Liver Cancer

Liver Cancer Surgery In Hyderabad, India

The cancer cells that originate in the liver give rise to liver cancer. The liver is the largest glandular organ that performs the function of removing toxins and harmful substances. This organ is found in the upper right side of the abdomen, underneath the diaphragm, and above the stomach. The constant filtering of the blood is done in the liver, which is then circulated throughout the body. This organ is also responsible for producing bile, a substance that helps in digesting vitamins, nutrients, fats, etc. The liver also stores glucose which helps at times when we are not eating. 

The growth of the cancer cells in this vital organ disorients the important functions performed by it. With their gradual and aggressive growth, these cancer cells break from the initial site and spread to other parts and organs of the body. 

However, it is often noticed that the cancer cells that spread to the liver from other organs are much more common than the cancer cells originating from the liver. 

Types of Liver Cancer

• Hepatocellular Carcinoma: It is also known as hepatoma. HCC is the most common category of liver cancer that is diagnosed among adults. This develops in the hepatocytes, the predominant liver cells. The cancer cells in HCC have the potential of spreading to different organs of the body. People with severe alcohol addiction can face the threat of Hepatocellular carcinoma.
• Cholangiocarcinoma: Cholangiocarcinoma, also known as bile duct cancer, is found in the small, tube-like bile ducts present in the liver. These ducts perform the function of delivering bile to the gallbladder so as to help with digestion. Cancer that begins in the bile duct is termed intrahepatic bile duct cancer. Cancer originates in sections of the duct outside the liver, then it is known as extrahepatic bile duct cancer. 
• Liver Angiosarcoma: This is a rare form of cancer found in the blood vessels of the liver. This is a very aggressive cancer that spreads at an alarming rate. Liver angiosarcoma is hard to detect in the initial stages and is usually found when it has reached the advanced stage.
• Hepatoblastoma: This is a very rare form of cancer, usually found in children under three years. 

Symptoms

In the case of liver cancer, most signs go undetected in the early stages. The symptoms experienced when it is advanced are as follows:

• Loss of appetite
• Vomiting
• Nausea
• Yellow discoloration of the skin
• White in the eyes 
• Upper abdominal pain
• Bruising or bleeding easily
• White/chalky stools
• Sudden weight loss

Causes

• Chronic infection with HBV (Hepatitis B virus) or HBC (Hepatitis C virus) can pose a risk for liver cancer.
• Cirrhosis is another risk factor for liver cancer. This is a progressive and relatively irreversible condition that causes scar tissue in the liver, thus, increasing the risk of liver cancer. 
• People who already have diabetes or any other blood sugar disorder also have the threat of liver cancer. 
• Accumulation of fat in the liver is a concern.
• Excessive alcohol consumption is another threat that can add to the risk of liver cancer.
• Certain inherited liver diseases like Wilson's disease or hemochromatosis can also lead to liver cancer.
• Continuous exposure to aflatoxins can be responsible for liver cancer. These aflatoxins are found in the molds that grow on crops grown poorly. These crops include grains and nuts. 

Prevention

1. Consume alcohol in moderation. It is better to let go of drinking, but if that seems impossible, then one might drink alcohol at the limit.
2. Maintain a healthy weight. Exercising daily will keep the body fit and healthy not just externally but also internally.
3. Get a vaccine for hepatitis B. This vaccine can be taken by anyone, including infants, teenagers, adults, and old people. 
4. Take measures against hepatitis C, as no vaccines are available for the same. These measures can be taken in the following manner:

• Don't engage in uncertain and unprotected sex. It is better to be aware of whether the partner is infected with HBV, HCV, or any other sexually transmitted infection or not.
• Don't indulge in IV (intravenous drugs). If this seems impossible, then one must use clean needles. Paraphernalia, a common cause of hepatitis C, is commonly transmitted through IV drugs. 
• While planning to get a tattoo or piercing, look for shops that are hygienic. 

Diagnosis

• Blood tests are the first step to be performed, which helps in diagnosing and revealing any abnormality in the functioning of the liver.
• Another method used for diagnosing the presence of liver cancer is imaging tests. The doctor can recommend various imaging tests such as x-rays, MRI, ultrasound, and CT scans to determine the presence of any abnormal growth of cells in the liver.
• Removing a sample of tissue from the liver for testing. A biopsy is performed, where the doctor inserts a thin needle into the liver to collect a tissue sample. This sample is then tested in the laboratory under the microscope to test the presence of cancer. 

