Understanding Liver Cancer | Symptoms, staging, and understanding a new treatment: Histotripsy

In recent years, liver cancer has remained one of the leading causes of cancer-related deaths in Hong Kong, with growing public concern over its associated health risks.

According to data from the Department of Health, liver cancer has been the third leading cause of cancer deaths in Hong Kong. People with chronic hepatitis B or C infection, obesity, or long-term alcohol consumption are all high-risk groups. With changes in dietary habits and increasing life stress, more people are paying attention to the health of the “silent organ” — the liver.

Although liver cancer remains a serious health challenge, medical technology is changing how it is treated. In particular, histotripsy, a non‑invasive treatment approach, offers patients new hope.

As a partner committed to the long-term health of you and your family, we will help you understand the causes, symptoms, staging, and latest treatment developments for liver cancer, and explain how histotripsy can offer patients a safer and more efficient treatment option.

What is liver cancer?

Liver cancer most commonly refers to hepatocellular carcinoma (HCC), a malignant tumour that arises from liver cells. The liver is responsible for metabolism, detoxification and energy storage. When it is chronically affected by viral infections, alcohol consumption or fat accumulation, persistent inflammation can lead to cellular changes and malignant transformation. Therefore, the following four groups of people should pay particular attention:

• People with a history of hepatitis B or hepatitis C
• People with long term alcohol consumption  
• People with fatty liver disease or metabolic syndrome
• People with a family history of liver cancer

Symptoms of liver cancer

Early-stage liver cancer often presents with no obvious symptoms, and many patients are only diagnosed during routine health examinations. As the disease progresses to the intermediate or advanced stages, the following symptoms may develop:

• Bloating or pain in the right upper abdomen
• Reduced appetite, nausea, or indigestion
• Significant weight loss and fatigue
• Yellowing of the skin or whites of the eyes (jaundice)
• Ascites and swelling of the lower limbs
• In advanced stages, serious complications may even occur, such as tumour rupture, bleeding, or hepatic coma

If you notice any of these “warning signs”, do not delay seeking medical advice.

Staging of liver cancer

The medical community commonly uses the Barcelona Clinic Liver Cancer (BCLC) staging system to assess disease severity and guide treatment decisions:

• Very early stage (Stage 0): a single tumour measuring 2 cm or less, normal liver function, and no cirrhosis.
• Early stage (Stage A): one or several small tumours, with relatively well-preserved liver function.
• Intermediate stage (Stage B): a large tumour of 3 cm or more, or multiple tumours, without metastasis.
• Advanced stage (Stage C): the cancer has spread, involving blood vessels or other organs, with more severe cirrhosis.
• End stage (Stage D): liver failure requiring long-term bed rest; only palliative care can be provided.

This is a simplified overview. Actual staging must be determined by a physician based on tumor characteristics, liver function, and overall health condition.

How is liver cancer treated?

• Surgical resection: removing the tumour and part of the liver tissue.
• Radiofrequency ablation (RFA): a minimally invasive probe uses high heat to destroy small tumours, with faster recovery and a smaller wound.
• Transarterial chemoembolisation (TACE): blocking the hepatic arterial blood supply to treat liver cancer.
• Targeted therapy: inhibiting tumour growth and helping patients with advanced disease stabilise their condition.
• Immunotherapy: Activates the immune system, enabling immune cells to recognise and destroy cancer cells more effectively.
• Histotripsy: A non‑invasive, ultrasound‑based technique that precisely disrupts tumour tissue without surgical incision, typically associated with less pain and a more natural recovery process.

Among these, histotripsy has emerged in recent years as one of the most notable therapeutic innovations and is often described as a “non‑invasive surgical scalpel”.

Histotripsy: New hope in the treatment of liver cancer

Conventional liver cancer surgery typically involves an incision or the insertion of needles for ablation, which carries higher risks for older patients or those with impaired liver function. Histotripsy, by contrast, uses high-intensity focused ultrasound (HIFU). The acoustic energy generates microbubble cavitation within the tumour, precisely fragmenting cancer cells. The procedure involves no incision, no thermal ablation, and no radiation. Crucially, surrounding healthy tissue can remain intact, significantly reducing post-operative pain and the risk of infection.

Clinical studies show promising outcomes. Among suitable cases in current clinical research, patients demonstrated good recovery, with no significant local recurrence observed and no major treatment-related complications reported to date. Many patients can be discharged as early as the next day, with noticeable improvement in quality of life.

At present, Histotripsy has been introduced in selected private hospitals in Hong Kong. Actual insurance claims are subject to individual policy terms, medical necessity, underwriting, and claims assessment.

Note: Histotripsy is an emerging treatment. Long-term efficacy and broader applicability are still under ongoing research.

Conventional liver cancer treatment vs histotripsy: what is the difference?

Item	Conventional surgery / radiofrequency ablation (RFA)	Histotripsy
Invasiveness	Requires an incision or needle insertion; an invasive treatment.	No incision; performed entirely non-invasively.
Treatment principle	Destroys the tumour by resection or thermal ablation.	Uses ultrasound-induced microbubble cavitation to mechanically fragment cancer cells.
Impact on healthy tissue	More prone to thermal injury or scarring.	Precisely focused, with minimal impact on normal tissue.
Recovery period	Hospitalisation for several days to one week.	Most patients can be discharged the next day.
Suitable patients	Early-stage patients with good liver function.	May also be suitable for those who are not good surgical candidates or are at higher risk.

 

Key advantages of histotripsy

• Non-invasive and high safety: No incision, no ionising radiation, and no thermal ablation injury.

• Precise targeting: Able to focus on the lesion accurately and clear tumour tissue effectively.
• Preserves liver function: Minimal damage to healthy tissue, helping maintain normal liver metabolism.
• Short recovery time: Patients can return to normal activities more quickly after the procedure.
• Low rate of side effects: Mild pain, with substantially reduced risks of infection and bleeding.
• Broad applicability: Suitable for older patients or those for whom surgery is not advisable.

Additional protection to support the road to recovery from liver cancer

As early as May 2025, Prudential successfully handled its first claims case involving histotripsy treatment for liver cancer, ensuring that customers retain the freedom to choose among different treatment options. For patients and families facing the challenge of liver cancer, this means not only being able to afford treatment, but also being able to receive better-quality care.

The emergence of liver cancer reminds us that every change in the body deserves attention. Regular check-ups, a balanced diet, and stress management are among the most fundamental ways to protect your health. At the same time, with appropriate protection in place, you can retain the right to choose and access the resources needed for treatment when illness occurs. Genuine peace of mind does not come from avoiding risk altogether, but from having the ability to respond calmly when risks arise—providing greater reassurance for yourself and your family.