What You Need to Know About Liver Cancer and Hepatitis B

Worldwide, chronic infection with hepatitis causes 80% of all primary liver cancers and more than 500,000 people die each year from this lethal cancer. Currently, primary liver cancer has a 5-year survival rate of only 10%.

Additionally, there are effective therapies to control and manage chronic hepatitis B infections to help prevent the progression to liver cancer as well.

What is primary liver cancer?

There are two types of cancers found in the liver: (1) Primary liver cancer which originates from the liver (also known as hepatocellular carcinoma or HCC), and (2) Secondary liver cancer which originates in other parts of the body and spreads to the liver. Worldwide, primary liver cancer is the 3rd leading cause of cancer deaths and the primary cause of cancer deaths among men

What is the link between hepatitis B and liver cancer?

The most common risk factor for liver cancer is chronic infection with the hepatitis B virus (HBV). Individuals chronically infected with HBV are 100 times more likely to develop liver cancer than uninfected people because the virus directly and repeatedly attacks the liver, which over time can lead to progressive liver damage and liver cancer.

Alarmingly, with chronic HBV infections on the rise in the United States, there is a growing incidence of primary liver cancer and it has become one of the three fastest growing cancers in the country. While the overall incidence of cancer has stabilized, and in many cases decreased, primary liver cancer is an increasing public health threat and has a five-year survival rate of less than 10% (making it the 2nd deadliest cancer in the U.S.).

What are the risk factors for liver cancer?

The risk for developing liver cancer among those who are chronically infected with HBV increases as a person gets older or if they have been diagnosed with cirrhosis. Although liver cancer most often occurs in the presence of cirrhosis, this is not always the case. Primary liver cancer can occur even in the absence of cirrhosis, which is why regular liver cancer screening is so important.

Additional factors that increase the risk of liver cancer include a family history of liver cancer, persistence of high HBV DNA levels, co-infection with HIV or HCV, and lifestyle choices such as excessive alcohol use and smoking. Studies have also shown that obesity and diabetes may be important risk factors for liver cancer. Liver cancer is more common among men than women regardless of race or ethnicity.

What are the symptoms of liver cancer?

Liver cancer is a silent killer because the majority of patients appear to be perfectly healthy and have no early signs or symptoms. Both small and large tumors may be undetected due to the shielded location of the liver underneath the ribs which does not register pain.

Pain is uncommon until the tumor is quite large. Later stages of liver cancer, when the tumor is very large or when it impairs the functions of the liver, can produce more obvious symptoms such as abdominal pain, weight loss, lack of appetite, weakness and fatigue, and finally the development of jaundice (yellowing eyes and skin) and abdominal swelling. People who experience any of these symptoms should see their doctor immediately for further evaluation.

Who should be screened for liver cancer?

Since liver cancer develops quietly, usually without symptoms, patients with chronic HBV should be screened for liver cancer as part of their routine medical management. For those with chronic hepatitis B, primary liver cancer can develop with or without cirrhosis, so regular screening is essential. Early detection of liver cancer results in more treatment options, which substantially improves the chances of survival after initial diagnosis.

What is liver cancer screening?

Liver cancer screening can be done as part of your regular doctor’s visit and generally consists of a simple blood test for alpha-fetoprotein (AFP) levels every 6 months and an ultrasound of the liver once or twice a year. Either test alone can miss the diagnosis. Some doctors prefer MRI or CT scans to ultrasounds. Once a patient develops cirrhosis, or has a family history of liver cancer, more frequent screening is generally recommended.

