 Dal Tadka Ingredients Tur dal: 200 gms Turmeric powder: 3 gms Cooking oil - 1/2 teaspoon Water - 2 cups Coriander powder: 5 gms Red chilli powder: 5 gms Onion (chopped): 50 gms Tomato: 30 gms Ginger (chopped): 5 gms Garlic (chopped): 5 gms Green chilli (chopped): 3 gms Cumin seeds: 3 gms Desi ghee: 25 ml Golden fried onion: 1 tablespoon ( optional ) Fresh coriander (chopped): 10 gms Method Boil dal with water in pressure cooker by adding turmeric powder, oil and salt. Separately heat ghee in a pan. Add cumin seeds and let them crackle. Add ginger, green chilli and garlic and sauté for 30 seconds. Add onions and cook till light brown. Add red chilli powder and coriander powder and sauté for 45 seconds on low heat. Add tomatoes and cook till the ghee comes on the top. Add boiled dal to this tadka, mix well and adjust salt to taste. Garnish with golden fried onion ( optional ) on top and chopped fresh coriander leaves.  |
 MTR Instant Rava Idli with Coconut Chutney Did you know Rava Idlis were first invented at MTR? During World War II, rice was in short supply. MTR experimented with wheat and thus was born the enormously popular "Rava Idli." Cooking Instructions Mix 1 measure of MTR Instant Rava Idli mix with 1/2 measure of sour curd. Add 50g of finely chopped coriander leaves to the mix. After 1 min, add 1 measure more of sour curd and mix well. After 2 min, steam batter in an idli cooker or idli vessel for 10-12 min. Serve with coconut chutney and potato sagu.  |
 Paneer is an Indian cottage cheese. It resembles tofu in colour, taste and feel. Paneer is the vegetarian substitute to chicken. Palak paneer, mutter paneer, paneer butter masala, paneer tikka masala, paneer pasanda, chilli paneer, paneer kofta, kadhai paneer and shahi paneer are dishes with iconic status for most restaurant-goers. Even fast food chains now sell pizzas topped with chunks of fried or barbecued paneer. How to make it? Paneer is surprisingly easy to make, which perhaps explains its popularity with homemakers and chefs. After curdling hot milk with some lemon juice or vinegar, the whey is drained and the curd is pressed dry and cut into firm blocks. Softer varieties of paneer go into the making of sweets such as rasogolla. The cheese does not require maturing. It has a short lifespan: refrigerated paneer keeps for five days while frozen paneer stays fresh for a month. Paneer is nutritious, and not too high in calories. The calorie count depends on whether whole milk or skimmed milk goes into the making of paneer. It also depends on whether the milk is from a cow or a buffalo – typically, buffalo milk is creamier and higher in calories. A hundred gram of paneer contains 100-160 calories. This is not a high number: many dried legumes contain more calories. Rajmah, for example, contains 335 calories for 100 gm. Paneer is rich in protein: 100 gm contains around 12-14 gm of first-class protein comparable with the protein in egg white and meat. Fat forms only 5 gm out of a 100 gm block of paneer, but it is predominantly saturated fat. The food is rich in minerals, but there are only insignificant amounts of vitamins and there is no dietary fibre. Paneer’s weakness is the company it keeps during cooking. As with the potato, butter, ghee and large amounts of oil tend to make paneer dishes fattening. Low-cal paneer recipes are not as popular as the richer ones, but they are worth trying out because very few vegetarian foods contain the high-quality protein that paneer does. Recipe & Photo Credit - The Hindu & ITC Mumbai Try these recipes ..  Paneer Tikka Ingredients Paneer - 50 gms Salt to taste Garam masala - 5 gms Red chilli paste- 8 gms Kasoori methi powder - 4 gms Ginger-garlic paste -10 gms Beaten hung curd - 30 ml Lemon juice - 3 ml Method Dice the paneer and marinate with the above mentioned ingredients. Keep aside for half an hour and cook in tandoor or grill on tawa or cook in OTG. Serve hot with mint chutney. Paneer Butter Masala Ingredients Paneer tikka - 10 pieces Ghee - 05 gms Tomato puree (fresh) -100 ml Butter 04 gms Cream -10 ml Onion (chopped) - 60 gms Salt - 05 gms Ginger (chopped) - 05 gms Green chillies (chopped) - 03 gms Garam masala - 03 gms Kasoori methi powder - 03 gms Red chilli powder - 03 gms Coriander (chopped) - 04 gms Sugar - 8 gms Yellow butter - 10 gms Method Heat the ghee and add chopped onions. Sauté till golden brown, then add chopped ginger, and green chillies and ginger-garlic paste. Then add tomato puree and cook till oil comes out. Put all the dry powders, check seasoning, finish it with yellow butter and cream and serve garnished with chopped coriander. Palak Paneer Ingredients Desi ghee: 50 ml Cumin seeds: 5 gms Garlic (chopped): 10 gms Spinach (chopped and blanched): 200 gms Spinach paste (blanched): 250 gms Salt: to taste Green chilli paste: 10 ml Paneer cubes (fried): 200 gms Cream: 30 ml Butter: 10 gms Method Heat ghee, add cumin seeds and let it crackle. Add chopped garlic and sauté. Add chopped spinach and simmer for two minutes. Add spinach paste and simmer till the moisture evaporates. To this add salt, green chilli paste, paneer cubes and cook it for a while. Finish the dish with butter and cream.  |
Sunday, April 25, 2010
MSTB sets up RM11mil software testing lab
KUALA LUMPUR: The Malaysian Software Testing Board (MSTB) spent RM11mil setting up its software testing lab in Puchong here.
