Liver Cancer: Symptoms, Hepatitis Link and Prevention in Pakistan

In Pakistan, millions of people live with hepatitis B or hepatitis C, often without knowing it. Over 10 to 30 years these viruses can quietly scar the liver and, in some people, lead to liver cancer. Liver cancer is often found late because the liver has few pain nerves and the early stages cause no symptoms. The encouraging part is that most of the risk is preventable, and people who are at risk can be watched closely so that any cancer is caught early.

What is liver cancer?

The most common form is hepatocellular carcinoma (HCC), which starts in the liver cells themselves. It usually develops on top of long-standing liver damage. Cancer that has spread to the liver from the colon, breast or lung is a different problem, called secondary or metastatic liver cancer.

Liver cancer symptoms

Early liver cancer rarely causes symptoms. As it grows, people may notice:

• Unexplained weight loss and loss of appetite
• Feeling full after eating very little
• A dull pain or heaviness in the upper right abdomen, or pain near the right shoulder blade
• A lump or swelling in the upper abdomen
• Nausea, vomiting and unusual tiredness
• Yellow eyes and skin (jaundice), dark urine, pale stools and itching
• A swollen belly from fluid, or swollen legs
• Vomiting blood or black stools, which is an emergency

These are also signs of advanced liver disease in general, so they do not always mean cancer, but they always mean you need to see a doctor quickly.

What causes it?

• Chronic hepatitis B and hepatitis C infection, the leading causes in Pakistan. See our guide to hepatitis C.
• Cirrhosis (scarring) from any cause
• Fatty liver, particularly with diabetes and obesity
• Heavy alcohol use
• Aflatoxin, a poison made by mould on stored grain, peanuts and nuts kept in damp conditions
• Family history, and some inherited liver diseases

How the infections spread in Pakistan

Hepatitis B and C pass through blood. The common routes are reused or unsafe syringes and injections, unsterilised dental or surgical instruments, shared razors at the barber, unscreened blood transfusions, needle-sharing and, for hepatitis B, from mother to baby at birth and through unprotected sex. Insist on a fresh, sealed syringe every time, and a new blade at the barber.

Who should be checked, and how?

Anyone with cirrhosis, or chronic hepatitis B or C, should have a liver ultrasound, often along with an AFP blood test, every six months. This routine surveillance can find a cancer when it is small and can still be treated. Everyone should have a one-time hepatitis B and C test, which is simple and inexpensive. Diagnosis is confirmed with imaging, such as a CT or MRI scan, and sometimes a biopsy.

Treatment

Treatment depends on the size of the tumour, the strength of the remaining liver and your overall health. Options include surgery to remove the tumour, liver transplant, destroying the tumour with heat or chemicals (ablation, chemoembolisation), radiotherapy, and targeted or immune-based drug therapy. Small tumours found through surveillance can often be treated with a good chance of cure, while advanced cancer can only be controlled. This is why prevention and early detection matter so much.

How to prevent liver cancer

• Get vaccinated against hepatitis B. The vaccine is safe, is part of routine childhood immunisation, and adults who missed it can have it too.
• Treat hepatitis C. Modern tablets such as sofosbuvir-based regimens cure the great majority of people, and cure greatly lowers cancer risk.
• Treat hepatitis B if your doctor advises. Antiviral medicines such as tenofovir keep the virus under control and protect the liver. They must be taken long term without gaps.
• Avoid alcohol if your liver is damaged.
• Keep a healthy weight and control diabetes.
• Store grains, peanuts and nuts dry, and throw away anything mouldy or bitter.
• Use only sterile syringes and new razor blades.

When to see a doctor

• Yellow eyes or skin, dark urine, or itching
• Unexplained weight loss, loss of appetite or abdominal swelling
• Pain or a lump in the upper right abdomen
• Vomiting blood or black stools. Go to emergency straight away.
• You have hepatitis B or C or cirrhosis and have not had a recent ultrasound

Key takeaways

• Liver cancer is mostly caused by hepatitis B, hepatitis C, cirrhosis and fatty liver, and has few early symptoms.
• People with these conditions need an ultrasound every six months.
• Hepatitis B vaccination and hepatitis C cure are the best prevention.
• Always use sterile syringes and fresh razor blades.

Related medicines on Medimart

These medicines are commonly used to prevent liver cancer by controlling hepatitis. Cancer treatment itself is decided by your oncologist or liver specialist.

• Hepatitis B vaccine: prevents hepatitis B infection
• Tenofovir: an antiviral used for chronic hepatitis B
• Sofosbuvir: an antiviral used in hepatitis C cure regimens

Prescription medicines are supplied only against a valid prescription. Please take them only as advised by your doctor.

Browse liver care medicines and cancer care products on Medimart with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor. If you have hepatitis or cirrhosis, please ask your doctor about regular liver screening.