Liver Cancer Treatment in Delhi, India

Overview

Liver cancer is fairly common and often difficult to treat. Liver cancer is divided mainly into primary liver cancer and metastatic liver cancer. Primary liver cancer begins in the liver tissues, whereas cancer that begins in another part of the body and spreads to the liver is known as metastatic liver cancer.

Associated Anatomy of Liver Cancer

As the name suggests, liver cancer affects the liver, which is an essential organ located in the upper right abdomen of the body, above the stomach.

Liver Cancer Stages

For a better understanding and treatment of liver cancer, medical professionals have divided liver cancer into four stages.

Stage 1: This is the stage where the tumor has remained in the liver and has not spread to other parts of the body.
Stage 2: In this stage, there are several small tumors smaller than 3 cm or one tumor that has spread to the blood vessels.
Stage 3: In this stage, either there is one tumor bigger than 5 cm or cancer has moved beyond the liver to a bigger blood vessel.
Stage 4: The last and most advanced stage of cancer wherein cancer has spread to other parts of the body.

Liver Cancer Causes

Currently, the exact cause behind liver cancer is not fully understood. Research studies suggest that the following factors potentially cause liver cancer.

Hepatitis B & C: This is a medical condition caused by the Hepatitis viruses that involve the inflammation of the liver. The hepatitis viruses can change the structure of the liver cells, which can affect normal liver functioning and may cause liver cancer.
Changes in DNA: Many studies suggest that chemical substances such as aflatoxins damage the TP53 tumor suppressor gene, which may lead to the increased growth of cancer cells.

Liver Cancer Symptoms

While the initial stages of liver cancer show no symptoms, in the later stages, one may develop the following symptoms.

Abdominal pain
Fatigue
Jaundice – Yellowish discolouration of the skin and eyes
Loss of appetite
Nausea and vomiting
Bloating
Dark-coloured urine
Enlarged liver
Fever
Back pain
Itching
Chalky, white stools
Bleeding or bruising easily
Weight loss, easy fatigability
Pain near the right shoulder blade

Liver Cancer Diagnosis

The first step of diagnosing liver cancer involves conducting a physical exam to check for any symptoms of liver cancer, such as jaundice, liver mass or abdominal pain. If the doctor suspects liver cancer, they may suggest a battery of tests for further diagnosis such as an ultrasound abdomen, Magnetic Resonance Imaging (MRI), or Computed Tomography (CT) scan to get clear images of the liver. Doctors may order for a blood test (Alpha Fetoprotein, AFP). In some cases, the doctor may conduct a biopsy, which involves taking sample tissue from the liver and sending it for testing.

Liver Cancer Treatment

Liver cancer treatment is dependent on factors such as the stage of tumor, size and location of cancer, proper functioning of the liver, whether the patient is having cirrhosis and whether it has spread to other parts of the body or not. Once these factors have been determined, the doctor may recommend either one or a combination of the following treatment options.

Liver Resection

Liver Resection is a surgical procedure that involves the partial or complete removal of the liver. Doctors opt for this surgery when the cancer is limited and confined to the liver. Once the surgery is conducted, the healthy tissues regrow over time. This is a potentially curable opinion.

Liver Transplant

Liver Transplant Procedure involves replacing an unhealthy liver with a healthy liver from a donor. Doctors go for this method when cancer has not spread to other parts of the body.

Ablation

In the Ablation procedure, the surgeon uses heat, chemical agents, or electromagnetic waves to destroy the cancer cells in the liver.

Chemotherapy

Chemotherapy is an aggressive form of drug therapy where the patient is injected intravenously with medication to destroy the cancer cells.

Targeted Therapy

Last decade has seen tremendous progression in targeted therapy of HCC, Sorafenib, Lenvatinib, and Bevacizumab are a few examples used in hepatocellular carcinoma.

