Liver Cancer Treatment in Delhi, India

Initially, the liver cancer symptoms might not be visible at all. The patient will start witnessing some of the symptoms after the liver begins to swell. However, there can be other reasons apart from liver tumor that can cause swelling in the liver. Below mentioned are a few symptoms that you might feel if liver cancer has been detected.

• Unexplained weight loss
• Loss of appetite
• Fatigue
• Swelling or fluid build-up in the abdominal area
• Jaundice
• White, chalky stools
• An enlarged liver
• Nausea
• General weakness and fatigue
• Vomiting
• Abdominal Pain
• Fever
• Itching

It is advisable that you undergo a diagnosis and let the physician interpret the results.

Several causes contribute towards liver cancer. Some of the causes are listed below.

• Cirrhosis is a condition where the liver cells are damaged and replaced with scar tissues. People with this health condition develop higher chances of liver cancer.
• Hepatitis B infection
• Diabetes
• NASH or non alcoholic steatohepatitis.
• Family history can also be the cause in some cases
• Alcohol abuse and smoking
• Prolonged use of anabolic steroids can significantly increase the risk of developing liver cancer
• Non-alcoholic fatty liver disease
• Certain inherited liver diseases (Haemochromatosis & Wilson’s Disease)
• Aflatoxins are substance made by a fungus and are found in mouldy wheat, groundnuts, corn, nuts, soybeans, and peanuts. Excess intake of these substances may lead to a tumour in liver.

• Hepatocellular Carcinoma (HCC): ​
  HCC or hepatoma is the most common type of liver cancer. In most cases, it occurs because of hepatitis B or C. Cirrhosis of the liver caused due to alcohol abuse is another reason.
  
• Fibrolamellar HCC:
  This is a rare type of Liver cancer and more responsive to treatments. It typically occurs in young adults between the ages of 20 to 40 without any gender predilection. Unlike, Hepatocellular Carcinoma (HCC), Fibrolamellar HCC does not have any association with cirrhosis, hepatitis or alcoholism.
  
• Cholangiocarcinoma:
  This type of liver cancer occurs in the bile ducts of liver, resulting in intrahepatic and extrahepatic bile duct cancer. It accounts for 10-20% of all liver cancers.
  
• Angiosarcoma:
  It starts in the blood vessels of the liver and proliferates. It is diagnosed at an advanced stage.
  
• Secondary Liver Cancer:
  Secondary liver cancer takes place when cancer originates in another part of the body and later spreads to the liver.

Liver transplant is a surgical treatment option where the entire liver is replaced by a healthy one through surgery. It is an extensive process and is divided into two types:

Deceased Donor Liver Transplantation (DDLT)

In this case, the diseased liver of the patient is replaced with a healthy liver from a donor who has died recently. To avail DDLT, a patient has to go through a number of tests for the doctors to determine if the patient is fit for transplant. Once the tests are through, patients get enrolled in the waiting list for the liver transplant.

Living Donor Liver Transplantation (LDLT)

In this case, the patient with a diseased liver receives a part of liver from family or a friend. Patient’s damaged liver is replaced with the healthy one, which eventually grows on later to its normal size. It is the preferred transplant option where the patient needs immediate transplantation and a DDLT is not feasible.

• Radiofrequency Ablation: Also known as RFA, it is a non-transplant surgical option used to kill cancerous cells. It is a minimally invasive medical procedure that is performed using local anesthesia. This liver tumor treatment employs image guidance to place a needle through the skin into a liver tumor. Using a probe, a high-frequency electrical current is passed through the needle which creates heat to destroy the cancer cells. RFA has a high success rate and is the recommended treatment option where surgery is not feasible.
  
  
• Partial Hepatectomy: An entire part of the liver is removed, ranging from a smaller section to an entire lobe in partial hepatectomy.

This treatment uses high-powered energy from sources such as X-rays and protons to destroy cancer cells and shrink tumours. Doctors carefully direct the energy to the liver, while sparing the surrounding healthy tissue. During external beam radiation therapy treatment, you lie on a table, and a machine directs the energy beams at a precise point on your body.

Liver Cancer Treatment is administered directly to the cancer cells or the area surrounding the cancer cells. Options include:

• Heating cancer cells: Using ultrasound or CT scan as a guide, your surgeon inserts one or more thin needles into small incisions in your abdomen. On reaching the tumour, the needles are heated with an electric current, destroying the cancer cells.
  