Pre-Op for Liver Cancer Treatment

The pre-operative preparation for liver cancer treatment includes:

• Medical Check-Up
  • Health History: Your doctor will review your medical history to understand your overall health and any previous liver issues.
  • Physical Exam: A thorough check-up to see how your body is functioning.
• Tests and Scans
  • Imaging: You may have tests like ultrasounds or CT scans to look at the liver and see the size and location of the tumor.
  • Blood Tests: Tests will be done to check your liver function and look for any infections.
• Assessing Liver Health
  • Your doctor will evaluate how well your liver is working to determine the best treatment plan.
• Consultations
  • Oncologist: Meet with a cancer doctor to discuss treatment options and what to expect.
  • Surgeon: If surgery is planned, talk to the surgeon about the procedure and any risks.
  • Anesthesia: You’ll meet with an anesthesiologist to discuss anesthesia for the surgery.
• Pre-Op Instructions
  • Medications: Your doctor will tell you which medications to stop or continue before the surgery.
  • Diet: You may need to avoid food and drinks before the procedure, and it’s important to stay away from alcohol.
  • Stop Smoking: If you smoke, it’s best to quit to help with recovery.
• Psychological and Emotional Support
  • Providing counseling and support services to assist patients and their families in managing the diagnosis and preparing for the upcoming treatment.
• Patient Education
  • Learn About the Procedure: Make sure you understand what will happen during the treatment and ask any questions you have.

Treatment

• Surgery: In most cases, the doctors suggest surgery depending on the age, overall health, and personal preference of the patient. This surgery can include the removal of a tumor from the liver. The other option for surgery can include a liver transplant option, where the infected liver is replaced with a healthy liver.  
• Radiation Therapy: This utilizes high-power energy rays, such as x-rays or protons, in order to eliminate cancer cells. Doctors direct these beams to the infected liver. 
• Targeted Drug Therapy: This procedure focuses on the abnormalities in the cancer cells. These abnormalities are blocked to stop the growth of cancer cells.
• Chemotherapy: This is the method where drugs are used to kill the aggressive growth of cancer cells. These drugs can be administered through the vein or can be taken as pills.
• Immunotherapy: It is the method that uses the immune system to block and kill cancer cells. This is generally used in the advanced stages of liver cancer. 
• Localized Treatments: These are directly administered to the cancer cells and include:
  • Heating the cancer cells. In this method, radiofrequency ablation uses an electric current in order to heat and destroy cancer cells. With the help of ultrasound, the doctor inserts needle/needles into the small incisions in the abdomen, which are then heated with an electric current to kill the cancer cells. 
  • Freezing the cancer cells. In this method, cryoablation utilizes extreme cold to kill cancer cells. An instrument, a cryo body filled with liquid nitrogen, is directed into the liver tumors. 
  • Injecting alcohol into the tumor. Pure alcohol is directed into the liver tumors. This alcohol will help in killing cancer cells.
  • Placing radiation beads inside the liver. Spheres containing radiation are placed in the liver. This radiation is directed toward the liver, killing the cancer cells. 

Post-Op Recovery for Liver Cancer

Post-operative recovery after liver cancer treatment is a crucial phase that can affect overall health and healing. 

• Postoperative Monitoring: Close observation in the recovery area, especially focusing on vital signs and liver function.
• Pain Management: Managing effective pain relief strategies to handle postoperative discomfort.
• Recovery and Rehabilitation: Provide instructions on diet, activity levels, and wound care for effective postoperative healing.
• Follow-Up Care: Arranging consistent follow-up visits to track recovery progress and identify any potential signs of cancer recurrence.
• Long-Term Health Management: Recommending lifestyle adjustments, dietary changes, and regular health screenings to promote ongoing health.
• Ongoing Support and Counseling: Offering continued emotional and psychological support for patients and their families following treatment.

Stages of Liver Cancer

Liver cancer is usually categorized into several stages based on the size of the tumor, the number of tumors, and whether the cancer has spread. 