Mastura Samah, president of MSTB, said the lab — called the Q Lab — has 50 certified software testers and has garnered interest from several local and foreign companies.
She declined to name the companies and said the lab would be officially launched in the near future.
Software testing involves detecting flaws and bugs in software before the products are released commercially, and the programs are also tested for ease-of-use.
The building of the lab dovetails with MSTB’s plan to position Malaysia as the regional hub for software testing. It also wants the country to be internationally recognised for software testing services.
Its plan involves offering state-of-the-art testing facilities and to attract software developers in neighbouring countries to employ the services of its certified lab testers.
“The fact that we speak English gives us an edge over our competitors. We believe that Malaysia can excel in software testing for the oil and gas, telecommunications, and financial services industries,” Mastura said.
The country has 600 certified testers and MSTB’s aim is to increase this to 10,000 over the next five years.
“Two years ago, we only had 90 testers. Malaysians are realising that software testing can be a very lucrative career because a certified tester could earn as much as RM50,000 a month,” she said.
MSTB also organises profile-raising events like the Software Testing Conference (Softec) 2010. The talk is themed Bridging the Gap and will run from July 19 to 21 at the Crowne Plaza Mutiara Hotel.
It targets software testing professionals, students and managers. MSTB expects 600 to 1,000 attendees at the seminar.
Among the speakers will be Dave Miller, vice-president of courier company FedEx, and Professor Jasbir Dhaliwal, head of the system testing excellence programme at the University of Memphis, in the United States.
Softec, now in its third year, will be introducing the Q-Merit Award, that gives recognition to individuals and organisations that have contributed to software testing in Malaysia.
Carrots for PHP on Windows developers
KUALA LUMPUR: Software giant Microsoft Malaysia in collaboration with the Multimedia Development Corporation (MDeC) and PHP.net.my — a community of developers for the scripting language — have launched two new websites, PHPAcade.my and PHPmarketplace.my.
PHP.net.my founder and president Ahmad Amran Kapi said the two sites would help PHP developers get more proficient in coding PHP in a Windows environment, as well as market their PHP skillsets.
“Although Linux (an open-source operating system) is still the most frequently used platform for PHP deployments, PHP developers are increasingly choosing Windows as their platform of choice because many organisations require new applications to run in that environment,” he said.
In a survey conducted by the special interest group and Microsoft late last year, it was found that 70% of PHP developers would consider deploying PHP-based applications on a Windows platform.
PHP is a general purpose scripting language widely used to create web applications. Popular sites like Facebook and Wikipedia, as well as applications like WordPress are PHP-based.
Answer to a call
According to the survey, the local PHP developer community also wanted more training and awareness programmes on how to deploy PHP in a Windows environment.
“PHPAcade.my is responding to this request,” Ahmad said. PHPAcade.my is an online, self-paced training facility that will provide thorough but easy-to-follow instructions for deploying PHP on the Windows platform.
However, participants must have a basic understanding of PHP before considering the programme because it is not an introductory course to PHP.
Upon successful registration, participants get to download the PHP on Windows Training Kit, which is developed by Microsoft.
PHPAcade.my also provides virtual lab facilities required to complete the course online so that the developers won’t need to invest in a server of their own.
The lab allows students to install, configure and operate a complete PHP application on a full Windows platformm, as well as get the tools they need to complete the lab exercises in the training kit.
They will also be able to seek further instructions and ask questions about the assignments and the programme through a moderated forum.
Coming soon
Ahmad said the programme lasts for a week and organisers are now deliberating over the fees. The programme is expected to kick off next month.
After honing their skills on PHPAcade.my, graduates will get the opportunity to moneytise their skills at PHPMarketplace.my.
This is an online service that matches PHP on Windows developers to organisations looking for such expertise.
Companies and individuals can bid for jobs, and the job advertisers will select the winning bidders based on their credentials, experience and asking price.
Graduates of PHPAcade.my are automatically channeled to PHPMarketplace.my, but other PHP developers are also welcome to use the service.
