Good Morning Doctor: Unmasking Liver Cancer

2:13 Morning. Morning.

2:14 Good morning, Dr. Thng. I guess the first question is what exactly does the liver do in our bodies?

2:19 Okay. So the liver is a organ that has multiple functions. You know in English we call it the bal. Okay.

2:26 Yeah. So what it does it help detoxifies all the toxins from the body. It creates some blood clotting factors that help our bloods to clot. It also helps with digestion um by secretreting bowel to help digestion of food and even acts as a store of energy.

2:43 So it’s kind of like the filter.

2:46 Yes. It’s like a washing machine of the body.

2:48 Okay.

2:48 Okay. Now uh just asking for um you know the alcoholics tuned in right now who might not necessarily ask you this question on Facebook or YouTube or or or whatever you know when one drinks alcohol what does that do to the liver?

3:02 Okay so what it does is that um when alcohol is broken down it forms a metabolite called acetalihide which actually damages the liver. It um combines with oxygen and acts as a free radical. it causes damage to liver cells.

3:20 So if you have a alcoholic that actually does a liver function test potentially we might pick up some abnormal liver function test the certain liver enzymes might be elevated and that’s how we tell.

3:35 All right.

3:35 So if a person stops drinking uh maybe after feeling you know discomfort or something like that and just decides to you know quit drinking altogether can the liver rejuvenate itself? Okay. It it actually depends on how severe the damage is. So initially um in the initial few years basically what happens is that all the changes are reversible but of course over prolonged periods of time there can be scarring within the liver and shrinkage of the liver and at that point of time um the ch the damage is less reversible.

4:16 But of course stopping is still advised because what it does it prevents it reduces the damage to the subsequent healthy parts. Still I say further damage basically further damage. Okay. All right. Uh let’s continue to talk to Dr. Thng on the big show TV. Meanwhile, here’s the weekend with dancing in the flames on Kiss 92.

4:40 And it’s not just alcohol that can can damage the liver. What else do we need to be looking out for to not put in our bodies or put less of?

4:48 Okay, so basically there are certain risk factors that actually lead to liver damage. So normally they classified into infective uh risk factors and social risk factors.

4:57 So the infective risk factors are the ones like hepatitis B, hepatitis C. Um this we get from blood and fluid transfusion. um which we could even get from our mothers or for those that use um intravenous drugs they can get things like hepatitis C. So those these are things that we definitely need to avoid.

5:17 Mhm.

5:17 Social risk factors include that of uh alcohol, heavy alcohol use. For men um it’ll be defined as more than 10 units a week and for women more than seven units a week.

5:29 When you say unit is one drink, right?

5:31 So a unit um is roughly one pint of beer. A unit. Okay.

5:36 So, roughly 10 10 units. Sorry, two pints of beer.

5:40 So, uh

5:41 So, that’s a liter.

5:42 Yeah. So, one unit one unit is roughly one pint of beer.

5:47 Five about 500 ml if I’m not wrong.

5:49 Maybe I’m okay. I’m not so bad.

5:50 10 a week. Do you drink 5 liters of alcohol? Like that’s what it is, right?

5:55 A pint a day. No, a pint. A pint is one unit.

6:00 So, 500 ml is one unit.

6:01 Like the most. So, if I’m at home, I’ll either have like a one stout, a small can, or maybe uh one whiskey on the rocks in the evening before, you know, going to bed or something like that.

6:14 And then, yeah, that’s that’s basically it. But actually, you know, she kind of exaggerates where I don’t drink every day. There’s some days where I just don’t feel like it.

6:23 And I’m sure people can understand that. You feel like having a drink, you you have you have a drink, right? Have a drink. Yes. But if you don’t then you know so yeah so someone as you said uh is in danger for guys 10 units for ladies seven units.

6:38 Yes. Yes.

6:39 So there’s uh I mean there are people that say indulge in a glass of wine every day right for dinner or there are people that don’t drink throughout the week and then binge drink at on the weekend.

6:51 Is there a difference in the consumption amount or or how we consume it?

6:57 Okay. So I mean binge drinking does actually do more damage the liver because at that point of time the liver will metabolize more of the alcohol and there will be more damage at that point of time.

7:11 So what we actually recommend is not to go beyond four units per drinking session.

7:16 Oh right. So that’s 2 L. That’s still quite a lot though.

7:21 Depends on what you drink.

7:22 Okay. Okay.