• Stage 0 (Carcinoma in Situ)
  • This is the earliest stage where cancer cells are found only in a small area of the liver but have not spread beyond that area.
  • Characteristics: There may be no noticeable symptoms. Treatment can be very effective at this stage.
• Stage A: Early Stage
  • At this stage, there is one tumor that is 2 cm or smaller.
  • Characteristics: The cancer has not spread to nearby blood vessels or lymph nodes. There are usually no symptoms, and the prognosis is generally good.
• Stage B: Intermediate Stage
  • This stage may involve either:
    • One tumor larger than 2 cm.
    • More than one tumor, but none larger than 5 cm.
  • Characteristics: The cancer still hasn’t spread to nearby blood vessels or lymph nodes. Some symptoms may start to appear.
• Stage C: Advanced Stage
  • Stage III is divided into two sub-stages:
    • Stage IIIA: The tumor has spread to nearby blood vessels or there are multiple tumors, at least one of which is larger than 5 cm.
    • Stage IIIB: The cancer has spread to nearby organs or tissues.
  • Characteristics: Symptoms may become more noticeable, including weight loss, abdominal pain, and jaundice (yellowing of the skin and eyes).
• Stage D: End-Stage (Terminal)
  • This is the most advanced stage and is also divided into two sub-stages:
    • Stage IVA: The cancer has spread to nearby lymph nodes but not to distant organs.
    • Stage IVB: The cancer has spread to distant organs, such as the lungs or bones.
  • Characteristics: At this stage, patients often experience more severe symptoms and may require palliative care to manage pain and improve quality of life.

Treatment According to the Liver Cancer Stage

The treatment of liver cancer largely depends on the stage of the disease, the patient’s liver function, and overall health. Here are the treatment options based on the stages of liver cancer according to the Barcelona Clinic Liver Cancer (BCLC) staging system:

• Stage 0: Very Early Stage
  • Surgery: Partial hepatectomy (removal of the tumor and a portion of healthy liver tissue) may be considered if the tumor is small and the liver is functioning well.
  • Liver Transplant: Ideal for patients with small tumors and underlying liver disease, as it removes both the tumor and the diseased liver.
  • Ablation Therapy: Techniques like radiofrequency ablation (RFA) or microwave ablation (MWA) can destroy small tumors.
• Stage A: Early Stage
  • Surgery: Partial hepatectomy for a single tumor or a liver transplant if eligible.
  • Ablation: RFA or MWA may be effective for small tumors.
  • Transarterial Chemoembolization (TACE): This involves delivering chemotherapy directly to the tumor and blocking its blood supply, effective for patients not eligible for surgery.
• Stage B: Intermediate Stage
  • TACE: This is the main treatment option for patients with multiple tumors who are not suitable for surgery or transplantation.
  • Ablation: RFA or MWA may still be used for small tumors if there are fewer than three.
  • Clinical Trials: Participation in clinical trials for new therapies may be an option.
• Stage C: Advanced Stage
  • Systemic Therapy:
    • Targeted Therapy: Drugs like sorafenib (Nexavar) or lenvatinib (Lenvima) can be used to slow tumor growth and spread.
    • Immunotherapy: Agents like atezolizumab (Tecentriq) in combination with bevacizumab (Avastin) have shown promise in treating advanced HCC.
  • TACE: This may still be used to manage symptoms and control tumor growth.
  • Palliative Care: Focus on relieving symptoms and improving quality of life.
• Stage D: End-Stage (Terminal)
  • Palliative Care: Focus on comfort and quality of life. This may involve pain management, nutritional support, and psychosocial support.
  • Symptom Management: Treatments to manage symptoms like jaundice, ascites (fluid accumulation in the abdomen), and pain.

Success Rates of Liver Treatment in India

Liver cancer treatments in India are renowned for their affordability compared to Western nations, making the country a popular choice for medical tourism worldwide. Success rates vary based on cancer stage, treatment type, and the quality of healthcare facilities. India's healthcare infrastructure and highly trained medical professionals have contributed to enhanced treatment outcomes, particularly in urban areas equipped with advanced medical facilities.

Risk Factors Associated with Liver Cancer Treatment

Factors associated with the risks involved in treating liver cancer include:

• Surgery Risks: Potential complications such as bleeding, infection, and damage to surrounding organs during surgical procedures like liver resection or transplant.
• Chemotherapy Side Effects: Adverse effects such as nausea, fatigue, hair loss, and lowered blood cell counts can occur with chemotherapy drugs used to treat liver cancer.
• Radiation Therapy Risks: Possible damage to healthy tissues surrounding the tumor site, leading to side effects like fatigue, skin changes, and gastrointestinal symptoms.
• Liver Function Impairment: Treatment methods may further compromise liver function, especially in patients with pre-existing liver disease or cirrhosis.
• Immunotherapy Complications: Immune-related adverse events such as inflammation of organs and skin reactions can arise from immunotherapy drugs used to treat liver cancer.
• Post-treatment Monitoring: Regular monitoring is essential to detect the recurrence or development of new tumors, requiring ongoing medical interventions.