Benign Liver Tumours

What are benign liver tumours?

Tumours are abnormal tissue growths that develop when cells begin to reproduce rapidly throughout the body, such as in the liver. Tumours can be divided into benign (noncancerous) or malignant (cancerous). Benign liver tumours are relatively common and harmless unless they bleed or compress on surrounding organs.

Three commonly seen benign liver tumours in Singaporeare:

• Focular nodular hyperplasia: focular nodular hyperplasia is generally harmless, with little chance of rupture. Additionally, no evidence suggests it can develop into cancer. With an incidence rate between 0.3% and 3%, this is the second most common type of benign liver tumour. 
• Hepatic hemangioma: hepatic hemangioma is commonly found in adults; however, it can also be found in children around 2 years of age. While they are usually harmless, larger-sized tumours can cause pain and discomfort. This is the most common type of benign liver tumour, with an incidence rate between 3% and 20%. 
• Hepatocellular adenoma: hepatocellular adenoma is more common in women of childbearing age as hormonal contraceptives encourage these tumours to grow. Typically, silent but larger-sized tumours can cause pain.

What are the symptoms of benign liver tumours?

Benign liver tumours are usually silent tumours. Hence, most benign tumours are incidentally detected when patients undergo treatment or imaging scans for a different health issue. In fact, patients with benign liver tumours are often asymptomatic, and they do not require any form of treatment. However, tumours that are larger or are pressing against surrounding organs may cause the following symptoms:

• Abdominal pain, bloating, or swelling
• Fatigue
• Feeling full
• Nausea and vomiting episodes

Are benign liver tumours painful?

Most of the time, benign liver tumours do not cause any symptoms. However, if the tumour grows large enough, it can cause symptoms such as pain. These larger tumours (> 4 cm) may add pressure on nearby organs as they push against the internal structure. As a result, some patients may experience abdominal pain, bloating and swelling.

Who is at risk of developing benign liver tumours in Singapore?

Benign liver tumours are common, but thankfully, most do not require any surgical intervention. Certain risk factors can predispose individuals to their development. Risk factors for developing benign liver tumours in Singapore often include:

• Women of reproductive age: benign liver tumours, particularly hepatic adenomas, are more commonly diagnosed in women of childbearing age, especially those who have used oral contraceptives or hormone replacement therapy (HRT). Oestrogen, a hormone found at higher levels in women, is believed to play a role in the development and growth of hepatic adenomas.
• Genetic conditions: certain genetic disorders and inherited conditions are associated with an increased risk of developing benign liver tumours, particularly hepatic adenoma.
• Metabolic syndrome or obesity: metabolic syndrome, a cluster of conditions including obesity, high blood pressure, high blood sugar, and abnormal lipid levels, is associated with an increased risk of liver disease and liver tumours, including benign ones. Obesity, in particular, is a risk factor for fatty liver disease and may contribute to the development of inflammatory-type hepatic adenomas.
• History of steroid use: prolonged and high-dose use of anabolic steroids, often used for performance enhancement or bodybuilding purposes, has been associated with an increased risk of hepatic adenomas. 

How are benign liver tumours diagnosed in Singapore?

Benign liver tumours do not usually cause significant symptoms; hence, they are typically discovered incidentally during imaging tests performed for other reasons. Common methods used for the diagnosis of benign liver tumours in Singapore include:

• Clinical evaluation: a thorough medical history and physical examination will be conducted to evaluate symptoms (if any), assess risk factors, and rule out other possible causes of liver abnormalities.
• Imaging studies: imaging tests are typically the first step in diagnosing benign liver tumours. These tests include ultrasounds, computed tomography (CT) scans and magnetic resonance imaging (MRI).

• Liver biopsy: if imaging is inconclusive, a biopsy may be suggested. During a biopsy, a small sample of liver tissue is obtained using a needle inserted through the skin into the liver. The tissue sample is then examined under a microscope to determine whether the tumour is benign or malignant.
• Blood tests: blood tests may be performed to assess liver function and detect any abnormalities associated with liver tumours. 

What are the treatment options for benign liver tumours in Singapore?

In most individuals, benign liver tumours may not require treatment, especially if they are small, asymptomatic, and do not cause any complications. The options for the management of benign liver tumours include:

• Observation and monitoring: small, asymptomatic benign liver tumours may be monitored by a specialist with regular imaging tests to track their size and growth over time. Active treatment may be unnecessary if the tumour remains stable and does not cause any symptoms or complications.
• Stopping medications: hormonal medications, such as oral contraceptives, hormone replacement therapy, or steroids, may be asked to be discontinued or adjusted if they are believed to contribute to the growth of hepatic adenomas.
• Surgery: surgical removal of the benign liver tumour may be recommended in certain situations, particularly if the tumour is large, causing symptoms, or at risk of rupture or bleeding. The type of surgical procedure performed will depend on the size and location of the tumour:
  • Liver resection or hepatectomy: in cases where the tumour is located in a specific segment of the liver, a liver resection may be performed to remove the affected segment.
• Embolisation therapy: for certain types of benign liver tumours, embolisation therapy may be recommended. During this minimally invasive procedure, a catheter is inserted into the blood vessels supplying the tumour, and small particles or substances are injected to block blood flow to the tumour, causing it to shrink or die off. This procedure is recommended if the tumour is at risk of bleeding or as an attempt to shrink the tumour before surgery.
• Radiofrequency ablation (RFA) or microwave ablation: RFA or microwave ablation may be used to treat small liver tumours by delivering heat energy directly to the tumour tissue, causing thermal destruction of the tumour cells.

Frequently asked questions

What is the recovery rate after having benign liver tumours removed?

Depending on your health condition, age, and the extent of the removal, it can take 2 to 4 weeks to recover fully.

Are there any risks to having the tumours removed?

Liver resection is generally a safe procedure. Most liver resections can be performed laparoscopically, so recovery is faster. The risks of surgery, such as infection, bleeding, and liver dysfunction, are low for benign liver tumours. 
What is the difference between benign tumours and cysts?

Cysts are fluid-filled cavities lined by epithelial cells. Most liver cysts are benign. However, the key difference between the two is that benign tumours are more solid, while cysts are usually fluid-filled.