Liver Cancer

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 cancer 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 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.

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

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