New body making an impact against cyberattacks
CYBERJAYA: Countries can now react faster to cyberattacks, thanks to the establishment of The International Multilateral Partnership Against Cyber Threats (Impact) Global Response Centre a year ago.
Prior to Impact’s establishment, there was a lack of co-ordination between governments, Internet service providers (ISPs) and antivirus companies in any reaction to cyberthreats.
Datuk Mohd Amin, chairman of Impact, said that when cyberattacks were launched against Estonia’s parliament, banking and newpaper websites in 2007, the attacks came from various places in the world, making it difficult for the country’s Computer Emergency Response Team (CERT) to respond effectively.
“The CERT struggled to call in the governments and ISPs from the countries where the attacks came from for a co-ordinated response,” he said.
Worse, Estonia did not have diplomatic ties with some of the other countries.
Thus, the idea for Impact, which comprises a cyberthreats resource centre, was born. An international organisation headquartered here, it is a one-stop contact point for countries that come under cyberattack.
“Impact bands governments all over the world against cyberthreats. It also works with prominent network security giants such as Trend Micro, F-Secure, Symantec and Kaspersky,” Amin said.
Expert help
Through Impact’s partnership with these security vendors, countries can get cutting-edge expertise.
Raimund Genes, chief technology officer at Trend Micro, said Impact helps governments better understand cyberthreats and to be better prepared to handle such attacks.
If Estonia were to be attacked today, all the CERT authority would have to do is call Impact, which would then organise and co-ordinate the response by the governments and ISPs in the countries where the attacks were originating from.
Genes also said that Impact provides collective intelligence on online security.
Syarisa Abubakar, director of policy at Impact’s centre of policy and international co-operation, said Impact has rolled out its services to 39 countries after just one year in operation.
“These countries include those in Africa, The Middle East and Asia Pacific. Some are developing nations where there are no cyberlaws or CERTs,” she said.
Impact also assesses the cyberneeds of some of these countries. “We have already done a needs assessment for Afghanistan and will be doing the same for East African companies at the end of this month,” Syarisa said.
“We will be reviewing the cyberlaws in these countries and their technical expertise requirements in the event of a cyberattack,” she added.
Hypnotherapy in hospitals
As hospitals increasingly acknowledge the therapeutic value of hypnotherapy, hypnotherapists are now looking toward putting their work under scientific scrutiny.
CLINICAL hypnosis, or hypnotherapy, may still be a new buzzword to many doctors here in Malaysia, but it is no stranger to Harvard Medical School associate professor of psychiatry Dr David C Henderson.
“While doing hypnosis is not a big part of what we do (in the Massachusetts General Hospital, the teaching hospital of the Harvard Medical School), it is a component,” he says in an interview during a lecture visit to Kuala Lumpur recently.
Dr Henderson’s “acquaintance” with hypnotherapy started when he was still in medical school.
“When I was a resident, I trained in psychiatry in the late 80s and early 90s. It was something I was taught how to do,” he says.
When he practised, hypnosis had helped him ease his patient’s pain. “I remember I had some patients who has been hospitalised for sickle cell anemia, and one of the things I did was hypnosis, to help them deal with the pain when they were in acute crisis,” he recalled.
However, as there is little evidence to support the efficacy of hypnotherapy in its other roles (such as smoking cessation, weight management, and overcoming phobia), even after it has been taught in medical schools and used for decades in US hospitals such as the MGH, the role of hypnotherapy is often limited to pain management and relief of mild psychological conditions such as depression.
“I would say that hypnotherapy needs to really catch up with other therapies ... it needs science to help us understand what it does,” says Dr Henderson.
To date, even hypnotherapists do not know exactly how it works. They have a rough idea: when a willing person is guided into a hypnotic trance (a state of deep relaxation where he is relaxed and focused at the same time), the hypnotherapist can access his subconscious mind and give positive suggestions to help him change his behaviour or emotional responses to one that is conducive to health and well-being.
So, whether it is coaxing a subconscious mind into reducing its perception of pain, or doing away with the irrational compulsion to shrink into a quivering ball at the sight of a spider, what hypnotherapy does is basically to equip a person, mentally, to overcome those physical and psychological challenges.
As the director of studies of the London College of Clinical Hypnosis (LCCH) Peter Mabbutt notes, “It is important to note that we don’t work with physical symptoms (like pain). We work with the psychological response to the symptom.”
In the United Kingdom, says Mabbutt, hypnotherapists are working in a variety of areas in palliative care. They are also looking at working with people with heart disease patients within the cardiovascular care unit. “We are helping them manage the emotional response they are having to their particular condition, and also the fact that they could be coming to the end of their lives.”
Beyond that, the possibilities are exciting. People with conditions that are linked to, or exacerbated by stress – like irritable bowel syndrome, asthma, or psoriasis, may benefit from hypnotherapy as it can help them relax.