7:23 If if it’s beer where the alcohol percentage is lower four. Yeah. Um

7:28 it’s roughly around that. But if you drink whiskey, 2 liters of whiskey, it’s a lot. It sounds like a lot. Yeah.

7:34 So it lowers as the alcohol level goes up.

7:36 Yes. Yes. Yes.

7:38 And nowadays most people drink whiskey, you know, the high ball way.

7:41 Yeah.

7:42 So they mix it with soda and stuff like that.

7:44 So it’s a little bit more diluted.

7:47 Yeah.

7:47 So Dr. Thng, how will we know something is wrong with our liver?

7:52 Okay. So for the initial stages um there are no signs no symptoms and you don’t get any complaints um only at the late stage then you tend to have signs and symptoms and what signs and symptoms you get you get jaundice meaning yellowing of the eyes yellowing of the skin you get te-olled urine okay then after that you get swelling swelling of the lower limbs swelling of the tummy all right and you also get uh easy bruising so you you keep getting bruises and you keep bleeding because the clotting factors are no longer produced in sufficient amounts.

8:28 Oh, bleeding where?

8:30 Um anywhere.

8:31 Anywhere under the skin. Um when you brush your teeth, you might get bleeding from the gums and all that. Okay.

8:38 Okay. So, but that is already too late.

8:40 Um that is too late. Yeah. That’s when the liver function is uh the liver has minimal function and you keep getting all these problems.

8:47 Yeah.

8:48 Right. What about fatty foods and all that? You know people tend to have bad diet here in Singapore. You know they maybe they eat ha food every day or fried food or will that also affect the liver?

9:00 Okay. So the liver acts as a store of energy and it stores um fat within the liver. So what you’re mentioning is probably what you’re talking about is fatty liver which is a pretty common problem in Singapore. Um when there’s too much fat in the liver, it also causes chronic inflammation in liver and actually leads to damage of the liver cells. Um so what we actually recommend is uh we recommend a clean diet involving five to six servings of fruits and vegetables a day. Go for lean cuts of protein. So um lean cuts. So no wagu beef, no sambar.

9:39 Yeah. Try to avoid the fatty streaky bacon. M yeah and then exercise will play a big part of this. You know exercise is divided into cardiovascular and strength training. So normally what I tell my patients is um go for 150 minutes of cardiovascular exercise a week.

9:58 Mhm.

9:58 At zone 2. Zone 2 essentially means um 70% of maximum heart rate. And how you calculate your maximum heart rate is 220 minus your age.

10:09 Okay. And um if you do that on a treadmill or on a bike um you you actually improve your cardiovascular fitness and then about two hours of strength training right a week.

10:21 Yeah.

10:22 That will help build lean body mass and because you know there are some people who are skinny fat. They are skinny but most of it is fat. So that’s not ideal.

10:31 Yeah. Yeah. Yeah. These are the people that can seem to eat anything they want, not exercise and still, you know, look like they’re not putting on weight. But internally it might not be all messed up. Yeah. Yeah. Uh at what age should we start to screen our livers?

10:46 Okay. So um currently liver screening is not routine. We only screen people for liver cancer if they have risk factors and the risk factors are hepatitis B and hepatitis C. For these patients we do regular ultrasounds and a a tumor marker test for them about every 6 months once.

11:06 um that is to pick up the liver cancer early when it’s still in a curative stage and we can do surgery to cure that. Um of course other social risk factors like heavy alcohol use um one could also consider doing um more frequent test to make sure we pick up something early.

11:25 Okay. Yeah. Okay.

11:26 Okay. I’m going to quit smok uh smoking. I’m going to quit uh drinking.

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11:39 [Applause]

11:40 [Music]

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12:06 Welcome back to the big show and the big show TV. We are talking to Dr. Thng Yongxian, general surgeon from Glenn Eagle’s Hospital about our liver today.

12:15 Yeah. So, doctor, we have um Kimberly on our Facebook says, “I drink weekly during family gatherings. Could be as much as a bottle of wine for that evening. How bad is this for my liver?”

12:27 Okay. So, a bottle of wine is roughly 7 to eight units.

12:33 So, that that’s a bit too much um for a single session. M.

12:38 So probably she should try to cut down that maybe half or or slightly more than half because you don’t want to also have I mean there’s some new data that actually also shows that low to moderate risk um use of alcohol can actually also affect um someone’s health span and lifespan.

12:58 So ideally ideally um we should try to avoid it all together. But if you can’t, then just try to go below seven units a week.

