By Lolleroll Hong Kong Food Blog
Seasoned Award-Winning Health & Food Writer
A 65-year-old engineer walked into an emergency room asking for diarrhea medication, convinced he had a minor stomach bug. An abdominal ultrasound later showed his liver was riddled with malignant tumors, with almost no healthy tissue left. In another case, a man in his seventies who had faithfully taken antiviral drugs for years and received normal liver function blood tests every twelve months was found to have a 17-centimeter tumor lurking inside his liver.
These two real-life cases, recently shared by Taiwanese emergency physician Dr. Becky Li, expose dangerous misconceptions about liver health monitoring that could be putting millions at risk.
The Engineer: Diarrhea for a Month, Liver “Full of Tumors”
The first patient, a 65-year-old engineer who frequently worked overseas, had suffered from diarrhea for over a month. He brushed it off as a temporary issue, planning to see a doctor only after finishing a major project. When he finally walked into the emergency department, his expectation was simple: grab some anti-diarrheal pills and leave.
But as he lifted his shirt for a routine abdominal exam, the physician noticed an abnormal bulge in his upper abdomen. Palpation revealed a hard, stone-like mass—nothing like typical gastroenteritis. An ultrasound confirmed the worst: the liver was diffusely infiltrated with tumors of varying sizes.
Further questioning uncovered a critical detail: the patient was a hepatitis B carrier who had never undergone regular follow-ups. “I never felt particularly unwell,” he said, echoing a common but dangerous assumption.
The Elderly Man: “Normal Blood Tests” Masking a 17cm Tumor
The second case is arguably more alarming because it shatters the belief that routine blood work guarantees safety.
An elderly man with a known history of hepatitis B presented to the emergency room with severe upper abdominal pain and jaundice. He proudly told the doctor that he had been taking self-funded antiviral medications for over a decade and underwent annual liver function tests. His ALT and AST levels—the standard markers for liver damage—had consistently been normal.
But an ultrasound revealed a massive 17-centimeter liver tumor, clearly delineated on the screen.
The man had never undergone an abdominal ultrasound or CT scan. Because his blood markers appeared healthy, he assumed his liver was fine. As Dr. Li explained, the liver is remarkably resilient: as long as some healthy cells remain functional, ALT and AST can stay within normal ranges even while a tumor silently grows to a life-threatening size.
The Three-Step Path from Hepatitis to Cancer
Not every hepatitis B carrier develops liver cancer. Many carriers live with the virus peacefully for decades if it remains in a low-activity state and they receive proper monitoring. However, for those with persistently active viral replication, the progression often follows a predictable trajectory:
- Step 1: Chronic inflammation. The immune system repeatedly attacks infected liver cells, causing ongoing damage and repair.
- Step 2: Fibrosis and cirrhosis. Over 15–20 years, roughly 15–20% of patients with chronic active hepatitis B develop cirrhosis.
- Step 3: Hepatocellular carcinoma (HCC). In the scarred environment of a cirrhotic liver, regenerating cells are more prone to mutations, eventually giving rise to cancer.
The key takeaway: being a carrier is not a death sentence—but skipping regular screenings is.
Who Is at High Risk? Four Groups Must Prioritize Screening
Based on clinical experience, Dr. Li emphasized that the following individuals should make routine liver checks a non-negotiable habit:
- Hepatitis B or C carriers
- Those with existing cirrhosis or advanced liver fibrosis
- People with a family history of liver cancer
- Individuals with additional risk factors, such as heavy alcohol consumption, severe fatty liver disease, or poorly controlled diabetes
Even if you feel perfectly fine, these risk factors mean the liver could be silently harboring trouble.
Three Defenses That Could Save Your Life
To avoid repeating the tragedies of the engineer and the elderly man, high-risk individuals should implement the following three-pronged strategy:
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Regular specialist visits: See a hepatologist or gastroenterologist every 6 to 12 months. For those with cirrhosis, high viral load, or family history, every 6 months—or even more frequently—is recommended.
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Comprehensive blood tests beyond ALT/AST: In addition to standard liver function tests, request alpha-fetoprotein (AFP), a tumor marker. An unexplained rise in AFP, even with normal transaminases, warrants immediate imaging.
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Abdominal ultrasound: This step is often skipped due to laziness, fear, or cost—but it is frequently the lifesaver. An ultrasound can detect tumors as small as 1–2 centimeters, when surgical removal or local ablation offers high cure rates. Waiting until a tumor reaches 10 centimeters leaves only palliative options.
Why Diarrhea Could Be a Red Flag
In the engineer’s case, persistent diarrhea was the only symptom that brought him to the hospital. While most diarrhea cases are benign, a month-long episode combined with risk factors like hepatitis B status should never be dismissed. The liver’s silent nature means that vague gastrointestinal complaints may be the first—and last—warning sign.
The Broader Impact: A Call for Systemic Change
These stories underscore a critical gap in public health awareness. Many individuals, particularly in busy urban centers like Hong Kong, believe that “a little discomfort is nothing” and that annual blood tests provide full reassurance. The reality is that liver cancer remains one of the deadliest cancers in Asia, partly because it is diagnosed late.
Moving forward, healthcare systems and patient education must emphasize that blood tests alone are insufficient for liver surveillance. Ultrasound imaging, along with AFP screening, should be standard for all high-risk populations. For carriers of hepatitis B or C, regular follow-up is not optional—it is essential.
What You Can Do Today
- Check your hepatitis B and C status if you have never been tested.
- If you are a carrier, schedule a specialist appointment immediately—do not wait for symptoms.
- Ask your doctor for an abdominal ultrasound during your next check-up, especially if you fall into any high-risk category.
- Share this information with family and friends who may be unaware of the risks.
The liver does not complain until it is too late. Don’t let “feeling fine” be the reason you miss the chance for early detection.