if it's just removing half the liver. The probability of me still living a long life. Because I can still function because a normal human body can function with just 30% and because it can regenerate. So I've got a higher probability of still surviving.
So, let me get this right you're asking me whether a patient should get treatment, if they're- if they are diagnosed with liver cancer is that what you're asking?
No. More of even if it's towards a mid stage or a later stage. I have seen a doctor late. Although it's a hard cancer to cure, but the chances of me surviving is still very high because I can still live with 30% of my liver?
Okay. No, it doesn't really work that way because when we talk about cancer we talk about tumour burden basically after a while the tumour gets too big or runs into complications. But generally when the patient has an advanced disease, what we call not curable in terms of either removing them by, by surgery, or by ablation which is I said just now earlier on, burning it. We have other options as well. To give localised chemotherapy to that area, localised radiotherapy to that area we have oral medication which works like chemotherapy. Those things basically can help prolong the patient's life even though it is an advanced tumour. Of course, if it's really, really very advanced, then a lot of times we can only give comfort care. Just make sure they have a comfortable next few months to live on.
Okay. Alright, I hope this has cleared up most of the questions that we've generally received from our care recipients. Doctor is there any other last advice for our Malaysians out there.
Well, the liver is a very important organ. I guess, a lot of times, most of us aren't aware of this, but it is a very vital organ. One cannot live without the liver or the heart or the brain but yeah, one cannot live without the liver. And I think we do a lot of things to- to harm our liver; unhealthy lifestyle and whatever not. So, generally, I think we all need to take care of what we eat, how we live our lives, because that will affect us in the long term. And I think we should not be afraid to seek the doctor's opinion in any case that you're uncomfortable, or we have some uncertainty, get it checked out, not too late. Before it grows into something worse. I think that would be my general advice for Malaysians out there.
Okay, thank you Dr. Ian for your time.
No problem.
And thank you for watching us. And if you would like to know more, or if you would like to understand more about other medical conditions, please do write into us or comment at the Facebook comment box below. Thank you.