13:07 Seven units a week and not more than four if you’re binge drinking once a week. Okay. All right.

13:12 Now, having an unhealthy liver is one thing. Um, let’s talk about liver cancer. So, what are the risk factors um and perhaps maybe uh high risk um causes that might lead to um liver cancer. So the risk factors are mainly genetic risk factors and non-genetic risk factors.

13:36 The genetic risk factors are relatively rare in our part of the world. There are things like hemocchromattosis and Wilson’s disease quite rare here. The non-genetic risk factors are quite common. So non-getic ones would include the infective ones like hepatitis B and hepatitis C. But with the national vaccination program, the hepatitis B rate has is has decreased dramatically.

14:01 And then we have those social risk factors that includes alcohol use, heavy alcohol use. Um, obesity can contribute to liver cancer because it causes accumulation of fat in the liver and then chronic inflammation and this leads to the de development of liver cancer. And there’s something that we call metabolic syndrome which involves a combination of hypertension, high cholesterol and diabetes. And this also leads to more fat storage within the liver leading to um liver cancer.

14:35 Okay. Andy is on our Facebook and Andy is asking what are your thoughts uh about the carnivore diet which contradicts the clean diet recommendations? uh basically high saturated flat fat and zero plants plus fiber.

14:51 Okay. So I mean um the carnivore diet advocates taking lots of protein.

14:57 Um but I think the choice of protein needs to to you need to be certain about the choice of protein. You need to avoid um pro you need to take lean protein.

15:08 Yeah.

15:09 And uh if you take protein that has a lot of fat I I don’t think it’s recommended.

15:14 Right. Yeah.

15:15 Um, fruits and vegetables do provide certain crucial elements and vitamins to our diet. So, I I think it’s very hard to be on the carnivore diet for a sustainable period of time.

15:31 Yeah.

15:31 Can you imagine just eating for decades?

15:34 It’s not realistic.

15:35 I think it’s so stupid the carnivore diet. I think it was started by that stupid guy, the liver king or something like that who came up later to to admit he was a fraud. Yeah.

15:44 Oh my gosh. Yeah, that was so extreme and so ridiculous. I mean, I think it’s common sense sometimes. It’s like you can’t just eat meat all the time. You need to have a balanced diet, right? Some fruit, some vegetables.

15:53 We’ve done that since we were children.

15:55 I know. But there are many stupid people.

15:57 And he ate it raw.

15:58 He ate it raw. And everyone but his fans believed it.

16:02 So silly. You mentioned hepatitis B vaccination, but you didn’t mention hepatitis C.

16:08 Yeah. So, so there’s no real vaccination for hepatitis C, but currently there’s treatment for hepatitis C.

16:15 Um, hepatitis C, how you get hepatitis C mainly is a blood to blood transfusion.

16:21 And hepatitis C is common among um people who who has intravenous drug use.

16:29 um not so common in Singapore but uh it is something definitely to avoid because when they share needles they actually get hepatitis C.

16:38 Okay.

16:39 Yeah.

16:40 How about promiscuous people?

16:43 That that can also lead to transmission of hepatitis C.

16:46 Okay. Okay. So exchange of as long as fluid exchange and blood exchange. Yeah. All right.

16:51 There you go. Just putting it out there.

16:52 Yeah. Of course. Yeah. Cuz it’s not just uh drug users that we need to know.

16:57 Okay. It’s 8:19

16:59 KISS 92 time check.

17:02 Okay.

17:03 Okay. So, uh reduce the lifestyle changes. We spoke about that. What about treatments? Uh treatment options for liver cancer.

17:11 So, um treatment options for liver cancer depends on the stage of liver cancer. So if you have a localized liver cancer um just localize the liver hasn’t spread anywhere then we’ll try to go for curative approach means to achieve cure and the best option is definitely surgery to have the tumor removed.

17:32 But if you have a tumor that is still localized the liver is too big is attached to crucial structures which we can’t sacrifice or after removing this tumor there’s inadequate liver F then we’ll try local regional approaches by which we deliver radiation or chemotherapy directly to the liver.

17:55 And of course in the later stages where the liver cancer has spread elsewhere to the lungs to other parts of the body then unfortunately in these cases we can only use systemic treatment meaning um drugs um targeted therapy drugs to deliver the drugs to these areas or immunotherapy.

18:16 Yeah.