Taking patients who have anxiety due to breathlessness as an example, Mabbutt says that they may benefit if hypnotherapy can help them change their response to the symptom. “By helping them change their response (from an anxious one to a relaxed one), we help them reduce their anxiety, and that helps them manage their breathing cycle more appropriately,” he explains.
Even skin disorders, like warts, appear to succumb to hypnotherapy. “There is good evidence that hypnotherapy is very good at clearing warts. But we don’t know how it works,” says Mabbutt. “(In hypnotherapy), you just visualise your wart and imagine it withering away. And it does.”
It does sound implausible, but Mabbutt attributes the phenomenon to the belief system that we all have in us. “I think when people have a strong belief system (that the wart will fall off), the wart does fall off.”
“So, we know that we are doing something that involves belief systems, but we don’t know the exact mechanisms on how it works yet.”
But with hypnotherapy finding its way to more and more clinical settings and medical schools, Mabbutt hopes this will change.
In Malaysia, we are doing some studies on pain control, and we are in the plan of carrying out a huge study in looking at the efficacy of hypnosis in smoking cessation, says Mabbutt. Studies to look at the use of hypnotherapy in other conditions, like cystic fibrosis, are also under way.
But the effectiveness of the therapy is not the only area hypnotherapists are interested in. As hypnotherapy does not work for everyone, hypnotherapists would also need to find out which are the best candidates who would benefit most from the therapy. “We’ve got to work out who it works for and why it works. And we’ve got to be open to other therapies that might work for somebody else,” says Mabbutt.
While properly conducted studies are planned and just about to start, Mabbutt foresees a strong future for hypnotherapy. “By working together with the medical community to quantify and research hypnotherapy, we want to work towards a situation where we fit in. We don’t want to be esoteric,” Mabbutt explains.
CLINICAL hypnosis, or hypnotherapy, may still be a new buzzword to many doctors here in Malaysia, but it is no stranger to Harvard Medical School associate professor of psychiatry Dr David C Henderson.
“While doing hypnosis is not a big part of what we do (in the Massachusetts General Hospital, the teaching hospital of the Harvard Medical School), it is a component,” he says in an interview during a lecture visit to Kuala Lumpur recently.
Not asleep: When a willing person is guided into a hypnotic trance (a state of deep relaxation where she is relaxed and focused at the same time) the hypnotherapist can access her subconscious mind and give positive suggestions to help her change her behaviour or emotional response to one that is conducive to health and well being.
“For decades, we’ve used it in pain management in acute inpatient care. For instance, in the programme we have in the burns unit, it is a component in pain management.”Dr Henderson’s “acquaintance” with hypnotherapy started when he was still in medical school.
“When I was a resident, I trained in psychiatry in the late 80s and early 90s. It was something I was taught how to do,” he says.
When he practised, hypnosis had helped him ease his patient’s pain. “I remember I had some patients who has been hospitalised for sickle cell anemia, and one of the things I did was hypnosis, to help them deal with the pain when they were in acute crisis,” he recalled.
However, as there is little evidence to support the efficacy of hypnotherapy in its other roles (such as smoking cessation, weight management, and overcoming phobia), even after it has been taught in medical schools and used for decades in US hospitals such as the MGH, the role of hypnotherapy is often limited to pain management and relief of mild psychological conditions such as depression.
“I would say that hypnotherapy needs to really catch up with other therapies ... it needs science to help us understand what it does,” says Dr Henderson.
To date, even hypnotherapists do not know exactly how it works. They have a rough idea: when a willing person is guided into a hypnotic trance (a state of deep relaxation where he is relaxed and focused at the same time), the hypnotherapist can access his subconscious mind and give positive suggestions to help him change his behaviour or emotional responses to one that is conducive to health and well-being.
So, whether it is coaxing a subconscious mind into reducing its perception of pain, or doing away with the irrational compulsion to shrink into a quivering ball at the sight of a spider, what hypnotherapy does is basically to equip a person, mentally, to overcome those physical and psychological challenges.
As the director of studies of the London College of Clinical Hypnosis (LCCH) Peter Mabbutt notes, “It is important to note that we don’t work with physical symptoms (like pain). We work with the psychological response to the symptom.”
In the United Kingdom, says Mabbutt, hypnotherapists are working in a variety of areas in palliative care. They are also looking at working with people with heart disease patients within the cardiovascular care unit. “We are helping them manage the emotional response they are having to their particular condition, and also the fact that they could be coming to the end of their lives.”
Beyond that, the possibilities are exciting. People with conditions that are linked to, or exacerbated by stress – like irritable bowel syndrome, asthma, or psoriasis, may benefit from hypnotherapy as it can help them relax.
