How Do You Know If You Have Liver Cancer? : Liver Cancer Treatment in India

What is liver cancer?

Liver cancer is cancer that starts in the cells of the liver. There are two main types: hepatocellular carcinoma (HCC) and cholangiocarcinoma.

HCC starts from the main cells in the liver (hepatocytes), and is the most common type of primary liver cancer. Cholangiocarcinoma starts in the cells lining the bile duct.

Cancer can also spread to the liver from another part of the body. This is called secondary liver cancer.

Liver cancer symptoms :-

Primary liver cancer usually has no symptoms in the early stages. Symptoms usually appear when the cancer has advanced. Symptoms for secondary cancer in the liver are similar and may include:

         

•        pain in the upper right side of the abdomen
•         weight loss
•        loss of appetite
•         feeling sick (nausea)
•         swelling of the abdomen (ascites)
•        yellowing of the skin and eyes (jaundice).
•     weakness and tiredness (fatigue)

How Do You Know If  You Have Liver Cancer?

Screening for early detection of primary liver cancer is not performed routinely, but it may be considered for people at high risk for the disease. However, studies haven't determined if screening is beneficial for anyone. To diagnose liver cancer, a doctor must rule out other causes of liver dysfunction.

Patients at high risk include patients with a condition called hemochromatosis, chronic hepatitis, and alcoholics.

Additional tests include:

·         Blood tests that measure tumor markers -- the levels of these substances rise in the blood if someone has a particular cancer -- can aid diagnosis. Liver cancers secrete a substance called alpha fetoprotein (AFP) that is normally present in fetuses but goes away at birth. An elevated AFP in adults may indicate liver cancer as it is produced in 70% of liver cancers. Elevated levels of iron may also be a tumor marker. 

·         Imaging with ultrasound is the initial diagnostic test as it can detect tumors as small as one centimeter. High resolution CT scans and contrast MRI scans are used to diagnose and stage these tumors. 

·         A liver biopsy will distinguish a benign tumor from a malignant one. However, depending on the results of other tests, a biopsy might not be required to diagnose cancer.

·         Laparoscopy, using tools and cameras through small incisions, is useful for detecting small tumors, determining the extent of cirrhosis, or obtaining a biopsy, and confirm previous tests, among other things.

What Are the Treatments for Liver Cancer?

Any liver cancer is difficult to cure. Primary liver cancer is rarely detectable early, when it is most treatable. Secondary or metastatic liver cancer is hard to treat because it has already spread. The liver's complex network of blood vessels and bile ducts makes surgery difficult. Most treatment concentrates on making patients feel better and perhaps live longer.

Patients with early-stage tumors that can be removed surgically have the best chance of long-term survival. Unfortunately, most liver cancers are inoperable at the time it's diagnosed, either because the cancer is too advanced or the liver is too diseased to permit surgery. In some patients, chemotherapy is given directly into the liver (chemoembolization) to reduce tumors to a size that may make surgery possible. This may also be done without chemotherapy (bland emoblization) in some cases, using ethanol instead. After surgery, radiation and chemotherapy have shown no advantage in improving survival. Patients in remission must be monitored closely for potential recurrence.

Cryotherapy, or freezing the tumor, and radiofrequency ablation (RFA), using radio waves to destroy the tumor, may be used to treat some cases of liver cancer. Radiation therapy can be given in various ways, but has its limitations due to the liver's low tolerance to radiation. When used, the role of radiation is to alleviate symptoms outside of the liver or to relieve pain within the liver by shrinking the tumor. Radioembolization therapy uses substances to cut off the blood supply to the tumor.

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Liver Cancer Treatment Options Available at Best Cancer Hospitals in India

Livercancer or Hepatocellular carcinoma (HCC) is one of the commonest cancers in the world which have a high incidence of Hepatitis B infection. Apart from Hepatitis B, it may be caused by other diseases that lead to cirrhosis of the liver such as Hepatitis C infection, and alcohol abuse. 

Unfortunately, like many other cancers, liver cancer may go undetected until a late stage. It is often brought to attention by an ultrasound or CT scan done for pain in the upper abdomen or another unrelated symptom. Liver cancers are malignant tumors that grow on the surface or inside the liver. Typers of liver cancer areHepatocellular Carcinoma 

, Cholangiocarcinoma , Hepatoblastoma and Angiosarcoma or Hemangiosarcoma

Each person is unique, each cancer is unique

No treatment or treatment plan is right for every person or every cancer. Only by working closely with their doctor can patients decide what treatment or combination of treatments may best fit their unique situation.

