PETALING JAYA: Fatty liver disease is now fast becoming a leading cause of liver cancer in Malaysia, which is the sixth most common cancer in the country, say experts.
University Malaya Medical Centre (UMMC) consultant hepatologist Prof Dr Rosmawati Mohamed said fatty liver, described as a “disease of the modern times”, could develop due to conditions such as diabetes, expanding waistline or abdominal obesity as well as excess body weight.
According to a liver cancer study published by UMMC this year, the leading cause of the cancer was Hepatitis B at 44%, followed by fatty liver disease at 42%, Hepatitis C at 8% and alcohol at 6%.
“These are the signs of modern times, with an increasing number of individuals – both adults and children – having expanding waist circumference. Fatty liver is now a major health problem and has become the commonest liver disease in Malaysia.
“Fatty liver is rapidly becoming the leading cause of liver cancer, nearly equal to Hepatitis B based on the current study,” she said in the “A Red Alert When You Turn Yellow” webinar on Oct 9 organised by Star Media Group and supported by Roche yesterday.
More commonly diagnosed in men than women and usually among those above 50, liver cancer is the sixth most common cancer in Malaysia.
Prof Rosmawati said for the majority of people with underlying liver disease such as Hepatitis B or Hepatitis C, treatment could reduce their risk of developing liver cancer.
However, a majority of people with liver disease, she said, had no symptoms, adding that major signs such as jaundice, tiredness or ascites occurred when the disease was already advanced or upon development of liver failure, advanced cirrhosis or liver cancer.
“That’s why we say there’s a red alert when you turn yellow.
“Patients with high risk of developing liver cancer should be entered into surveillance programmes, which means screening every six months,” she said.
Prof Rosmawati said to reduce the risk of developing liver cancer, people should get their diabetes under control if they were diabetic and to lose weight if they were overweight.
“Studies have also shown that losing between 7% and 10% weight can reverse the inflammation of your liver completely and stop the progression of the cancer.
“Getting 150 minutes of exercise per week and having a healthy diet helps.
“Avoid unsafe injection practices and the sharing of needles and lastly, avoid alcohol, as it can cause liver disease which can progress to liver cancer,” said Prof Rosmawati.
Clinical oncologist Dr Cheah Soon Keat said based on his experience, patients might sometimes appear asymptomatic, adding that even those with fit lifestyles might still develop liver cancer due to other causes.
“In my practice, especially in my early days in the Health Ministry, majority of patients have symptoms such as bloatedness and weight loss.
“But other symptoms such as fatigue, jaundice, abdominal or leg swelling, easy bruising or pain are the typical but also non-specific signs as well,” he said.
At the same time, he said some patients might have bone or back pain for a few months before going to the doctor.
“The doctor must be vigilant knowing that these may be symptoms of underlying malignancy,” said Dr Cheah.
This was the case for liver cancer patient Lim Jit Sai, who shared how he was diagnosed in 2017 after having an ultrasound scan for a persistent back pain due to a kidney stone.
Lim said the ultrasound did not detect any kidney stone but instead showed growth in the liver, which was confirmed by a subsequent CT scan.
“I don’t have a family history of liver cancer and I don’t smoke or drink and was careful with my diet so I didn’t think at the time that I was at risk for liver cancer.
“I didn’t have any alarming symptoms that would warrant medical attention. It was only due to that kidney stone pain in my back that brought me to the emergency department of the hospital.
“I had no other symptoms that interfered with my daily activities, nothing noticeable, no loss in appetite and nothing that would indicate anything unusual,” said Lim.
The only thing he noticed was a gradual weight loss but a liver function test he took did not raise any alarm bells, and he attributed the weight loss to his active lifestyle.
Prof Rosmawati said Lim was one of the rare cases of a patient without an underlying cirrhosis of the liver but still ended up with liver cancer.
Lim, who had surgery in February 2018 to remove part of his liver affected by cancer, has been going for regular checkups and managed to pick up another small growth in July 2019, which was also treated.
Another scan this year again showed a new small growth, which was also treated.
Dr Cheah said this showed the importance of routine checkups as cancer could recur after remission, adding that it would allow doctors to pick up if something was wrong with the patient.
“As for individuals with no other risk factor for liver cancer, I would say that doing a yearly screening is sufficient,” he added.