Taking patients who have anxiety due to breathlessness as an example, Mabbutt says that they may benefit if hypnotherapy can help them change their response to the symptom. “By helping them change their response (from an anxious one to a relaxed one), we help them reduce their anxiety, and that helps them manage their breathing cycle more appropriately,” he explains.
Even skin disorders, like warts, appear to succumb to hypnotherapy. “There is good evidence that hypnotherapy is very good at clearing warts. But we don’t know how it works,” says Mabbutt. “(In hypnotherapy), you just visualise your wart and imagine it withering away. And it does.”
It does sound implausible, but Mabbutt attributes the phenomenon to the belief system that we all have in us. “I think when people have a strong belief system (that the wart will fall off), the wart does fall off.”
“So, we know that we are doing something that involves belief systems, but we don’t know the exact mechanisms on how it works yet.”
But with hypnotherapy finding its way to more and more clinical settings and medical schools, Mabbutt hopes this will change.
In Malaysia, we are doing some studies on pain control, and we are in the plan of carrying out a huge study in looking at the efficacy of hypnosis in smoking cessation, says Mabbutt. Studies to look at the use of hypnotherapy in other conditions, like cystic fibrosis, are also under way.
But the effectiveness of the therapy is not the only area hypnotherapists are interested in. As hypnotherapy does not work for everyone, hypnotherapists would also need to find out which are the best candidates who would benefit most from the therapy. “We’ve got to work out who it works for and why it works. And we’ve got to be open to other therapies that might work for somebody else,” says Mabbutt.
While properly conducted studies are planned and just about to start, Mabbutt foresees a strong future for hypnotherapy. “By working together with the medical community to quantify and research hypnotherapy, we want to work towards a situation where we fit in. We don’t want to be esoteric,” Mabbutt explains.
More foreign investors targeted for Nusajaya
UEM Land MD says good progress being made there
GELANG PATAH: UEM Land Holdings Bhd is targeting more international investors to participate in the development of Nusajaya this year.
Its managing director Datuk Wan Abdullah Wan Ibrahim said the company was eyeing investors from China, India, Europe, Singapore, South Korea and the United States.
“Nusajaya is progressing well and moving on the right track and we are confident of keeping the momentum going as planned,’’ Abdullah told StarBiz.
He was speaking at the launch of “Green Programme”, a collaboration between UEM Land and Universiti Kebangsaan Malaysia at SK Taman Nusa Perintis 1, near here on Saturday.
The Green Programme is outlined under the Nusajaya Green Plan launched in December last year to ensure a sustainable development of the country’s first economic growth corridor.
“Even during the global economic slowdown in the last two years, Nusajaya attracted interest from both local and foreign investors,’’ he added.
Abdullah said the company believed there were always opportunitie,s even during times of economic uncertainty, as there were investors and individuals with funds.
He said the company’s high-end residential projects, East Ledang and Horizon Hills, a joint venture between UEM Land and Gamuda Bhd, had attracted a large number of foreign buyers.
Abdullah said foreigners made up 65% and 56% of the buyers at East Ledang and Horizon Hills respectively and that the projects had recorded good take-up rates.
UEM Land is the master developer of the 9,308ha Nusajaya, the key driver of Iskandar Malaysia which was launched on Nov 4, 2006.
Nusajaya comprises eight catalyst developments – Kota Iskandar (Johor State New Administrative Centre), Southern Industrial and Logistic Clusters, Puteri Harbour Waterfront Development, EduCity, Medical City, International Destination Resort and Nusajaya Residences.
Nusajaya is one of five flagship development zones in Iskandar. The other four are the JB City Centre, Western Gate Development, Eastern Gate Development and Senai-Kulai.
Abdullah said works on infrastructure and several development projects in Nusajaya were on schedule and were expected to be completed in the next three to five years.
These include the RM1.4bil Coastal Highway linking Johor Baru city centre to Nusajaya, Asia’s first Legoland Theme Park, Indoor Theme Park @ Puteri Harbour, Marlborough College, Newcastle University Medical Faculty and Pinewood Studios.
“On completion of these projects, Nusajaya will have enough content to attract investors and residents,’’ he said.
Abdullah said it would be much easier to convince and attract investors to Nusajaya as they could witness the developments taking place.
He said another contributing factor was that Iskandar received continuous support and commitment from the Federal and Johor governments.
“The support from the Federal and Johor governments is important to ensure the success of Iskandar, which in turn will ensure that Nusajaya succeeds too,’’ Abdullah said.
He said other stakeholders, namely Iskandar Regional Development Authority and Khazanah Nasional Bhd-backed Iskandar Investment Bhd, also played crucial role in determining Nusajaya’s success.
Abdullah said its close proximity to Singapore was another added advantage for Nusajaya as it would not only able to attract Singaporean investors but also expatriates and multinational corporations there.
“As the master developer, UEM Land has an enormous task to ensure that Nusajaya succeeds and looking at its progress, we are well on our way to achieving it,’’ he said.