Factors in treating liver cancer

Recommended treatments for liver cancer can depend on:

·         a patient’s age, overall health, physiology and pre-existing conditions

·         the number of tumors and degree of invasion of other tissues (stage)

·         the degree of liver damage or dysfunction

·         the tumor location(s) and proximity to major blood vessels, bile ducts or other organs

·         the type of cancer, including whether it is primary or secondary

·         the degree of cancer cell resemblance to surrounding tissue (grade)

·         a patient’s individual preferences

Treatment strategies

Treatments for cancer may involve:

·         surgical removal of cancerous tissue

·         destroying cancerous tissue with drugs or other chemicals

·         using hot or cold energy, such as from microwaves, ultrasound, radiofrequency or super-cooled high pressure gases

·         radiation

Many treatment plans attack cancer by using multiple therapies, enabling customization to the unique physiologies, conditions and preferences of patients.

Resection methods

Surgeons often use two methods to perform a surgical liver resection: laparoscopic surgery or open surgery. A laparoscopic surgery is a minimally invasive procedure that allows the surgeon to access the liver through a few small "porthole" incisions. The surgeon performs the procedure using a laparoscope, a device that provides a camera view of the liver. The surgeon will also access the organ through ports for the surgical instruments. During open surgery, the surgeon makes a larger incision in the abdomen to access the liver directly.

Chemotherapy is a treatment that uses drugs to destroy cancerous tissue in the body. Normal cells typically grow and die in a controlled cycle; cancerous cells keep dividing, uncontrollably forming more cells. Chemotherapy drugs destroy cancer cells by stopping them from growing or multiplying. These drugs can also be harmful to healthy cells, especially those that divide quickly. This may cause side effects such as hair loss. Healthy cells usually can repair themselves after chemotherapy.

Some types of cancer respond better than others to chemotherapy. The chemotherapy drug(s) selected depend on the type of cancer and other factors.

Because some drugs work better in combination with others than alone, two or more drugs are often given at the same time. This is called combination chemotherapy.

A transplant is when one organ, or part of an organ, is transferred from a donor to a recipient. For liver cancer patients, a liver transplant is one treatment option that is considered to be potentially curative, provided the cancer is indeed confined to the liver.

Few patients with liver cancer are candidates for a liver transplant. It is not an option for people withsecondary liver cancer, and it is an option for only a small percentage of people with primary liver cancer. In most cases, since liver cancer symptoms may not manifest until later stages of the disease, the cancer may be too large or have spread outside the liver by the time it is diagnosed.

 

Complete livertransplant

Liver transplantation is an option for some patients if the cancer has not spread to other organs, is below a total maximum size and a suitable liver can be found. The most common transplant procedure involves complete replacement with a healthy liver from a non-living donor. This is sometimes called deceased donor liver transplant (DDLT).

The average wait time for a donor liver is 796 days.¹ Due to tumor growth (progression) while waiting for a matching liver, most eligible people will need other medical interventions, such aslocal ablation, before receiving a liver. These other interventions may help control tumor growth so the patient can remain on the transplant list. If the cancer spreads outside the liver or grows too large while a person awaits a liver, he or she may become ineligible.

Radiation Therapy

Radiation therapy, sometimes called radiotherapy, is the delivery of high doses of radiation to a defined local area of the body.

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Nonsurgical Treatments for Liver Cancer in India

Liver cancer or Hepatocellular carcinoma (HCC) is one of the commonest cancers in the world which have a high incidence of Hepatitis B infection. Apart from Hepatitis B, it may be caused by other diseases that lead to cirrhosis of the liver such as Hepatitis C infection, and alcohol abuse. 

Unfortunately, like many other cancers, liver cancer may go undetected until a late stage. It is often brought to attention by an ultrasound or CT scan done for pain in the upper abdomen or another unrelated symptom. Liver cancers are malignant tumors that grow on the surface or inside the liver. 

Typers of liver cancer are 

HepatocellularCarcinoma  , Cholangiocarcinoma , Hepatoblastoma and Angiosarcoma or Hemangiosarcoma

Liver cancer is usually diagnosed with a number of different tests, which may include:

§  Blood tests: To check your general health and check for a chemical usually found inincreased levels in people with primary liver cancer.

§  Ultrasound: A picture of the liver is taken using sound waves.

§  Computed Tomography (CT) Scan: A specialised x-ray taken from many different angles to build a three-dimensional (3-D) picture of the body.

§  Magnetic Resonance Imaging (MRI): Similar to a CT scan, but uses a powerful magnet and magnetic field instead of x-rays to build an image of the body.

§  Liver Biopsy: A small piece of liver tissue is removed with a needle and examined for cancer cells.