18:17 And what about things like liver transplants though I mean are those very common and when does that happen? So um liver transplant uh is done with curative intent um when the tumor is localized to liver um that’s when liver transplant can be used and especially in the cases where there’s already surrounding liver damage.

18:39 So in those cases it’s very useful liver transplant but there can’t be that many livers out there that uh you know work with who needs it right. So I mean there there are two sources of of li of livers. Um one is a cataric cataric liver transplant. Someone gets brain dead and you get the liver.

19:00 Or the other option is from a living donor.

19:04 But you you need to get a match.

19:06 Yeah. Of course. Yeah.

19:07 Which is why I mean a classic example is Pierre and Andrea right back then.

19:10 That’s right. Yes.

19:11 I mean um you know I think she was really lucky that Pierre was a match.

19:14 Was a match. Yes. Yeah.

19:16 Anyway. Okay. Um doctor I also want to ask you like you know over the years I’ve had friends who have like parents you know who have come down with like liver cancer and all that and all of them were and the funny thing is I’m talking about like seriously over the years over the past like maybe 15 years or whatever maybe about 10 of my friends you know whose whose uh family members and all that who have come down with liver cancer none of them were drinkers.

19:41 Mhm.

19:41 Uh I dare say also the majority of them, well at least my friends claim that their their parents led a healthy lifestyle,

19:49 but they still got liver cancer.

19:52 Uh when they discovered it, it was too late. Stage four already. Why why does these things why do these things happen?

19:58 Okay. So the older generation um at that time there wasn’t a hepatitis B vaccination.

20:05 I see. I see. So many of the older generation got liver cancer because they had undiagnosed hepatitis B. They’re carrying the virus and it caused chronic inflammation and damage the liver cells and over decades then you develop liver cancer.

20:21 But um we have sort of eradicated that problem with the national vaccination program from from from babies.

20:28 Yeah.

20:29 By giving the vaccines as their babies.

20:31 No. What about us?

20:33 We must have had mandatory to have hepatitis because you would have been like 3 months, 6 months, whatever it is before a year old. I don’t remember.

20:42 Yeah, you’ve probably got a scar like on your somewhere. Is it a lifetime vaccination then? It doesn’t need to be topped up or anything.

20:49 Um, it only needs to be topped up uh if you’re a healthare worker, right? Where where you get regular exposure?

20:55 Exposure.

20:56 But just to be sure, can I go for He loves his

20:59 We can do a blood test to check whether you you are immune to hepatitis B, the antibodies you have and all that.

21:06 Oh, okay. Okay. So, because I go for yearly checkups, so I think my doctor will probably have a record there. Okay.

21:12 So, regular blood uh tests already test for this, right? Whether you’re protected against it or do you need to ask for it?

21:18 You need to ask for it.

21:19 Okay.

21:20 Yeah, you need to ask for it.

21:21 Okay. Uh we have Charlene uh that’s come on that’s uh messaged on our Facebook as well. What about taking liver supplements daily? Does it help if I drink two to three glasses of alcohol a day? Like I take milk milk thistle every day.

21:35 So natural I take uh not so natural I take Heprol 400.

21:39 So okay.

21:41 So things like that do they help? I mean a lot of my patients do ask me about this and um what I tell them is that uh there’s no hard scientific data that shows that it helps

21:56 um but um people often take this supplements because they have done something to damage the liver and they hope that this will sort of um res resolve some of the damage.

22:09 But I think the key thing is to avoid damage to the liver. M.

22:14 So if she’s drinking two to three glasses of wine, don’t use it to offset that that over a week that might that I think is definitely more than uh seven units.

22:25 So she’ll probably need to try to cut down on that. Um the best way is to find something. We often drink because of the emotions drinking give to us. You know, it makes you more relaxed.

22:37 Um puts you more at ease. So the best way is to find something that does the same. Either exercise

22:46 Yeah.

22:47 listening to music, listening to Glenn and Andrea.

22:50 Yeah. Yeah. Yeah. No, that’s that’s true. Um cold plunge.

22:55 Like cold like for me, I take the milk.

22:58 I take the milk thistle as a preventative measure cuz if I have a drink, it’s only on the weekend.

23:03 Yes.

23:03 Right. So I feel like that keeps the liver healthy. Yes. Is is that is that the right frame of mind or I don’t need to be taking any supplements for the liver at all?

23:13 I don’t think the milk thistle will help that much if you Yeah, it’s not going to

23:18 What about non-drinkers though? I mean, if can they take any supplements to kind of keep the liver healthier than than normal or not?

