Can Hepatitis B Cause Liver Cancer?
Persistent loss of appetite and frequent abdominal pain should not be ignored, as they may be signs of liver cancer — the third leading cause of cancer-related death in Hong Kong.
According to a clinical oncologist, well-known symptoms of liver cancer such as yellowing of the skin and eyes (jaundice) and rapid weight loss, usually appear only in the later stages of the disease. In many cases, patients initially experience only stomach discomfort and difficulty eating, believing they have a stomach problem. Medical examinations later reveal that a tumour in the liver is pressing against the stomach.
Can Hepatitis B Lead to Liver Cancer?
In Hong Kong, around 80% of liver cancer cases are caused by hepatitis B infection. Therefore, people with chronic hepatitis are strongly advised to undergo regular medical check-ups so that any abnormalities can be detected and treated early.
Liver cancer is the third leading cause of cancer death in Hong Kong. Data from the Hospital Authority shows that there are about 1,800 new liver cancer cases each year, with over 1,500 deaths annually. The disease is more common in men.
Clinical oncologist Dr Cheung explained that early‑stage liver cancer is usually silent and without obvious symptoms. By the time symptoms appear, the cancer is often already in the middle or late stages. Many patients initially experience symptoms such as fatigue, mild abdominal pain, or stomach discomfort, which are often mistaken for other illnesses. Some patients only receive a liver cancer diagnosis after undergoing multiple medical tests.
Jaundice and Rapid Weight Loss Are Mid-to-Late Stage Symptoms
“Many patients first feel that their stomach feels full and they cannot eat properly, so they go to the doctor thinking it’s a stomach problem,” said Dr. Cheung.
Some patients even undergo gastroscopy (endoscopy), which shows no abnormalities. Further tests then reveal that the problem originates from the liver.
Some patients also experience abdominal pain. The liver itself does not contain pain nerves, but if a tumour grows outward or develops near the liver’s outer capsule, patients may feel pain. If the tumour continues to grow, it may bleed or rupture, causing sudden severe abdominal pain, which is sometimes when the tumour is finally discovered.
Other mid-to-late stage symptoms of liver cancer include:
- Jaundice (yellowing of the skin and eyes)
- Significant weight loss
Dr. Cheung explained that jaundice appears when liver function has already deteriorated. The liver is responsible for producing proteins, and when liver function declines, it cannot produce enough proteins. Combined with the effects of the tumour, patients may experience rapid weight loss.
Most cases of early-stage liver cancer detected before symptoms appear occur in patients who already have hepatitis and are undergoing routine ultrasound monitoring. Some cases are also discovered incidentally during health check-ups.
However, in clinical practice, most patients are diagnosed only at the mid or late stages, when treatment options are mainly targeted therapy and immunotherapy to control tumour growth and extend survival.
It Takes at Least Five Years for Hepatitis B to Develop Into Cancer
Approximately 80% of liver cancer cases in Hong Kong originate from hepatitis B infection.
Dr. Cheung noted that the progression from hepatitis to liver cirrhosis and eventually liver cancer usually takes at least five years. Hepatitis B carriers who undergo regular medical screening can detect abnormalities early and receive treatment promptly, which may even allow for curative treatment in some cases.
Therefore, patients with chronic hepatitis or liver cirrhosis should undergo the following every six months:
- Liver function blood tests
- Alpha-fetoprotein (AFP) tumour marker tests
- Abdominal ultrasound scans
For the general population, the most important preventive measure is receiving the hepatitis B vaccine.
People should also:
- Avoid excessive alcohol consumption
- Avoid smoking
- Avoid foods contaminated with aflatoxin
Maintaining a diet that is low in oil, salt, and sugar can also help support liver health.
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