Protecting Your Liver Health: Understanding Liver Cancer, Prevention and Early Screening

31 December 2025

 

Liver cancer is a serious, potentially life-threatening disease. It can be broadly classified into primary liver cancer and secondary liver cancer, depending on where it originates.

Primary liver cancer occurs when an cancerous lump or growth occurs in the liver, which may then spread to other parts in the body. Secondary liver cancer, on the other hand, occurs when cancer cells spread to the liver from other organs in the body. 

Hepatocellular carcinoma is most common type of liver cancer, accounting for approximately 90 percent of primary liver cancer cases in Malaysia. It is the eighth most common cancer in Malaysia and the sixth most common cancer worldwide, and remains the third leading cause of cancer-related deaths globally.

Risk Factors for Liver Cancer

Almost all cases of hepatocellular carcinoma are associated with liver injury and cirrhosis. In fact, around 80 percent of patients with hepatocellular carcinoma have underlying cirrhosis. In Malaysia, chronic hepatitis B or hepatitis C infections are the leading risk factors. Men are about three times more likely than women to develop hepatocellular carcinoma. 

Other common risk factors include:

• Alcohol-related liver disease
• Fatty liver disease, also known as metabolic-dysfunction associated fatty liver disease (MAFLD)
• Exposure to a fungal toxin called aflatoxin B1
• Iron overload conditions
• Genetic conditions that lead to liver cirrhosis
• Smoking
• Diabetes mellitus or obesity
• Intravenous drug use
• Heavy alcohol consumption

Liver Cancer Symptoms

Liver cancer often has no obvious symptoms in its early stages. In fact, around 60 to 70 percent of patients experience no symptoms before diagnosis. Unfortunately, symptoms usually develop in the later stages of the disease.

These may include:

• Pain in the upper right abdomen
• Jaundice (yellowing of the skin and eyes)
• Unexplained weight loss
• Persistent fatigue
• Abdominal swelling
• Leg oedema

Liver Cancer Diagnosis and Screening

Liver cancer can be detected through a liver ultrasound or elevated tumour markers called alpha fetoprotein in the blood. If abnormalities are detected, further evaluation with triple phase CT liver scans or MRI with hepatobiliary contrast is required to confirm the diagnosis.

To determine the stage of the disease, including whether cancer has spread, a staging CT scan to look at the chest and pelvis is also required. 

For individuals at high risk, liver ultrasound screening every six months is recommended. Alpha fetoprotein testing may be performed to improve early detection and enable timely treatment.

Treatment Options for Liver Cancer

Treatment for liver cancer is guided by the Barcelona Clinic Liver Cancer staging system, which classifies the disease from Stage 0 to Stage D based on tumour size, number of tumours and liver function. The stages are divided into:

• Stage 0: Very early disease
• Stage A: Early disease 
• Stage B: Intermediate disease
• Stage C: Advanced disease 
• Stage D: End-stage disease.

Patients diagnosed at very early or early stages may achieve curative outcomes through surgical resection, ablation or liver transplantation. However, for those with liver cancer at the intermediate and advanced-stage liver cancer, treatment is usually palliative and may include:

• Transarterial chemoembolisation (TACE)
• Stereotactic ablative radiotherapy (SABR)
• Immunotherapy

Treatment decisions are typically made through multidisciplinary team discussions, involving specialists in radiology, hepatobiliary surgery, hepatology, clinical oncology and pathology.

How to Prevent Liver Cancer

Reducing the risk of liver cancer requires proactive lifestyle changes and medical management, including:

• Maintaining a healthy weight
• Limiting, or ideally abstaining, from alcohol consumption
• Quitting smoking
• Adopting a healthy diet with reduced intake of processed foods and sugary drinks
• Regular follow-up and treatment for conditions such as hepatitis B, fatty liver disease and diabetes

With rising rates of obesity and diabetes, fatty liver disease has become an increasingly important risk factor for liver cancer, second only to hepatitis B. This makes public awareness and early intervention more important than ever.