Chemoembolization

Immunotherapy

Risk Factors of Liver Cancer

Certain factors increase the risk of developing liver cancer. They are:

Family history: Patients with a family history of liver cancer have a higher chance of developing liver cancer in their lifetime.
Liver cirrhosis: Liver Cirrhosis is a liver condition where the healthy tissues of the liver are replaced by fibrous tissues which prevents its normal functioning and lead to a higher possibility of developing liver cancer.
Diabetes: Individuals with diabetes or high blood sugar have two to three times the risk of developing primary liver cancer in comparison to those without diabetes.
Alcohol Abuse: Drinking excess alcohol over a long period can lead to liver damage and increase a person’s risk of developing liver cancer.
Hepatitis B & C: Can lead to hepatocellular carcinoma.

Liver Cancer Prevention

While liver cancer cannot be entirely avoided, there are some ways to decrease the risk of developing liver cancer. These include:

Limit or completely abstain from regular alcohol consumption to reduce the risk of developing liver cirrhosis and liver cancer.
Since hepatitis is one of the major causes of liver cancer, one should get the required vaccination against hepatitis B to lower one’s chance of getting liver cancer.
Eat a healthy diet and keep physically active by engaging in exercise.
Practice safe sex to reduce the risk of contracting hepatitis - B & C or other sexually transmitted diseases that may lead to one developing liver cancer.

Epidemiology of Liver Cancer

Studies suggest that the liver is the fifth most common cancer in the world, with most cases due to hepatitis B and hepatitis C. Statistics show that:

Men are at a higher risk of developing liver cancer than women
People over the age of 50 have a higher risk of developing liver cancer

Expected Prognosis of Liver Cancer

Liver cancer has a poor prognosis due to the majority of the cases being diagnosed in the advanced stage. Studies estimate that 31% of the people diagnosed with liver cancer live up to at least 5 years after proper treatment, but once cancer spreads, the survival rate goes down to 11%.

Pathophysiology

While the current understanding of liver cancer is limited, studies indicate that changes in the nuclear structure and genetic mutation of the TP53 gene may play a large role in the formation of liver cancer.

Possible Complications of Liver Cancer

Liver cancer can result in possible complications such as low red blood count (anaemia), excessive bleeding, obstruction in the bile duct, high level of calcium in the blood (hypercalcemia), high blood pressure (hypertension), memory loss, disorientation, and kidney diseases.

Frequently Asked Questions

1. Is liver cancer hereditary?

While some liver cancers may have a hereditary component, the majority of liver cancer cases are not directly inherited. Certain genetic conditions, such as hereditary hemochromatosis, can increase the risk of liver cancer, but most cases are related to lifestyle factors and chronic liver diseases.

2. Can liver cancer be treated without surgery in Delhi?

Yes, liver cancer can be treated without surgery, depending on the stage of cancer and the overall health of the patient. Treatment options include radiation therapy, ablation therapy, embolisation, targeted therapy, immunotherapy, and chemotherapy.

3. How is liver cancer staged?

Liver cancer is staged with the TNM system by evaluating tumour size (T), lymph node involvement (N), and distant metastasis (M). Staging helps classify liver cancer into different stages, guiding treatment decisions and predicting patient prognosis.

4. Can liver cancer recur after treatment?

Yes, liver cancer can recur even after successful treatment. Regular follow-up visits and imaging scans are essential to manage the disease effectively.

5. What stage of liver cancer causes jaundice?

Jaundice can occur in various stages of liver cancer. In some cases, jaundice may develop when the tumour obstructs the bile ducts, preventing the normal flow of bile from the liver to the intestines.

6. How long can you live with untreated liver cancer?

The survival rate for untreated liver cancer depends on the stage of cancer at diagnosis, the size and location of the tumour, and the individual's overall health.

7. Can you feel fine while liver cancer treatment?

During liver cancer treatment, some patients may feel relatively fine, especially if the cancer is detected early and the treatment is effective in controlling the disease. However, treatment for liver cancer can also be physically demanding and may cause side effects such as fatigue, loss of appetite, and pain.

8. Can you have liver cancer with no symptoms?

Yes, it is possible to have liver cancer with no symptoms, especially in the early stages of the disease. Some individuals may only discover they have liver cancer during routine medical check-ups or screenings for other health conditions.

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