Medical Tribune September 2008 SFXIX
David Brill
A panel of experts has called on GPs to
step up screening for liver cancer, which
carries the second highest mortality of all the
common cancers.
As the prognosis of the disease continues
to improve, physicians need to take a more
active role in early case identification, the
group of specialists from the National Cancer
Centre Singapore (NCCS) said.
Speaking at the start of Liver Cancer
Awareness Month, they also advised GPs
to familiarize themselves with the latest advances
in diagnosis and treatment, encouraging
them to attend an educational forum
which will take place in September.
“As outcomes improve we need to become
more aware of what is potentially possible
for our patients in order to give them
hope as well as a chance of a cure,” said Professor
London Lucien Ooi, deputy director
of the NCCS and chairman of the campaign.
“GPs have a big role to play in prevention,
treatment and early screening, and they
need to understand that part.”
Hepatitis B carriers and people with cirrhosis
of the liver are at high risk for developing
cancer and should be screened every 6
months to a year, he said.
“For hepatitis B patients the risk of liver
cancer is about one hundred to three hundred
times more than in the normal population
… it’s a huge number and for that
it makes sense to screen them on a regular
basis,” he said.
The Ministry of Health is currently working
on a set of stand-alone guidelines for liver
cancer screening, according to Ooi, who
expects them to be published later this year.
In the meantime he recommended that
ultrasound and alpha fetoprotein be used for
screening, with the regularity decided on a
case-by-case basis. Once a potential tumor is
identified by ultrasound, MRI and CT can be
used for further investigation.
Left untreated, liver cancer kills most
patients within 6 months. Surgical resection
or transplantation, however, can extend life
to over 5 years in around half of patients,
Ooi said. Other promising new approaches
include transarterial chemoembolization,
radiofrequency ablation and percutaneous
ethanol injection, he added.
Liver Cancer Awareness Month is aimed
at both the public and medical community,
with a view to raising the profile of the disease
and promoting understanding of the
link to hepatitis B, which is the most common
cause of liver cancer and is highly prevalent
in East Asia.
Four hundred free hepatitis B screenings
are being offered at SingHealth Polyclinics,
and adults who have not been vaccinated are
being encouraged to do so.
Dr. Tan Yu Meng, deputy head of surgical
oncology at NCCS, said that in most cases
the tumor has already reached around 5 to 10
cm in diameter at the time of diagnosis.
“We want to get out the message that the
at-risk group needs to go and get themselves
screened because if you pick up these tumors
early then liver surgery, radiofrequency ablation
or chemotherapy can control your disease
very well,” he said.
The forum for GPs will be held on 20th
September, covering a range of subjects
from imaging through to treatment options.
There will also be an open case discussion,
with attendees encouraged to share their
own experiences.
A roundtable discussion for specialists
from both public and private institutions
will take place on 27th September.
David Brill
A panel of experts has called on GPs to
step up screening for liver cancer, which
carries the second highest mortality of all the
common cancers.
As the prognosis of the disease continues
to improve, physicians need to take a more
active role in early case identification, the
group of specialists from the National Cancer
Centre Singapore (NCCS) said.
Speaking at the start of Liver Cancer
Awareness Month, they also advised GPs
to familiarize themselves with the latest advances
in diagnosis and treatment, encouraging
them to attend an educational forum
which will take place in September.
“As outcomes improve we need to become
more aware of what is potentially possible
for our patients in order to give them
hope as well as a chance of a cure,” said Professor
London Lucien Ooi, deputy director
of the NCCS and chairman of the campaign.
“GPs have a big role to play in prevention,
treatment and early screening, and they
need to understand that part.”
Hepatitis B carriers and people with cirrhosis
of the liver are at high risk for developing
cancer and should be screened every 6
months to a year, he said.
“For hepatitis B patients the risk of liver
cancer is about one hundred to three hundred
times more than in the normal population
… it’s a huge number and for that
it makes sense to screen them on a regular
basis,” he said.
The Ministry of Health is currently working
on a set of stand-alone guidelines for liver
cancer screening, according to Ooi, who
expects them to be published later this year.
In the meantime he recommended that
ultrasound and alpha fetoprotein be used for
screening, with the regularity decided on a
case-by-case basis. Once a potential tumor is
identified by ultrasound, MRI and CT can be
used for further investigation.
Left untreated, liver cancer kills most
patients within 6 months. Surgical resection
or transplantation, however, can extend life
to over 5 years in around half of patients,
Ooi said. Other promising new approaches
include transarterial chemoembolization,
radiofrequency ablation and percutaneous
ethanol injection, he added.
Liver Cancer Awareness Month is aimed
at both the public and medical community,
with a view to raising the profile of the disease
and promoting understanding of the
link to hepatitis B, which is the most common
cause of liver cancer and is highly prevalent
in East Asia.
Four hundred free hepatitis B screenings
are being offered at SingHealth Polyclinics,
and adults who have not been vaccinated are
being encouraged to do so.
Dr. Tan Yu Meng, deputy head of surgical
oncology at NCCS, said that in most cases
the tumor has already reached around 5 to 10
cm in diameter at the time of diagnosis.
“We want to get out the message that the
at-risk group needs to go and get themselves
screened because if you pick up these tumors
early then liver surgery, radiofrequency ablation
or chemotherapy can control your disease
very well,” he said.
The forum for GPs will be held on 20th
September, covering a range of subjects
from imaging through to treatment options.
There will also be an open case discussion,
with attendees encouraged to share their
own experiences.
A roundtable discussion for specialists
from both public and private institutions
will take place on 27th September.
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