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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Minimally-Invasive Radiofrequency Ablation in India - Effective Treatment for Small Tumors

Radiofrequency ablation (RFA):

A minimally invasive treatment called radiofrequency ablation (RFA), one of several types of ablation therapy, may be an alternative when surgery for certain types of cancer is not a good option. Guided by imaging techniques, the doctor inserts a thin needle through the skin and into the tumor. High-frequency electrical energy delivered through this needle heats and destroys the tumor. Months after the procedure, dead cells turn into a harmless scar.

RFA can be used to treat certain types of cancers in the liver, bone, kidney, lung and other locations, destroying cancer cells while preserving surrounding healthy cells. Whether you are a good candidate for RFA depends on several issues, such as the size and location of your tumor.

 Radiofrequency ablation (RFA) is a minimally invasive alternative to surgery if you are not a good surgical candidate, have recurrent or multiple small tumors, or do not benefit from conventional therapies. RFA can also be used before or after surgery or in combination with radiation therapy and chemotherapy. Your doctor will determine whether RFA is the most appropriate treatment for you.

Advantages of RFA include:

·         Effective treatment for small tumors

·         Minimally invasive with no skin incision

·         Minimal risk

·         Few complications

·         Typically little or no pain

·         Minimal hospital stay

·         Can be repeated if new cancer appears

Types of cancer treated with RFA :

·         Liver cancer. RFA can be effective for cancer that starts in the liver and for some types of cancer that have spread to the liver, such as colon cancer.

·         Kidney cancer. For select people, RFA may be considered for small kidney tumors.

·         Lung cancer. For select people who have lung cancer tumors that are limited in size and number, RFA may be a nonsurgical alternative.

·         Bone cancer. RFA may be used to try to control severe pain caused by bone cancer that's limited to one or two sites, rather than to cure bone cancer.

Procedure:

The procedure is performed with patient under conscious sedation (a state of consciousness achieved through medication where the patient can bear unpleasant procedure while maintaining cardiorespiratory function. It is now called as procedural sedation) using drugs like midazolam, fentanyl and meperidine. These drugs are introduced into the body intravenously.

The instruments that are used for this procedure include image guiding technique like ultrasound, MRI or CT scan, a radiofrequency generator to produce radiofrequency waves, straight needles and straight hollow needles with retractable electrodes, insulating wires and earthing pads, and an endoscope in case of a laparoscopic procedure is done. The ablation procedure is performed by a specifically trained interventional radiologist in an operation theatre or a radiology room. The patient is connected to a monitor where his pulse, respiratory rate and blood pressure are monitored continuously throughout the procedure. In case the patient is sedated under general anesthesia, a tube is inserted down the wind pipe and connected externally to an artificial breathing unit (ventilator). The area where the needles are to be inserted is sterilized and draped. The grounding pads are attached to the back or thigh of the patient. The needles can be introduced into the patient’s body surgically, percutaneously or through endoscope.

 In the percutaneous method the surgeon makes small punctures in the skin of the abdomen through which the needle probes are inserted. The probe is guided towards the site of tumor using the image guiding option of US, MRI or CT scan or microscopic camera. Once the needle is inside the target tissue, radiofrequency energy is generated by the generator that passes between the needle probes and grounding pads. This creates a large amount of ionic vibration around the needle which in turn produces a lot of heat. This large amount of heat destroys the cancer cells and closes the nearby feeding blood vessels, ensuring no nutrition to the tumor cells. The dead cells shrink away and are replaced by scar tissue. If the tumor is large or located at multiple places in the same organ, the needles are removed and replaced into the various tumor sites for complete destruction of the cancer. This helps to prevent recurrence to a large extent. After the procedure the needles are pulled out and pressure is put at the entry site to prevent any bleeding. The skin is covered with a simple dressing. No sutures are required.

