A recent segment on the Taiwanese health program 57 Health Classmates highlights a critical oversight in liver cancer screening, underscored by the tragic case of a 38-year-old physician who succumbed to advanced hepatocellular carcinoma (HCC). Despite regularly monitoring his liver enzyme levels through blood tests that showed normal results, the young doctor was ultimately diagnosed with late-stage liver cancer, featuring a massive 10-centimeter tumor, demonstrating that blood work alone is insufficient to catch the disease in its crucial early stages.
The deceased physician, identified as Dr. Liao Yong-xiang, a gastroenterologist at National Taiwan University Hospital, was a carrier of Hepatitis B—a major risk factor for HCC. His routine blood tests, intended to track liver function (often measured by liver enzyme levels), consistently reassured him that his liver health was stable. However, as medical experts on the program pointed out, relying solely on these markers proved catastrophic, illustrating a gap in early detection protocols, particularly for high-risk individuals.
The Blind Spot of Liver Enzyme Testing
In the discussion, critical care specialist Dr. Huang Hsuan emphasized that consistently normal liver enzyme levels, such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT), do not equate to a liver free of disease, cancer, or cirrhosis.
“Liver enzyme levels often do not rise during the quiescent stages of chronic hepatitis, or paradoxically, when the liver has reached terminal failure or advanced cirrhosis,” Dr. Huang explained. This phenomenon creates a dangerous false sense of security.
For individuals with underlying risk factors, such as Hepatitis B or C, fatty liver disease (NAFLD/NASH), or heavy alcohol consumption, experts stress that comprehensive screening must extend beyond chemistry panels. The missing and essential step that Dr. Liao inadvertently skipped was regular abdominal ultrasound.
Key Actionable Takeaway for High-Risk Individuals:
- Do not rely solely on blood tests (AST/ALT).
- Mandatory annual or semi-annual abdominal ultrasound is essential to visualize the liver structure and detect masses or nodules before symptoms appear.
Recognising Advanced Symptoms
When HCC is detected merely through physical symptoms, it is often already advanced. Dr. Hsiao Tun-Jen, a gastrointestinal specialist, shared a case where a patient presented with persistent abdominal pain that multiple clinics failed to diagnose. Upon examination, Dr. Hsiao was palpably able to feel the patient’s liver, which had swollen so significantly that two 10-centimeter tumors were identifiable—a dangerous sign, as the liver is typically protected by the ribcage and not easily felt.
Furthermore, physicians highlighted that certain persistent skin conditions may serve as overlooked warning signs of underlying liver malignancy:
- Persistent jaundice or yellowing of the skin/eyes.
- Spider angiomas (small, spider-like blood vessels on the skin).
- Palmar erythema (unusual redness in the palms).
These dermatological changes reflect the liver’s inability to properly detoxify the blood due to advanced disease.
Protecting Liver Health in Everyday Life
The liver is renowned for its regenerative capacity, maintaining function longer than many other organs. However, its efficiency declines significantly after age 60, with volume and blood flow reducing drastically. Preventing injury is vital, and experts identified four common habits that accelerate liver damage:
- Chronic and excessive alcohol intake.
- Poor dietary choices leading to obesity and non-alcoholic fatty liver disease (NAFLD).
- Consumption of mycotoxin-contaminated foods, particularly those from moldy grains or improperly stored nuts (Aflatoxin is a known carcinogen).
- Misusing or overusing medications and supplements that stress liver metabolism.
The case of Dr. Liao serves as a stark reminder that even those with medical knowledge can fall victim to the silent nature of liver cancer if monitoring protocols are incomplete. For those with chronic underlying liver conditions, incorporating regular imaging via ultrasound is not optional—it is the difference between early intervention and a late-stage diagnosis.