• Freezing cancer cells: Cryoablation uses extreme cold to destroy cancer cells. During the procedure, your doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumours. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells.
  
• Injecting alcohol into the tumor: During alcohol injection, pure alcohol is injected directly into tumours, either through the skin or during an operation. Alcohol causes the tumor cells to die. Injecting chemotherapy drugs into the liver. 
  
• Placing beads filled with radiation in the liver: Tiny spheres that contain radiation may be placed directly in the liver where they can deliver radiation directly to the tumour.

After a successful liver cancer treatment, you too can live a normal life and resume your daily activities. It is important to follow the directions given by your doctor. Post-treatment, the patient is required to make healthy choices and efforts to stay fit. It will indeed take some time for the patient to recover completely both physically and mentally. Here are a few things that can help the patient in recovering fast.

• Take adequate rest and give some time for self
• Do not include tasks in your work routine that require strenuous efforts from your end.
• Avoid it for at least some time post the treatment
• Socialize more, it will help in making you feel better
• Exercise regularly, but moderation should be the key
• Start having a healthy diet with lots of green vegetables and avoid junk food
• In case of discomfort, visit the physician at the earliest

Max Institute of Cancer Care (MICC) at Max Hospitals, India, is one of the leading facilities in India, which offers the latest treatments under surgical oncology, radiation oncology, and medical oncology. It is one of the largest Cancer Centres in North India, with presence in Saket, Patparganj, Shalimar Bagh, Vaishali, Mohali and Bathinda. It offers high-end treatments like cone-beam CT and ExacTrac.

Diagnostic tests and procedures for liver cancer include:

• Blood Tests
• Liver function tests
• Imaging Tests (Sonography, CT Scan and MRI)
• Hepatic arteriography
• Liver biopsy

At Max Institute of Cancer Care, we know that cancer treatment involves multiple specialities (Surgical, medical and radiation oncology, molecular oncology, pathology, radiology, palliative oncology, psycho-oncology, onco rehabilitation, etc.), and the best outcome in any patient can be ensured only if all decisions are taken collectively by all specialists involved.
Therefore, a Tumor Board of such specialists who meet periodically and discuss the best approach to the management of cancer patients is facilitated. It ensures that many heads are planning holistic management of a patient.

Liver cancer is treated by involving complete medical history and physical examination, and diagnostic procedures. A series of physical examinations, medical tests, or both methods can be used as follow-up care by the concerned physician.

For a liver cancer patient, the right treatment is determined based on the age, overall health, medical history, extent of the disease, tolerance of specific medicines, procedures, or therapies, expectations for the course of the disease and the patient’s opinion or preference.

The doctor will also evaluate the side effects of the treatment. Whatever changes you feel in your body post the treatment, let your physician be aware of it, so that a proper follow-up care routine is designed

1. What is liver cancer?

Liver cancer is a type of cancer that begins in the liver cells and can spread to other body parts.

2. What are the types of liver cancer?

There are various types of liver cancer, including hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), hepatoblastoma, and various other relatively uncommonly seen cancers.

3. What are the common risk factors for liver cancer?

Common risk factors for liver cancer include chronic infection with hepatitis B or C, cirrhosis, excessive alcohol consumption, non-alcoholic fatty liver disease (NAFLD), and exposure to aflatoxins.

4. What are the common symptoms of liver cancer?

Symptoms of liver cancer include abdominal pain, unexplained weight loss, fatigue, jaundice, loss of appetite, and swelling in the abdomen.

5. How is liver cancer diagnosed?

Liver cancer is usually diagnosed through imaging tests, such as an ultrasound or CT scan.

6. What are the stages of liver cancer?

Liver cancer is typically staged using the TNM system, which takes into account the size and location of the tumour, as well as whether it has spread to other parts of the body.

7. How is liver cancer treated?

Treatment of liver cancer depends on various factors, including the stage of the cancer, the condition of the underlying liver (functional status of the liver) and the patient's overall health and may include surgery, radiation therapy, targeted therapy, chemotherapy, immunotherapy, and ablation techniques.

8. What are the surgical options for liver cancer treatment?

Surgical options for liver cancer treatment include resection, in which part of the liver is removed, and liver transplantation.

9. What is liver transplantation for liver cancer?

Liver transplantation involves replacing the diseased/damaged liver with a healthy liver from a donor and can be an effective treatment option for early-stage liver cancer.