§  Laparoscopy: A small cut in the lower abdomen is made and this allows a thinmini-telescope (laparoscope) to be inserted to look at the liver and take a sample of liver tissue.

§  Needle Biopsy: Needle biopsy, also called image-guided biopsy, is usually performed using a (MR) to guide the procedure. In many cases, needle biopsies are performed with the aid of equipment that creates a computer-generated image and allows radiologists to see an area inside the body from various angles. This “stereotactic” equipment helps them pinpoint the exact location of the abnormal tissue.

§  Large Core Needle Biopsy: In this technique, a special needle is used that enables the radiologist to obtain a larger biopsy sample. This technique is often used to obtain tissue samples from lumps or other abnormalities in the breast that are detected by physical examination or on mammograms or other imaging scans. moving X-ray technique (fluoroscopy) computed tomography (CT), ultrasound or magnetic resonance.

Liver Cancer Treatment in India

§  Surgery: Procedure to remove a portion of the liver. Your doctor may recommend partial hepatectomy to remove the liver cancer and a small portion of healthy tissue that surrounds it if your tumor is small and your liver function is good.

§  Transplant Surgery: During liver transplant surgery, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery may be an option for people with early-stage liver cancer who also have cirrhosis.

§  Freezing Cancer Cells: Cryoablation uses extreme cold to destroy cancer cells. During the procedure, your doctor places the instrument (cryoprobe) containing liquid nitrogen directly onto liver tumor.

§  Heating Cancer Cells: In a procedure called radiofrequency ablation, electric current is used to heat and destroy cancer cells. It is also called hyperthermia cancer treatment.

§  Injecting Alcohol: During alcohol injection, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol dries out the cells of the tumor and eventually the cells die.

§  Chemoembolization: A type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver. It is palliative and not curative treatment.

§  Radiation Therapy: This treatment uses high-powered energy beams to destroy cancer cells and shrink tumors.

§  Targeted Drug Therapy: Drugs designed to interfere with a tumor’s ability to generate new blood vessels.

Nonsurgical Treatments for Liver Cancer at World Class Hospitals in India

1) Chemoembolization: Chemoembolization is a minimally invasive treatment for liver cancer that can be used when there is too much tumor to treat with radiofrequency ablation (RFA), when the tumor is in a location that cannot be treated with RFA, or in combination with RFA or other treatments. In this the anticancer drug is given along with another substance that blocks the hepatic artery. (artery supplying the liver). Thus the anticancer drug is gets concentrated in the cancerous portion of the liver.2) Radiofrequency Ablation: For inoperable liver tumors, radiofrequency ablation (RFA) offers a nonsurgical, localized treatment that kills the tumor cells with heat, while sparing the healthy liver tissue. Thus, this treatment is much easier on the patient than systemic therapy. 3) Cryosurgery: It is a treatment that uses an instrument to freeze and destroy abnormal tissue, such as cancerous cells. This type of treatment is also called Cryotherapy. The doctor may use ultrasound to guide the instrument. 4) Drugs called radio-sensitizers may be given with the radiation therapy to make the cancer cells more sensitive to radiation therapy. 5) Percutaneous Ethanol Injection: Percutaneous ethanol injection is a cancer treatment in which a small needle is used to inject ethanol (alcohol) directly into a tumor to kill cancer cells. The procedure may be done once or twice a week. Usually local anesthesia is used, but if the patient has many tumors in the liver, general anesthesia may be needed. 6) Hyperthermia Therapy: Hyperthermia therapy is a type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. Because some cancer cells are more sensitive to heat than normal cells are, the cancer cells die and the tumor shrinks. 7) Biologic Therapy: Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. For more information visit:          http://www.medworldindia.com                             https://www.facebook.com/medworld.india Please scan and email your medical reports  to us at care@medworldindia.com and we shall get you a Free Medical Opinion from India’s Best Doctors. Call Us : +91-9811058159 Mail Us : care@medworldindia.com

Nonsurgical Treatment for Liver Cancer: Extend Life and Improve Quality

Liver cancer or Hepatocellular carcinoma (HCC) is one of the commonest cancers in the world which have a high incidence of Hepatitis B infection. Apart from Hepatitis B, it may be caused by other diseases that lead to cirrhosis of the liver such as Hepatitis C infection, and alcohol abuse. 

Unfortunately, like many other cancers, liver cancer may go undetected until a late stage. It is often brought to attention by an ultrasound or CT scan done for pain in the upper abdomen or another unrelated symptom. Liver cancers are malignant tumors that grow on the surface or inside the liver. Typers of liver cancer are Hepatocellular Carcinoma , Cholangiocarcinoma  ,Hepatoblastoma .