Outcome:

The outcome of this procedure is very encouraging especially for persons with large tumor who are not in a position to withstand the stresses of conventional surgery. Single ablation requires around 10-30 minutes and in case of multiple ablations the procedure takes 1-3 hours. The patient is kept in the recovery room till the effect of sedation wears away. He is then permitted to go home. Very few patients experience any pain at the site of needle entry. This pain goes away in a week’s time and the person is then able to resume his daily activities.

Benefits:

1.      Radiofrequency ablation can be an effective treatment for primary liver cancer and for cancers that have spread to the liver in those patients whose liver tumors are unsuitable for surgical resection.

2.      The success rate for completely eliminating small liver tumors is greater than 85 percent.

3.      Treatment-related serious complications are rare and discomfort, pain and muscle weakness is minimal. This reduces the hospital stay.

4.      Radiofrequency ablation may be used repeatedly to treat recurrent liver tumors.

5.      The percutaneous method of radiofrequency ablation, in which electrodes are inserted through the skin, is minimally invasive, produces few complications, and does not require hospital admission.

6.      RFA is a relatively quick procedure and recovery is rapid so that chemotherapy may be resumed almost immediately in patients who need it.

7.      Radiofrequency ablation is less expensive than other treatment options.

8.      It does not require general anaesthesia.

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Advantages of CyberKnife Radio Surgery Over Other Radio surgery Methods - CyberKnife Radio Surgery in India

Cyberknife is the world's first and only robotic radiosurgery system which treats tumours anywhere in the body without any surgery. Though it is called Radiosurgery or Cyberknife- No knife is used for incision and no surgery is performed to treat the tumours. A new hope for patients who have inoperable or surgically complex tumors, or who may be looking for a non-surgical option.Cyberknife radiosurgery is a non –invasive, high-energy radiation treatment that delivers very precise beams of radiation from many angles outside the body. The accuracy of Cyberknife is so precise that radiation can be 'matched' to the shape of small complex tumors, even those located near critical organs. This ability allows Cyberknife to treat many lesions including some considered inoperable or untreatable with surgery.

The CyberKnife Robotic Radiosurgery System treats both cancerous and non-cancerous tumors anywhere in the body, including the prostate, lung, brain, spine, liver, pancreas and kidney.It provides a pain-free, non-surgical treatment to the patients with complex tumours which are un operable or too risky to be operated and to the patients who are looking for an alternative to surgery. To date, more than 100,000 patients have been successfully treated and more than 150 systems are installed worldwide.

How Cyberknife  Radiosurgery works ?

CyberKnife System uses image guidance software to track and continually adjust treatment for any patient or tumor movement. This sets it far ahead of other similar treatments. It allows patients to breathe normally and relax comfortably during treatment. The Cyberknife integrates two highly advanced technologies:

- An image-guidance system tracks and verifies tumor locations and enables automatic compensation for patient movement during treatment delivery. This system eliminates the need for an invasive head frame.

- A multi –jointed robotic arm with six degrees of freedom provides exceptional maneuverability in targeting tumors. A high-energy X-ray source mounted on a robotic arm precisely locates the position of tumor in the body and delivers pinpoint radiation from more than 1200 angles with sub-millimeter accuracy.

- The Cyberknife accuracy represents a major advance in radiosurgery. Digital radiographic images of anatomical features or implanted fiducials are used to precisely target the radiation. The focused radiation beams converge at the tumor to maximize the amount of radiation that reaches the tumor and minimize exposure surrounding health tissue

What can the Cyberknife treat?

The CyberKnife Robotic Radiosurgery System is FDA approved,  non-invasive alternative to surgery for the treatment of both cancerous and non-cancerous tumors anywhere in the body, including the prostate, lung, brain, spine, liver, pancreas and kidney. To date, more than 100,000 patients have been treated and more than 150 systems are installed worldwide.

