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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Low Cost Bladder Cancer Treatment in India

Bladder cancer is a type of cancer that begins in your bladder — a balloon-shaped organ in your pelvic area that stores urine. Bladder cancer begins most often in the cells that line the inside of the bladder. Bladder cancer typically affects older adults, though it can occur at any age.

The great majority of bladder cancers are diagnosed at an early stage — when bladder cancer is highly treatable. However, even early-stage bladder cancer is likely to recur. For this reason, bladder cancer survivors often undergo follow-up tests to look for bladder cancer recurrence for years after treatment.

Signs & Symptoms

• Blood in urine
• Pain and/or burning during urination (dysuria)
• Frequency, urgency

These symptoms are non-specific and may be linked with other conditions that are unrelated to cancer. Urinary bladder cancer often causes no symptoms until it reaches an advanced stage. If you experience, any of these symptoms, you must see the doctor immediately. 

Staging:

• Stage CIS: Flat cancer limited to the innermost lining of the bladder. It is high grade.
• Stage T1: Cancer penetrated into the submucosal tissue.
• Stage T2: Cancer penetrated the muscular bladder wall.
• Stage T3: Cancer penetrated through muscular bladder wall into the surrounding fat.
• Stage T4: Cancer penetrated into the adjacent structures (prostate, uterus, or vagina). Regional lymph nodes not involved yet.
• Stage T1-4N1-2M1-2: Cancer spread out of abdomen/pelvic wall to lymph nodes or distant organs like liver, lungs, or bones.

Diagnosis

The mainstay of diagnosis is a cystoscopy and biopsy where a long tubular instrument is inserted into the urinary bladder and the entire bladder lining is inspected. If any tumour is seen, the urologist tries to resect as much tumour as possible. Any abnormal looking tissue is taken for biopsy and sent to the pathologist for examination under a microscope. The pathologist will confirm any cancer if present, and the depth of penetration into the wall of the urinary bladder. Some of the other tests that the patient may have to undergo for diagnosis and staging are: urine for cytology, ultrasound, CT/MRI scan, and sometimes PET-CT and bone scan, if indicated.

The purpose of doing these tests is to find out the stage of the cancer as the prognosis and treatment depends upon the stage. Broadly speaking, there are four stages depending upon how deep the cancer has penetrated into the bladder wall, and whether it has spread into other structures outside the bladder like lymph nodes, bone, liver etc.

Treatment

There are three main modalities of treatment - surgery, radiotherapy, and chemotherapy, either alone or in combination. In very early bladder cancers limited to the superficial layer of the bladder wall, immunological therapy is used where the patient comes in for multiple sessions of a drug being instilled into the bladder.

Surgery is one of the most widely used treatments. In most of the locally advanced tumours, the surgery is called radical cystectomy where the entire bladder and some adjoining structures are also removed. This operation requires some form of urinary diversion for the urine to come out through a new pathway. In certain less advanced tumours, a partial cystectomy may be sufficient where only a part of the bladder will be removed.

Radiotherapy alone or in combination with chemotherapy is an alternative to surgery where the patient wants to conserve his bladder. Radiotherapy is the use of high energy X-rays which are focused on the area to be treated without affecting the tolerance of surrounding normal structures. Today, there are a number of sophisticated treatment techniques like IMRT, IGRT etc. To achieve this aim using state of art linear accelerators.

Chemotherapy is the use of medicines given intravenously and is called systemic treatment as it can kill cancer cells anywhere in the body.

Appropriate treatment in a good multidisciplinary hospital can result in curing more than 50 per cent of patients. If the cancer is diagnosed at an early stage, the results are much better.

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Bladder Cancer Symptoms and Treatment - Advanced Treatment for Bladder Cancer in India

Approximately 70 to 80 percent of patients newly diagnosed with bladder cancer have superficial, noninvasive bladder cancer. If the cancer spreads further into the muscle wall of the bladder or to nearby lymph nodes and organs, it is called invasive bladder cancer. Bladder cancer occurs more frequently among older men, with the median age of diagnosis being 58 and the media age of death being 65, based on data collected from 2010 to 214.