10. What are the non-surgical treatment options for liver cancer?

Non-surgical treatment options for liver cancer include ablation techniques (such as radiofrequency ablation, cryoablation, microwave ablation, transarterial chemoembolization, transarterial radioembolization), radiation therapy, chemotherapy, targeted therapy, and immunotherapy.

11. What is targeted therapy for liver cancer?

Targeted therapy uses drugs that target specific proteins or genes in cancer cells to stop their growth and spread.

12. What is immunotherapy for liver cancer?

Immunotherapy uses the body's immune system to fight cancer cells and is a newer treatment option for liver cancer.

13. What is cryoablation for liver cancer?

Cryoablation for liver cancer is a minimally invasive interventional radiologic technique that uses extreme cold temperatures to destroy cancerous tissue in the liver. During the procedure, a thin probe called a cryoprobe is inserted into the liver tumour, and liquid nitrogen or argon gas is circulated through the probe to create an ice ball that freezes and destroys the cancer cells. Cryoablation is often used as an alternative treatment for liver cancer patients who cannot undergo surgery or who have tumours that cannot be treated with other treatment modalities, such as chemotherapy or radiation therapy. 

14. What is transarterial chemoembolization (TACE) for liver cancer?

TACE is a type of targeted therapy that involves injecting chemotherapy drugs directly into the blood vessels that supply the tumour, followed by blocking the blood flow to the tumour.

15. What is transarterial radioembolization (TARE) for liver cancer?

TARE is a type of targeted therapy that involves injecting radioactive particles directly into the blood vessels that supply the tumour, causing the radiation to kill the cancer cells.

16. What is microwave ablation for liver cancer?

Microwave ablation is a minimally invasive procedure that uses microwave energy to destroy cancer cells in the liver.

17. Can liver cancer be prevented?

While it is not always possible to prevent liver cancer, there are several steps you can take to reduce your risk. This includes getting vaccinated against hepatitis B, avoiding exposure to hepatitis C, getting treated for hepatitis B and C as needed, limiting alcohol consumption, maintaining a healthy weight, and managing diabetes.

18. What are the dietary guidelines for liver cancer prevention?

You should aim to eat a diet that is high in fruits, vegetables, whole grains, and lean protein sources and low in saturated fats, red meats, and processed foods. It's also important to limit your intake of alcohol and sugar-sweetened beverages.

19. What is the role of hepatitis B and C in liver cancer?

Hepatitis B or C virus is a significant risk factor for liver cancer. These viruses can cause ongoing inflammation in the liver, which can lead to the development of liver cancer over time.

20. What is the role of non-alcoholic fatty liver disease (NAFLD) in liver cancer?

Non-alcoholic fatty liver disease (NAFLD) is a condition where excess fat accumulates in the liver. It is a significant risk factor for liver cancer, particularly in individuals with advanced fibrosis or cirrhosis.

21. What is the role of genetics in liver cancer?

Genetics can play a role in the development of liver cancer, particularly in individuals with a family history of liver cancer or certain genetic mutations. Genetic testing may be recommended for individuals with a family history of liver cancer.

22. What is irreversible electroporation for liver cancer?

Irreversible electroporation (IRE) is a minimally invasive procedure that uses electrical currents to destroy cancerous cells in the liver. It is used to treat liver tumours that are not suitable for surgery or other treatments.

23. What is high-intensity focused ultrasound (HIFU) for liver cancer?

High-intensity focused ultrasound (HIFU) is a non-invasive treatment that uses high-frequency sound waves to heat and destroy cancer cells in the liver. It is used to treat small liver tumours that are not suitable for surgery or other treatments.

24. What is the prognosis for liver cancer?

The prognosis for liver cancer depends on several factors, including the stage of cancer, the size of the tumour, whether cancer has spread to other parts of the body, the condition of the underlying liver (functional status of the liver) and the overall health of the patient. The earlier the cancer is detected and treated, the better the prognosis.

25. What is the survival rate for liver cancer?

The survival rate for liver cancer varies depending on several factors, including the type of liver cancer and the stage of cancer, the size of the tumour, the condition of the underlying liver (functional status of the liver) and the overall health of the patient.

FAQs Reviewed by Dr. Vivek Mangla, Director - Gastrointestinal and Hepatopancreatobiliary (GI & HPB) Surgical Oncology, Cancer Care / Oncology, Surgical Oncology, Gastrointestinal & Hepatobiliary Oncology, Gastro Intestinal & Hepatopancreatobiliary Surgical Oncology, Robotic Surgery on 26-Jun-2023.

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