- Primary & Metastatic Brain Tumors

- Spine Cancer

- Spinal Cord Tumors

- Soft Tissue Tumors ( Lung, Kidney, Liver, Pancreas )

- Acoustic Neuromas

- Meningiomas & Skull-base Tumors

- Pituitary Tumors

- Recurrent & Residual Tumors

- Arteriovenous Malformations ( AVMs )

- Functional Disorders, such as Trigeminal Neuralgia

What are the advantagesof Cyberknife Radiosurgery Treatment ?

Painless Treatment: There is no pain associated with radiation treatment delivered by Cyberknife Radiosurgery system.

Frameless: The ability of Cyberknife to correct for patient movement during treatment eliminates the pain and inconveniences associated with the rigid metal head frame used with other stereotactic techniques.

 Full body capability: Cyberknife's unique design allows treatment of tumors or lesions throughout the body, an entirely new approach for radiosurgery. Radiation treatment can be administered to the brain and spine, as well as soft tissues such as the lungs, liver, kidney and other organs.

 Outpatient treatment: The Cyberknife treatment greatly reduces the risk of complications and lenghty recovery time associated with traditional surgery. Cyberknife can also perform 'staged' radiosurgery – where the total radiation dose is divided into two to five smaller doses over several days. This is particularly beneficial for treating larger tumors or those near sensitive areas, because it better protects surrounding tissue. After treatment, most patients can return home and resume normal activities.

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Colon Cancer Treatment at World Best Cancer Hospitals in India

How is Colon Cancer detected?

• Colonoscopy: An endoscope is inserted into the rectum and advanced through the colon, through this the doctor can examine the entire colon.
• Diagnosis is confirmed with a colon biopsy
• Colon function tests
• Stage of disease is confirmed by pathologists and imaging tests, such as computerized tomography (CT or CAT) scans
• Endoscopic ultrasound and magnetic resonance imaging (MRI) may also be used to stage rectal cancer
• Sigmoidoscopy: In this an endoscope is interested in the rectum and moved through the left side of the colon. It cannot be used to view the middle and right sides of the colon.
• Fecal occult blood test (FOBT) along with Complete blood count (CBC) to check for anemia and CT , MRI or PET scans of the abdomen, pelvic area
  
  

Treatment Options available for Colon Cancer at Top CancerHospitals in India

Medical Oncology : diagnoses the treatment of all hematological malignancies( liquid tumor) as well as treating a spectrum of solid tumors with chemotherapy

• Radiation Therapy : Fortis Radiation Oncology involves treating cancer using radiation in the form of high energy rays or particles . Radiation therapy is an effective way to treat many cancers either as the sole treatment or in combination with surgery or chemotherapy .
• Brachytherapy : This involves precise placement of radiation sources directly at the source of the cancerous tumor , and it affects only the localized area around the radiation source.. This is mainly used for cancers of the prostate ,breast, head and neck,uterus, thyroid ,cervix in combination of external radiation therapy

Advantages of Minimal Invasive Laparoscopic Colon Cancer Surgery

• Minimal Invasive Laparoscopic Colon Cancer Surgery
• Image guided Radiotherapy (IGRT )
• Intensity Modulated Radiation therapy (IMRT )
• Volumetric Modulated ARC Therapy (VMAT)
• Stereotactic Radio Surgery.
• Colonoscopy
• Upper GI
• ARCP
• Endoscopy
• CT Scan
• MRI
• Ultrasound

How isMinimal Invasive Laparoscopic Colon Cancer Surgery performed?

• The surgeon enters the abdomen by placing a canula (a narrow tube like instrument) into the abdomen (belly) through a small incision (½ –– ¼ inch)
• Carbon Dioxide gas is pumped into the abdomen through the port (cannula) to puff-up or inflate the belly, making working room for the surgeon.
• A laparoscope (a tiny telescope connected to a video camera) is placed through the canula, and allows the surgeon to see a magnified lighted view of the internal organs on a TV monitor
• 2 ‹to 4 other canulas are inserted to allow use of special instruments to work inside the abdominal cavity (belly).
• If a portion of the colon is removed, one of the small canula incisions is slightly enlarged to permit removal of the tissue.