Friday, April 23, 2010
When liver meets cancer,
As the liver’s ability to regenerate itself makes it more difficult to detect liver cancer early, prevention is key.
IF the liver was a machine that exists in our modern world, it would be the embodiment of the perfect workhorse. It will be able to work 24/7 with little rest, juggle multiple tasks at the same time, and regenerate parts that are old or damaged so they will continue to work at peak performance, day in, day out.
And that’s not all. If there is a greater demand of its services, it’ll be ready to work harder to take on the challenge.
Datuk Dr Ibrahim Wahid ... While chronic infection with viruses such as Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are the more common causes of liver cancer, chemicals that cause cancer (carcinogens) and alcohol can also cause it.
But while the liver’s ability to regenerate itself when damaged can be a blessing, it can also be a curse, because when it has trouble recovering from damage, or coping with the demands placed on it, you can’t really feel it.
“The liver is an organ that does not complain very much until it is very, very late,” says Malaysian Liver Foundation chief executive officer Datuk Dr Nor Shahidah Khairullah. Because of that, patients with liver cancer often see their doctors in late stages of the disease, where treatment options are limited.
“(Liver cancer) is dangerous because the liver is our powerhouse, when it comes to internal organs,” Dr Nor Shahidah says. “It stores all your energy and vitamins, nourishes you by manufacturing amino acids (building blocks of proteins), secretes hormones and bile, and helps to emulsify the fats in your body. So, it’s an organ that is virtually life itself.”
The good news is that many liver cancers can be prevented. However, not many people know that.
So, to create more awareness about the disease and its treatments, Dr Nor Shahidah and Malaysian Oncological Society president Datuk Dr Mohd Ibrahim Wahid shares with Fit4Life the following insights.
How do the cells in the liver become cancerous?
When the DNA of normal liver cells are damaged, cell mechanisms can repair it to some extent. However, when the damage is too severe, the cells will die, and new cells will be formed to take their place.
Sometimes these processes can go wrong, says Dr Mohd Ibrahim.
When they go wrong, the cells that are repaired or regenerated may contain DNA that is different from normal cells. So, unlike normal cells that grow, multiply, and eventually die in a tightly controlled manner, these new cells can now multiply freely. And when they get old or damaged, they don’t die, as they should. This will cause the extra cells to accumulate into a mass of tissue called a growth, nodule, or tumour.
While some of these growths, nodules, or tumours are benign (they do not grow and multiply aggressively, invade surrounding tissues or travel to other parts of the body), some of them, which are malignant or cancerous, do.
What are the types of liver cancer?
If the cancer starts in the cells of the liver, it is called primary liver cancer. However, the four types of primary liver cancer are categorised according to the types of cells that become cancerous first.
The most common form of liver cancer (hepatocellular carcinoma) begins in hepatocytes, the main type of cells in the liver. Others begin in the cells in the bile duct (cholangiocarcinoma), and very rarely, blood vessels in the liver (angiosarcoma or hemangiosarcoma). When it happens to children under the age of four, it’s called hepatoblastoma.
What are the causes?
Most of the causes of liver cancer are those that cause long term damage to liver cells. As acute infections such as Hepatitis A do not affect the liver in the long term, it does not result in chronic liver disease, hence it is not a risk factor for liver cancer.
While chronic infection of viruses such as Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are the more common causes of liver cancer, chemicals that cause cancer (carcinogens) and alcohol can also cause it, says Dr Mohd Ibrahim. However, in most of Asia, chronic HBV infection is the main cause of liver cancer.
You will also have a higher risk of developing liver cancer if you smoke, are obese, diabetic, or have a history of cirrhosis (when your liver has been scarred by chronic disease).
Are there any early symptoms?
Before looking at the symptoms, it is good to note that liver cancer affects more men than women, usually in their 40s to 50s. Worldwide, men who are diagnosed with liver cancer outnumber women three to one.
Unfortunately, many people do not experience signs or symptoms in the early stages of liver cancer, says Dr Nor Shahidah.
But as the cancer progresses, some may notice some of the following symptoms:
·Weight loss
·An ongoing lack of appetite
·Feeling very full even after a small meal
·A hard lump on the right side just below the rib cage
·Pain around the right shoulder blade
·Yellow-green colour to the skin and eyes (jaundice)
·Discomfort or pain in the upper abdomen on the right side
·Unusual tiredness
·Nausea
As these symptoms are non-specific and can be caused by many health problems other than liver cancer, it is always wise to consult your doctor to have them checked out.
Are blood tests useful in detecting early liver cancer?
Blood tests, like liver function tests (which tests for proteins produced by the liver and enzymes found in the liver) and tumour markers can be used to detect changes in the liver that may indicate the presence of liver cancer. However, they are not very reliable, says Dr Mohd Ibrahim.