Smoking is the greatest risk factor for bladder cancer, according to the Centers for Disease Control and Prevention, causing approximately 20 to 30 percent of bladder cancers among women and 50 to 65 percent of bladder cancer among men.

It is characterized by urine that may appear dark yellow, bright red or cola colored, However hematouria can be intermittent, even when caused by serious disease, and its severity is not correlated to the severity of the underlying cancer. Other symptoms of bladder cancer may also include frequent urination, painful urination, urinary tract infection and lower back pain, according to the National Institutes of Health.

Diagnosis & Tests

Initial physically examination usually involves the doctor inserting gloved fingers into the vagina and/or rectum to feel for lumps and abnormal growth, according to the National Cancer Institute. This is usually followed with blood tests, urine tests and cystoscopy. Flexible cystoscopy uses a thin tube with a light at the end (called a cystoscope) to look inside the bladder. It is a low-risk procedure that is generally conducted in the physician's office under local anesthesia, However inflammations and bleeding can result in poor visualization and reduced accuracy. Hence additional tests are usually needed.
If invasive bladder cancer is suspected, the doctor may also order MRIs, CT scans and X-rays in order to determine if the cancer has spread to the kidneys, ureters and other internal organs.

Treatment of Bladder Cancer in India

Bladder Sparing Surgery

This involves using a combination of chemotherapy and radiotherapy to destroy the cancer cells locally and also if they have spread to other parts of the body. Transurethral resection of bladder tumour and partial removal of bladder are also types of bladder sparing surgeries which are used when the tumor is superficial or minimally invasive. These treatment techniques can be used in combination with each other.

Neobladder or Urine diversion techniques

Neobladder or Urine diversion techniques : This is required after radical cystectomy or complete removal of bladder in cases where the tumor has penetrated the bladder wall and spread beyond it

Radical Cystectomy :

If the cancer is larger or is in more than one part of the bladder, a radical cystectomy or complete removal of the bladder is needed. This operation removes the entire bladder and nearby lymph nodes. In men, the prostate is also removed. In women, the ovaries, fallopian tubes (tubes that connect the ovaries and uterus), the uterus (womb) and a small portion of the vagina are often removed along with the bladder. These surgeries are typically done through a cut (incision) into the abdomen while the patient is placed under general anesthesia. The patient needs to stay in the hospital for about a week after the surgery. The patient can usually go back to his normal activities in 4 to 6 weeks.

Laparoscopic Radical Cystectomy :

In some cases, the surgeon may operate through several smaller incisions using special long, thin instruments, one of which has a tiny video camera on the end to see inside the pelvis. This is known as laparoscopic, or “keyhole” surgery. The surgeon may either hold the instruments directly or may sit at a control panel in the operating room and maneuver robotic arms to do the surgery. If it can be done, laparoscopic surgery may result in less pain and quicker recovery after the operation (due to the smaller incisions). But it has not been around as long as the standard type of surgery and it’s not yet clear if it is equally as effective. This technique is still in its infancy and is not practiced very commonly.

Medworld India offers comprehensive care for patients with Bladder Cancer  including advanced diagnosis, best treatment options . A team of Surgical Oncologists, Radiation Oncologists, Medical Oncologists, Urologists, Rehabilitation team and other medical specialties work together to treat each Bladder Cancer patient We consider each patient's type and extent of Bladder Cancer to recommend the most appropriate treatment plan. They also carefully consider and select the treatment option that will allow the patient to maintain quality of life with good survival rate.

Why should you choose to get Indian hospitals offer the Best Cancer Treatment in India at affordable prices. MedWorld india associated Best Cancer Treatment Hospitals in India have the latest technology and infrastructure to offer the Most Advanced Cancer Treatment at low cost.