23:26 So, there are few ways to actually keep your liver healthy. Um, not you you don’t really need to spend money on supplements. Um what my typical advice is um diet. So diet I think um five to six servings of fruits and vegetables a day. Um keep to lean proteins. Um avoid highly processed foods and as much as possible stick to whole grains. And actually the way we cook our food is really important. If even if we choose lean protein and everything is uh fried and deep fried that’s that that’s probably not ideal. So, we need to keep it clean. Yeah. Um, the cooking method should be steaming, uh, boiling instead of frying. And then, of course, exercise.

24:13 Okay.

24:13 Okay. All right. Going back on air for traffic update. And then, uh, one last

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24:29 m.

24:32 Kiss 92 traffic on the KJ towards the PIE right before Chachukong Drive. Exit avoid lane one, an accident. Also on the BKE towards the PIE, an accident at the dairy farm road entrance. And finally on the on Kanehill Circle, I beg you pardon, towards Kanehill Rise, right after Kanehill Road, avoid lane one, a vehicle has broken down. Wherever you are, stay safe.

24:57 Welcome back to the Big Show and the Big Show TV. We have been speaking to Dr. Thng Yongxian, general surgeon, Glenn Eagle’s Hospital about the silent killer unmasking liver cancer today. And uh speaking of liver cancer, is it on the up here in uh Singapore? Doctor,

25:14 um the the number of liver cancer patients actually has gone down quite a bit due to hepatitis B, the vaccination of hepatitis B. But there are now more patients getting liver cancer due to fatty liver

25:29 and we call it nash. Basically there’s too much fat within the liver. Um it’s called non-alcoholic uh fatty liver disease. Too much fat within the liver it causes chronic inflammation and then you get a liver cancer and that is actually on the up.

25:45 Wow. So that’s very food related.

25:47 Food related. Lifestyle related.

25:49 Basically we have a westernized um lifestyle. lots of processed food, food that’s high in saturated fat and all that. Yeah,

25:58 we have, speaking of food, uh Jeremy is just asking how balance should the HDL and LDL levels be? Is there a ratio?

26:06 Okay, so um that’s mainly due to the cholesterol thing.

26:10 Um HDL is is good cholesterol. So that should be as high as possible, but LDL ideally should be as low as possible.

26:20 Less than 2.6. Yeah. M so no ratio no ratio yeah less than 2.6 six.

26:26 So does it mean u I mean someone with high cholesterol also has a high risk of um developing liver disease.

26:33 Okay. I mean someone with high cholesterol it tends to come together with other issues. So a high cholesterol is just a manifestation of your lifestyle normally unless you have a genetic issue. Um and when you have high cholesterol, your lifestyle probably will lead to hypertension, increased risk of diabetes and all this do contribute to increased amount of fat within the liver and increased chance of liver cancer. Yeah.

27:01 Okay.

27:01 Now I’m feeling my tummy is aching like wait I just want to ask where exactly is the liver doctor? Is it on the right side?

27:09 On the right behind or underneath? Just below the rib.

27:12 Just below the ribow.

27:14 Just have a final question cuz you spoke about frying, you spoke about oily, you spoke about fat. What about things like sugars? Is that bad for the liver?

27:22 Yeah. So, so simple sugars, very simple sugars like if you take lot of uh copip a lot of sugar, a lot of condensed milk ideally that’s not good for liver.

27:34 Um because they do get converted to fat within the liver.

27:39 Yeah. Um so fat within the liver is not not a bad thing. Okay.

27:44 One last question. What about intermittent fasting? Does that do anything for the liver?

27:50 I think intermittent fasting um is good. It reduces the calories with within uh the amount you take within a day. And what it actually helps is if you have a bad diet, you eat less of your bad diet.

28:06 Right. Right.

28:08 Which is ideal. A good thing. Yeah.

28:08 Which is a good thing. Yeah. But of course, when you come off the fast, ideally you eat the good stuff, healthy stuff.

28:16 Okay. All right. Well, thank you very much, doctor, for joining us today.

28:19 We’ve had fun talking to you and uh it wasn’t that scary.

28:24 Not hurting anywhere.

28:26 Uh still a little bit, but maybe it’s because um you know, I ate too much just now for breakfast.

28:30 It is possible.

28:30 Okay. Thank you very much, doctor, for joining us. Thank you. For more insight,