Liver Tumour Markers

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Dr Thng Yongxian

MBBS

MMed

MRCS (IRE)

FRCSED

FAMS

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Liver tumour markers are biochemical substances, typically proteins, found in the blood, that indicate the presence of liver cancer. These markers are produced either by the cancer cells themselves or by the body in response to cancer.

They are important in the detection, diagnosis, and monitoring of liver cancer, including hepatocellular carcinoma (HCC), the most common type, which often develops from chronic liver diseases such as hepatitis or cirrhosis.

Liver Tumour Markers

Liver tumour markers are critical in diagnosing and managing liver cancer. The most commonly used markers include:

  • Alpha-fetoprotein (AFP)
    This is the most frequently used marker for liver cancer, particularly hepatocellular carcinoma (HCC). Elevated AFP levels are common in liver cancer but can also occur in other conditions, such as hepatitis and cirrhosis. AFP levels are instrumental in monitoring treatment responses and detecting recurrences after therapy.
  • Carcinoembryonic antigen (CEA)
    While CEA is more commonly associated with colorectal cancer, elevated levels can also occur in liver metastasis and other types of cancer, as well as various non-cancerous conditions. Elevated levels of Carcinoembryonic antigen (CEA) are not specific to metastasis or advanced liver disease; further diagnostic context is needed.
  • Des-gamma-carboxy prothrombin (DCP)
    Also known as PIVKA-II, DCP is more specific than AFP and does not increase with benign liver diseases. It is particularly useful in detecting early-stage HCC and in patients whose AFP levels remain normal.

The Role of Liver Tumour Markers in Diagnosing Liver Cancer

Liver tumour markers play a pivotal role in the diagnostic process for liver cancer. Their primary use includes:

Screening and Early Detection

For people at high risk of liver cancer, such as those with chronic liver disease or hepatitis, regular screening using tumour markers can help detect cancer at an earlier, more treatable stage.

Diagnosis

While no single tumour marker is definitive for diagnosing liver cancer on its own, the presence of elevated levels of specific markers like AFP or DCP in the context of clinical findings can support the diagnosis.

Monitoring and Prognosis

After a liver cancer diagnosis, tumour markers are frequently monitored over time. Changes in their levels can indicate how well the cancer is responding to treatment or if there is a recurrence.

Limitations of Liver Tumour Markers

While liver tumour markers are useful in the management of liver cancer, they have certain limitations:

  • Specificity and Sensitivity

    Not all liver tumour markers are exclusively specific to liver cancer. For example, AFP can also be elevated in conditions like hepatitis and cirrhosis, which may lead to false positives in cancer diagnosis.

  • Staging and Localisation

    Tumour markers alone cannot determine the stage of the cancer or its exact location within the liver. Imaging studies are required for detailed staging and localisation.

  • Variability in Levels

    There can be significant variability in marker levels between people, and some patients with liver cancer may not show elevated levels at all, reducing the efficacy of these markers in certain cases.

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Dr Thng Yongxian

MBBS (SG)

MMed (Surg)

MRCS (Ire)

FRCSEd (Gen)

FAMS (Surg)

Dr Thng Yongxian is a dual fellowship-trained Hepatopancreatobiliary & General Surgeon who has performed over 6000 surgical procedures.

  • Bachelor of Medicine & Bachelor of Surgery,
    National University of Singapore
  • Membership of the Royal College of Surgeons, Ireland
  • Master of Medicine, General Surgery, Singapore
  • Fellow of the Royal College of Surgeons, Edinburgh
  • Fellow of the Academy of Medicine, Singapore

He pursued his subspecialty training in Hepatopancreatobiliary surgery first in the Department of Hepatopancreatobiliary Surgery, Singapore General Hospital. Following this, he completed a clinical fellowship in Minimally Invasive Hepatopancreatobiliary Surgery at Seoul National University Hospital in Bundang, South Korea.

Dr Thng set up and pioneered the Minimally invasive surgery program for his hospital in complex liver and pancreas cases. His surgeries were featured on live national television. His surgical videos have also been presented at international surgical conferences. He also pioneered the use of capsule colonoscopy for colorectal screening.

Dr Thng has served on various committees at hospital, cluster and ministry level. Dr Thng served as a member of the Ministry of Health (MOH) Laparoscopic cholecystectomy Clinician workgroup for value-driven care (VDC).

Patient Reviews

I cannot possibly express how grateful I am for the compassionate care received by Dr Thng during my hospitalization. I was 20 hours away from flying back to the USA after a long work trip, and homesick already when diagnosed with acute appendicitis and a UTI. To say that I was nervous to undergo surgery so far away from home, friends and family is an understatement. He was expedient, attentive and thorough. He even took the time to text and call my husband back home multiple times to update him on my status. His infectious laugh, sense of humor and kindness helped to sooth my own frazzled nerves. I am so appreciative to have had Dr Thng as my surgeon.

Ms Tina Hunter

I was diagnosed for ampullory cancer in 2021. I am very thankful to Dr. Thng Yongxian who kept me calm when revealing the report to me. I really felt like God sent his angel to speak to me.He helped me overcome the operation. Dr. Thng said 3 things that I needed to do before the operation....Stay positive, exercise n eat well, have faith in God. He even gave me his handphone number incase I need to consult him when home. Indeed the 8 hrs operation was a success n I am able to write this testimonial, living a normal life. Finally, its still God who works all things good for those who love Him... Romans 8:28.

Mdm Tang K H

I recently underwent gallbladder stone removal surgery performed by Dr. Thng, and I am impressed with the quality of care I received during this process. Dr. Thng demonstrated exceptional professionalism and expertise throughout my entire experience. From the initial consultation to the post-operative care, Dr. Thng explained the procedure in great details, answered all my questions, and alleviated my concerns and ensuring that I fully understood each step of the process. His compassionate and caring demeanor put me at ease, making me feel confident in his abilities. The outcome of the procedure was beyond my expectations. Dr. Thng successfully removed all my 3 gallstones, and I experienced a smooth recovery process. I am grateful for his expertise and the care I received under his supervision. Overall, my experience with Dr. Thng was exceptional. I highly recommend him for his professionalism, compassion, and outstanding surgical skills. Thank you, Dr. Thng for your excellent care.

Mr Low LT

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    Frequently Asked Questions (FAQ)

    What Are Liver Tumour Markers?

    Liver tumour markers are proteins or other substances produced by cancer cells or by the body’s immune response to liver cancer. They are measurable in blood tests and are used to help diagnose, monitor, and manage liver cancer.

    Which Liver Tumour Marker Is Most Commonly Used?

    Alpha-fetoprotein (AFP) is the most commonly used liver tumour marker, particularly for detecting hepatocellular carcinoma (HCC), the most common type of liver cancer.

    Can Liver Tumour Markers Be Used for Screening?

    Yes, liver tumour markers, especially AFP, are used for screening people at high risk for liver cancer, such as those with chronic hepatitis or cirrhosis.

    How Reliable Are Liver Tumour Markers in Diagnosing Liver Cancer?

    While useful, liver tumour markers are not definitive for diagnosing liver cancer on their own. They must be used in conjunction with imaging studies and other tests for accurate diagnosis.

    Do Normal Levels of Tumour Markers Guarantee the Absence of Liver Cancer?

    No, normal levels of tumour markers do not guarantee the absence of liver cancer. Some patients with liver cancer may not exhibit elevated marker levels, particularly in the early stages.

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