At MedWorld India Affiliated Best Cancer Hospitals are to deliver highest quality and advanced oncology care in a supportive and compassionate environment to all our patients, and to advance the treatment and prevention of cancers through innovative research.

MedWorld India Affiliated Best Cancer Hospitals in India offer:

• World class results for Cancer Treatment
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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

Do we know what causes liver cancer ? Can liver cancer be prevented .

Although several risk factors for hepatocellular cancer are known , exactly how these may lead normal liver cells to become cancerous is only partially understood.

Cancers develop when the DNA of cells is damaged. DNA is the chemical in each of our cells that makes up our genes – the instructions for how our cells function. We usually look like our parents because they are the source of our DNA. But DNA affects more than how we look. Some genes have instructions for controlling when cells grow, divide into new cells, and die. Genes that help cells grow and divide are called oncogenes. Genes that slow down cell division or cause cells to die at the right time are called tumor suppressor genes. Cancers can be caused by DNA changes that turn on oncogenes or turn off tumor suppressor genes. Several different genes usually need to have changes for a cell to become cancerous.

Certain chemicals that cause liver cancer, such as aflatoxins, are known to damage the DNA in liver cells. For example, studies have shown that aflatoxins can damage the TP53 tumor suppressor gene, which normally works to prevent cells from growing too much. Damage to the TP53 gene can lead to increased growth of abnormal cells and formation of cancers. Infection of liver cells with hepatitis viruses can also damage DNA. These viruses have their own DNA, which carries instructions on how to infect cells and produce more viruses. In some patients, this viral DNA can insert itself into a liver cell's DNA, where it may affect the cell's genes. But scientists still don't know exactly how this might lead to cancer.

Although scientists are starting to understand how liver cancer develops, much more must be learned. Liver cancer clearly has many different causes, and there are undoubtedly many different genes involved in its development. It is hoped that a more complete understanding of how liver cancers develop will help doctors find ways to better prevent and treat them.

Liver cancersymptoms

Like many types of cancer, liver cancer symptoms often do not appear in the early stages. As a result, liver cancer tends to be diagnosed at a more advanced stage.
Because there are no widely recommended routine screening tests for liver cancer, people with a family history of the disease or other risk factors should talk with their doctor about steps they can take to monitor or reduce their risk.

The symptoms of liver cancer may be different for each person and any one of these symptoms may be caused by other, benign conditions.
When present, common liver cancer symptoms may include:

• Weight loss not associated with changes in diet.
• Decrease in appetite or a feeling of fullness after a small meal.
• Nausea and vomiting not associated with other known conditions.
• General weakness and/or fatigue that is persistent, ongoing weakness or fatigue.
• Fever that is unrelated to other conditions.
• Pain occurring in the upper abdomen on the right side or near the right shoulder blade.
• Enlarged liver (hepatomegaly) felt as a mass under the ribs on the right side.
• Enlarged spleen felt as a mass under the ribs on the left side.
• Abdominal swelling (ascites) or bloating in the abdomen can occur as a mass forms.
• Jaundice, which appears as yellowing of the skin and eyes. Jaundice occurs when the liver is not functioning properly.

Many of the above mentioned symptoms are similar to other types of benign liver infections or diseases. In the case of liver cancer, the symptoms will continue to evolve and worsen as the disease advances. It is important to see a doctor for an accurate diagnosis if you have any of the above signs of liver cancer.

In rare cases, other disorders may develop as a result of liver cancer, especially in the early stages of the disease. Paraneoplastic syndromes cause symptoms in other parts of the body. Awareness of these symptoms may help with diagnosing liver cancer.

Some paraneoplastic syndromes related to liver cancer include:

• Hypercalcemia: High blood calcium levels
• Hypoglycemia: Low blood sugar levels
• Erythrocytosis: High red blood cell count
• Hypercholesterolemia: High cholesterol levels
• Gynecomastia: Breast enlargement
• Shrinking of testicles in men

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