As the test results could be influenced by other factors as well, most of the time, a doctor needs to investigate the abnormal blood test results further with ultrasounds, MRI, and CT scans, or biopsies to determine the presence of a cancerous growth in the liver.
Who do you see when your blood tests are abnormal?
“It depends on the type of blood test,” says Dr Nor Shahidah. If they are liver function tests, all doctors should be able to advise you. But if they are serology tests for hepatitis infections, your doctor might refer you to another doctor who specialises in liver diseases (hepatologist).
Also, if your doctor suspects you may have liver cancer, he or she will also refer you to a cancer specialist (oncologist).
Nevertheless, your best bet is to visit your family doctor or a general practitioner first, because he or she will be able to treat you or advise you on which doctor to see next, whether it is a hepatologist or oncologist.
Are surgery and chemotherapy the only treatment options for liver cancer?
No. Although surgery to remove the cancer is still the main method of treatment, many liver cancer patients could not be operated upon. Often, when the cancer is diagnosed too late, the cancer has spread to a large area of the liver, or has occurred in too many sites. Sometimes, it’s just a matter of the cancer growing too close to an important artery.
For these patients, doctors may consider starving the cancer to death by cutting off the blood supply through a procedure called embolisation.
And if embolisation is not possible, doctors may consider killing the cancer by freezing (cryoablation), heating (radiofrequency ablation) or damaging it with chemicals (chemotherapy).
In the year 2008, the Malaysian Ministry of Health had approved the use of a drug initially licensed for the treatment of kidney cancer (sorafenib) as a treatment for liver cancer that could not be operated upon.
However, it is not easily accessible to many liver cancer patients due to its cost.
Therefore, to make sorafenib more accesible to patients, its maker has collaborated with the Malaysian Liver Foundation in a programme that allows eligible patients to purchase two months supply of the drug and get the rest of the year’s supply free.
How do I prevent liver cancer?
As chronic hepatitis B infection is the main cause of liver cancer here in Asia, the best way to prevent it is to get vaccinated against it, says Dr Nor Shahidah.
But what if you are already infected with the HBV or HCV? The answer is to get your liver monitored regularly (about every six months) by your doctor to detect liver cancer early if it develops. (Not all people who are infected with the viruses develop liver cancer.)
Of course, by reducing all other risk factors, including obesity, diabetes, smoking, and alcohol consumption, you will also reduce your chances of developing liver cancer.
TELU take note.....
> For more information about liver cancer, please visit the Malaysian Liver Foundation website at www.liver.org.my.
IF the liver was a machine that exists in our modern world, it would be the embodiment of the perfect workhorse. It will be able to work 24/7 with little rest, juggle multiple tasks at the same time, and regenerate parts that are old or damaged so they will continue to work at peak performance, day in, day out.
And that’s not all. If there is a greater demand of its services, it’ll be ready to work harder to take on the challenge.
Datuk Dr Ibrahim Wahid ... While chronic infection with viruses such as Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are the more common causes of liver cancer, chemicals that cause cancer (carcinogens) and alcohol can also cause it.
But while the liver’s ability to regenerate itself when damaged can be a blessing, it can also be a curse, because when it has trouble recovering from damage, or coping with the demands placed on it, you can’t really feel it.
“The liver is an organ that does not complain very much until it is very, very late,” says Malaysian Liver Foundation chief executive officer Datuk Dr Nor Shahidah Khairullah. Because of that, patients with liver cancer often see their doctors in late stages of the disease, where treatment options are limited.
“(Liver cancer) is dangerous because the liver is our powerhouse, when it comes to internal organs,” Dr Nor Shahidah says. “It stores all your energy and vitamins, nourishes you by manufacturing amino acids (building blocks of proteins), secretes hormones and bile, and helps to emulsify the fats in your body. So, it’s an organ that is virtually life itself.”
The good news is that many liver cancers can be prevented. However, not many people know that.
So, to create more awareness about the disease and its treatments, Dr Nor Shahidah and Malaysian Oncological Society president Datuk Dr Mohd Ibrahim Wahid shares with Fit4Life the following insights.
How do the cells in the liver become cancerous?
When the DNA of normal liver cells are damaged, cell mechanisms can repair it to some extent. However, when the damage is too severe, the cells will die, and new cells will be formed to take their place.
Sometimes these processes can go wrong, says Dr Mohd Ibrahim.
When they go wrong, the cells that are repaired or regenerated may contain DNA that is different from normal cells. So, unlike normal cells that grow, multiply, and eventually die in a tightly controlled manner, these new cells can now multiply freely. And when they get old or damaged, they don’t die, as they should. This will cause the extra cells to accumulate into a mass of tissue called a growth, nodule, or tumour.
While some of these growths, nodules, or tumours are benign (they do not grow and multiply aggressively, invade surrounding tissues or travel to other parts of the body), some of them, which are malignant or cancerous, do.