Liver Cancer Treatment Options Available at Best Cancer Hospitals in India

The treatment options are dictated by the stage of Liver Cancer and the overall condition of the patient. The treatment to be given depends mainly on the size, number, and site of tumors in the liver. Before planning the appropriate treatment the functioning of the Liver is checked as also the spread of the cancer within and outside the liver is to be tested. The Various treatment options available are as follows:

• Surgery : Surgery is the removal of the tumor and surrounding tissue during an operation. It is likely to be the most successful disease-directed treatment, particularly for patients with small tumors (smaller than 5 cm). A surgical oncologist is a doctor who specializes in treating cancer using surgery.
• Hepatectomy : When a portion of the liver is removed, the surgery is called a Hepatectomy. A Hepatectomy can be done only if the cancer is in one part of the liver, and the liver is working well. The remaining section of liver takes over the functions of the entire liver and may regrow to its normal size within a few weeks
• Liver Transplantation :Liver transplant may be the best option for some people with small liver cancers. At this time, liver transplants are reserved for those with small tumors (either 1 tumor smaller than 5 cm across or 2 to 3 tumors no larger than 3 cm) that have not invaded nearby blood vessels. In most cases, transplant is used for tumors that cannot be totally removed, either because of the location of the tumors or because the liver is too diseased for the patient to withstand removing part of it.
• Chemoembolization:This is a type of chemotherapy treatment in which drugs are injected into the hepatic artery and then the flow of blood through the artery is blocked for a short time so the chemotherapy stays in the tumor longer. Blocking the blood supply to the tumor also kills cancer cells
• Radiation Therapy :Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. External-beam radiation therapy is radiation given from a machine outside the body. External-beam radiation therapy is not often used for HCC.
• 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.
  
  
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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 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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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.

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Liver Cancer Treatment at World Best Cancer Hospitals 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 andAngiosarcoma or Hemangiosarcoma

The liver cancer symptoms are often indistinct Following are some indications of Liver cancer. The major symptoms are :

• Abdominal pain or tenderness, especially in the upper-right part
• Weight loss and poor appetite
• Fever, Fatigue and Nausea
• Easy bruising or bleeding
• Enlarged abdomen
• Yellow skin or eyes (jaundice)
• Ascites - an accumulation of fluid around the liver and intestine

To make the diagnosis, a thorough medical history must be taken, followed by a physical examination. Your doctor may then recommend some of the following tests:

• blood tests to check liver enzyme levels

• abdominal ultrasound to check liver size and to look for any tumours or abnormalities

• magnetic resonance imaging (MRI) of the abdomen

• computed tomography (CT) scan of the abdomen

• laparoscopy - through a small incision, the doctor inserts a small, thin tube called a laparoscope, which allows viewing of the liver and surrounding organs

• biopsy - using a laparoscope, a small piece of tissue is taken from the liver for microscopic examination

• angiography - a dye is injected into the veins and its progress through the liver is tracked by X-ray

• chest X-rays to see if the cancer has spread

Liver Cancer Treatment Options at World Best Cancer Hospital in India

The treatment options are dictated by the stage of Liver Cancer and the overall condition of the patient. The treatment to be given depends mainly on the size, number, and site of tumors in the liver. Before planning the appropriate treatment the functioning of the Liver is checked as also the spread of the cancer within and outside the liver is to be tested. The Various treatment options available are as follows:

• Surgery : Surgery is the removal of the tumor and surrounding tissue during an operation. It is likely to be the most successful disease-directed treatment, particularly for patients with small tumors (smaller than 5 cm). A surgical oncologist is a doctor who specializes in treating cancer using surgery.
• Hepatectomy : When a portion of the liver is removed, the surgery is called a Hepatectomy. A Hepatectomy can be done only if the cancer is in one part of the liver, and the liver is working well. The remaining section of liver takes over the functions of the entire liver and may regrow to its normal size within a few weeks
• Liver Transplantation :Liver transplant may be the best option for some people with small liver cancers. At this time, liver transplants are reserved for those with small tumors (either 1 tumor smaller than 5 cm across or 2 to 3 tumors no larger than 3 cm) that have not invaded nearby blood vessels. In most cases, transplant is used for tumors that cannot be totally removed, either because of the location of the tumors or because the liver is too diseased for the patient to withstand removing part of it.
• Chemoembolization:This is a type of chemotherapy treatment in which drugs are injected into the hepatic artery and then the flow of blood through the artery is blocked for a short time so the chemotherapy stays in the tumor longer. Blocking the blood supply to the tumor also kills cancer cells.
• Radiation Therapy :Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. External-beam radiation therapy is radiation given from a machine outside the body. External-beam radiation therapy is not often used for HCC.
• 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.