Surgical removal of liver tumors offers the best chance for a cure. Unfortunately, liver tumors are often inoperable because the tumor may be too large, or has grown into major blood vessels or other vital structures. Sometimes, many small tumors are spread throughout the liver, making surgery too risky or impractical. Surgical removal is not possible for more than two-thirds of primary liver cancer patients and 90 percent of patients with secondary liver cancer.

Diagnosis of Liver Cancer

There are a number of tests that can help in the diagnosis of cancer, including blood tests, physical examination and a variety of imaging techniques including X-rays (e.g., chest X-rays and mammograms); computed tomography (CT); magnetic resonance (MR) and ultrasound. Usually, however, the final diagnosis cannot be made until a biopsy is performed. In a biopsy, a sample of tissue from the tumor or other abnormality is obtained and examined by a pathologist. By examining the biopsy sample, pathologists and other experts also can determine what kind of cancer is present and whether it is likely to be fast or slow growing. This information is important in deciding the best type of treatment.

Although there are no standard or routine screening tests for liver cancer, the following tests are being used or studied to screen for it

• Physical examination : Physical examination may show an enlarged, tender liver. Also, your skin and eyes may be checked for signs of jaundice.
• Blood tests :Physical examination may show an enlarged, tender liver. Also, your skin and eyes may be checked for signs of jaundice.
• Imaging Studies like Abdominal CT scan and Abdominal Ultrasound test
• Liver biopsy or Aspiration.
• Liver enzymes (liver function tests)

In order to check if the Liver Cancer has spread elsewhere in the body, the following tests are to be done:

• PET Scan
• Bone Scan- to check if the cancer has spread to the bones.

Nonsurgical TreatmentOptions for Liver Cancer at Best Hospitals in India

Tumors need a blood supply, which they actively generate, to feed themselves and grow. As vascular experts, interventional radiologists are uniquely skilled in using the vascular system to deliver targeted treatments via catheter throughout the body. In treating cancer patients, interventional radiologists can attack the cancer tumor from inside the body without medicating or affecting other parts of the body by using embolization and radiofrequency heat.

Embolization is a well-established interventional radiology technique that is used to treat trauma victims with massive bleeding, to control hemorrhage after childbirth, to decrease blood loss prior to surgery and to treat tumors. In treating cancer patients, interventional radiologists use embolization to cut off the blood supply to the tumor (embolization), deliver radiation to a tumor (radioembolization), or combine this technique with chemotherapy to deliver the cancer drug directly to the tumor (chemoembolization)

Chemoembolization

Chemoembolization is a minimally invasive treatment for liver cancer that can be used when there is too much tumor to treat with radiofrequency ablation (RFA), when the tumor is in a location that cannot be treated with RFA, or in combination with RFA or other treatments.

Chemoembolization delivers a high dose of cancer-killing drug (chemotherapy) directly to the organ while depriving the tumor of its blood supply by blocking, or embolizing, the arteries feeding the tumor. Using imaging for guidance, the interventional radiologist threads a tiny catheter up the femoral artery in the groin into the blood vessels supplying the liver tumor. The embolic agents keep the chemotherapy drug in the tumor by blocking the flow to other areas of the body. This allows for a higher dose of chemotherapy drug to be used, because less of the drug is able to circulate to the healthy cells in the body. Chemoembolization usually involves a hospital stay of two to four days. Patients typically have lower than normal energy levels for about a month afterwards.

Radiofrequency Ablation

For inoperable liver tumors, radiofrequency ablation (RFA) offers a nonsurgical, localized treatment that kills the tumor cells with heat, while sparing the healthy liver tissue. Thus, this treatment is much easier on the patient than systemic therapy. Radiofrequency energy can be given without affecting the patient's overall health and most people can resume their usual activities in a few days.

In this procedure, the interventional radiologist guides a small needle through the skin into the tumor. From the tip of the needle, radiofrequency energy (similar to microwaves) is transmitted to the tip of the needle, where it produces heat in the tissues. The dead tumor tissue shrinks and slowly forms a scar. The FDA has approved RFA for the treatment of liver tumors.

Targeted Therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells. Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor.

Benefits of Nonsurgical Treatment for Liver Cancer

• Is most effective when all the cancer is localized in the liver
• Can be used to treat primary liver cancer and tumors that have metastasized (spread) from other areas in the body to the liver
• Usually does not require general anesthesia
• Is well tolerated-most patients can resume their normal routine the next day and may feel tired for a few days
• Can be repeated if necessary
• May be combined with other treatment options
• Can relieve pain and suffering for many cancer patients

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