What are the types of liver cancer?
If the cancer starts in the cells of the liver, it is called primary liver cancer. However, the four types of primary liver cancer are categorised according to the types of cells that become cancerous first.
The most common form of liver cancer (hepatocellular carcinoma) begins in hepatocytes, the main type of cells in the liver. Others begin in the cells in the bile duct (cholangiocarcinoma), and very rarely, blood vessels in the liver (angiosarcoma or hemangiosarcoma). When it happens to children under the age of four, it’s called hepatoblastoma.
What are the causes?
Most of the causes of liver cancer are those that cause long term damage to liver cells. As acute infections such as Hepatitis A do not affect the liver in the long term, it does not result in chronic liver disease, hence it is not a risk factor for liver cancer.
While chronic infection of viruses such as Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are the more common causes of liver cancer, chemicals that cause cancer (carcinogens) and alcohol can also cause it, says Dr Mohd Ibrahim. However, in most of Asia, chronic HBV infection is the main cause of liver cancer.
You will also have a higher risk of developing liver cancer if you smoke, are obese, diabetic, or have a history of cirrhosis (when your liver has been scarred by chronic disease).
Are there any early symptoms?
Before looking at the symptoms, it is good to note that liver cancer affects more men than women, usually in their 40s to 50s. Worldwide, men who are diagnosed with liver cancer outnumber women three to one.
Unfortunately, many people do not experience signs or symptoms in the early stages of liver cancer, says Dr Nor Shahidah.
But as the cancer progresses, some may notice some of the following symptoms:
·Weight loss
·An ongoing lack of appetite
·Feeling very full even after a small meal
·A hard lump on the right side just below the rib cage
·Pain around the right shoulder blade
·Yellow-green colour to the skin and eyes (jaundice)
·Discomfort or pain in the upper abdomen on the right side
·Unusual tiredness
·Nausea
As these symptoms are non-specific and can be caused by many health problems other than liver cancer, it is always wise to consult your doctor to have them checked out.
Are blood tests useful in detecting early liver cancer?
Blood tests, like liver function tests (which tests for proteins produced by the liver and enzymes found in the liver) and tumour markers can be used to detect changes in the liver that may indicate the presence of liver cancer. However, they are not very reliable, says Dr Mohd Ibrahim.
As the test results could be influenced by other factors as well, most of the time, a doctor needs to investigate the abnormal blood test results further with ultrasounds, MRI, and CT scans, or biopsies to determine the presence of a cancerous growth in the liver.
Who do you see when your blood tests are abnormal?
“It depends on the type of blood test,” says Dr Nor Shahidah. If they are liver function tests, all doctors should be able to advise you. But if they are serology tests for hepatitis infections, your doctor might refer you to another doctor who specialises in liver diseases (hepatologist).
Also, if your doctor suspects you may have liver cancer, he or she will also refer you to a cancer specialist (oncologist).
Nevertheless, your best bet is to visit your family doctor or a general practitioner first, because he or she will be able to treat you or advise you on which doctor to see next, whether it is a hepatologist or oncologist.
Are surgery and chemotherapy the only treatment options for liver cancer?
No. Although surgery to remove the cancer is still the main method of treatment, many liver cancer patients could not be operated upon. Often, when the cancer is diagnosed too late, the cancer has spread to a large area of the liver, or has occurred in too many sites. Sometimes, it’s just a matter of the cancer growing too close to an important artery.
For these patients, doctors may consider starving the cancer to death by cutting off the blood supply through a procedure called embolisation.
And if embolisation is not possible, doctors may consider killing the cancer by freezing (cryoablation), heating (radiofrequency ablation) or damaging it with chemicals (chemotherapy).
In the year 2008, the Malaysian Ministry of Health had approved the use of a drug initially licensed for the treatment of kidney cancer (sorafenib) as a treatment for liver cancer that could not be operated upon.
However, it is not easily accessible to many liver cancer patients due to its cost.
Therefore, to make sorafenib more accesible to patients, its maker has collaborated with the Malaysian Liver Foundation in a programme that allows eligible patients to purchase two months supply of the drug and get the rest of the year’s supply free.
How do I prevent liver cancer?
As chronic hepatitis B infection is the main cause of liver cancer here in Asia, the best way to prevent it is to get vaccinated against it, says Dr Nor Shahidah.
But what if you are already infected with the HBV or HCV? The answer is to get your liver monitored regularly (about every six months) by your doctor to detect liver cancer early if it develops. (Not all people who are infected with the viruses develop liver cancer.)
Of course, by reducing all other risk factors, including obesity, diabetes, smoking, and alcohol consumption, you will also reduce your chances of developing liver cancer.
TELU take note.....
> For more information about liver cancer, please visit the Malaysian Liver Foundation website at www.liver.org.my.
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