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How Much Does Cervical Cancer Treatment Cost in India?

When you get a diagnosis of cervical cancer, it's natural to wonder what may have caused the disease. Doctors usually can't explain why one woman develops cervical cancer and another doesn't. However, we do know that a woman with certain risk factors may be more likely than other women to develop cervical cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found that infection with the virus called HPV is the cause of almost all cervical cancers. Most adults have been infected with HPV at some time in their lives, but most infections clear up on their own. An HPV infection that doesn't go away can cause cervical cancer in some women.

Other risk factors, such as smoking, can act to increase the risk of cervical cancer among women infected with HPV even more. A woman's risk of cervical cancer can be reduced by getting regular cervical cancer screening tests. If abnormal cervical cell changes are found early, cancer can be prevented by removing or killing the changed cells before they become cancer cells.

DiagnosisOf Cervical Cancer

• Pap Test. Cervical Cone Biopsy (Conization). Using a scalpel, Gyneconcologist removes a cone-shaped piece of cervical tissue where the abnormality is found. A Pap test can detect abnormal cells in the cervix, including cancer cells and cells that show changes that increase the risk of cervical cancer.

• HPV DNA Test. Your doctor may also use a lab test called the HPV DNA test to determine whether you are infected with any of the types of HPV that are most likely to lead to cervical cancer. Like the Pap test, the HPV DNA test involves collecting cells from the cervix for lab testing.

If you experience signs and symptoms of cervical cancer or if a Pap test has revealed cancerous cells, you may undergo further tests to diagnose your cancer. To make a diagnosis, your doctor may:

• Examine your Cervix. During an exam called colposcopy, your doctor uses a special microscope to examine your cervix for abnormal cells. If your doctor identifies unusual areas, he or she may take a small sample of cells for analysis .

• Take a Sample of Cervical Cells. During a biopsy procedure your doctor removes a sample of unusual cells from your cervix using special biopsy tools.

• Remove a Cone-Shaped Area of Cervical Cells. A cone biopsy so called because it involves taking a cone-shaped sample of the cervix - allows your doctor to obtain deeper layers of cervical cells for laboratory testing. Your doctor may use a scalpel, laser or electrified wire loop to cut away the tissue.

Treatment of Invasive Cervical Cancer

In the event that cancer cells found in the cervix have extended deeper into the tissues of the cervix, a doctor will decide between surgery, radiation, chemotherapy or a combination of all three to treat the cancer, depending on the stage and severity of the cancer spread upon diagnosis.

• Surgery - the most common treatment, involves the removal of the uterus in a process called a hysterectomy. A hysterectomy is usually the first step for treating early stages of cervical cancer. Hysterectomies may be called simple or radical depending on the amount of cancerous cell growth and amount of organ structures that may be removed.
• Radiation -radiation therapy involves the external use of high beam energy light rays (called external beam radiation) focused over the area of the body affected by cancerous cell growth.  Radioactive pellets may be inserted into the body to work internally in a form of radiation called brachytherapy.
• Chemotherapy - utilizes anti-cancer drugs medications that kill cancer cells, injected in IV (intravenous) solutions in a vein. Two of the most common drugs used to treat cervical cancer are called cisplatin and Hycamtin (generic topotecan). Chemotherapy is often combined with radiation therapy to improve prognosis, and at times surgery, radiation and chemotherapy will be recommended for optimal outcome prognosis.

How Much Does Cervical Cancer Treatment Cost in India?

In the India the cost of a hysterectomy may range between $8,000 and $15,000, depending on the type of procedure, such as a vaginal approach or a laparoscopic hysterectomy, as well as the specific organs of the reproductive system removed.  In many cases, an individual may need several treatments, depending on case by case scenarios and rate of effectiveness.

Individuals traveling to foreign destinations such as Singapore, Panama, UK, Jordan, and USA may save between 40 and 70% on costs not only of cervical cancer surgeries, but Other therapy treatments.

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