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

31 December 2025

Liver cancer is a serious disease and a significant threat to human health. It is broadly classified into primary liver cancer and secondary liver cancer. Primary liver cancer originates in the liver, with hepatocellular carcinoma being the most common type. In Malaysia, hepatocellular carcinoma accounts for about 90 percent of primary liver cancer cases. Secondary liver cancer, on the other hand, occurs when cancer cells spread to the liver from other parts of the body. 

According to statistics, hepatocellular carcinoma ranks sixth among the most common cancers worldwide and eighth in Malaysia. It is also 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. Other common risk factors include:

• Alcohol related liver disease
• Fatty liver disease, also known as metabolic dysfunction-associated fatty liver disease (MASLD)
• Exposure to aflatoxin B1
• Iron overload and hereditary liver diseases
• Smoking, diabetes and obesity

Men are about three times more likely than women to develop hepatocellular carcinoma. Individuals with cirrhosis, people who inject drugs, long-term smokers, heavy alcohol users, those who are overweight and individuals with diabetes are considered high risk groups.

Liver Cancer Symptoms

Liver cancer often has no obvious symptoms in its early stages. Around 60 to 70 percent of patients experience no symptoms before diagnosis. As the disease progresses to intermediate or advanced stages, symptoms may include:

• Pain in the upper right abdomen
• Yellowing of the skin and eyes known as jaundice
• Unexplained weight loss
• Persistent fatigue
• Abdominal swelling and leg oedema

Liver Cancer Diagnosis and Screening

Initial screening for liver cancer is commonly performed using liver ultrasound or alpha fetoprotein blood testing. If abnormalities are detected, further evaluation with triple phase CT scans or hepatobiliary MRI is required to confirm the diagnosis and determine the stage of the disease, including whether cancer has spread.

For individuals at high risk, such as those with advanced liver fibrosis, cirrhosis, chronic hepatitis B infection or a family history of liver cancer, liver ultrasound screening every six months is recommended. Alpha fetoprotein testing may be added to improve early detection and enable timely treatment.

Treatment Options for Liver Cancer

Liver cancer treatment 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 and liver function. 

• 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. For those with intermediate and advanced stages, treatment is usually palliative and may include:

• Transarterial chemoembolisation
• Stereotactic ablative radiotherapy
• Immunotherapy

Treatment decisions are typically made by a multidisciplinary team, 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 management, including:

• Maintaining a healthy weight
• Limiting or avoiding 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, second only to hepatitis B. This makes public awareness and early intervention more important than ever.