Liver Cancer Treatment in India
he liver continuously filters blood that circulates through the body, converting nutrients and drugs absorbed from the digestive tract into ready-to-use chemicals. The liver performs many other important functions, such as removing toxins and other chemical waste products from the blood and readying them for excretion. Because all the blood in the body must pass through it, the liver is unusually accessible to cancer cells traveling in the bloodstream. The liver can be affected by primary liver cancer, which arises in the liver, or by cancer which forms in other parts of the body and then spreads to the liver. Most liver cancer is secondary or metastatic, meaning it started elsewhere in the body. Primary liver cancer, which starts in the liver, accounts for half of all cancers in some undeveloped countries. This is mainly due to the prevalence of hepatitis, caused by contagious viruses, that predisposes a person to liver cancer.
The more common benign tumors of the liver include:
- Hepatic adenoma
- Focal nodular hyperplasia
Types of Liver Cancer
The place where a cancer starts is called the primary site, so cancers that start in the liver are known as primary liver cancers.
Hepatocellular carcinoma (HCC)
This is the most common form of liver cancer in adults. It begins in the hepatocytes, the main type of liver cell. About 4 out of 5 cancers that start in the liver are this type.
Bile duct cancer (cholangiocarcinoma)
Bile duct cancers account for 1 or 2 out of every 10 cases of liver cancer. These cancers can start in the small tubes (called bile ducts) that carry the bile that is made in the liver to the gallbladder or from the gallbladder to the intestines
Rare types of primary liver cancers
Angiosarcomas and hemangiosarcomas are rare cancers that start in the cells lining the blood vessels of the liver. These tumors grow quickly. Often by the time they are found they are too widespread to be removed. Treatment may help slow the disease, but these cancers are usually very hard to treat.
Hepatoblastoma is a very rare kind of liver cancer that is usually found in children younger than 4 years old. About 2 out of 3 children with these tumors have good outcomes with surgery and chemotherapy, although the tumors are harder to treat if they have spread outside the liver.
Cancers that spread to the liver (secondary liver cancers)
If a cancer starts somewhere else and then spreads to the liver, it is called secondary liver cancer. Secondary liver cancer is much more common than cancer that starts in the liver (primary liver cancer). Many common types of cancer, including colon, rectum, lung, and breast, spread (metastasize) to the liver.
Causes of Liver Cancer
- Gender: this cancer is more common in men than women
- . Hepatitis C and Hepatitis B long-term infections are associated with liver cancer as they often result in cirrhosis. Hepatitis B can cause liver cancer without cirrhosis.
- Long-term infections with hepatitis B and/or C
- Heavy alcohol use
- Being obese (very overweight)
- Type 2 diabetes
- Certain inherited conditions, such as hereditary hemochromatosis
- Arsenic exposure, which can come from drinking water
- Exposure to the solvent vinyl chloride
- Using anabolic steroids
- Tobacco use
Symptoms of Liver Cancer
Most of the time liver cancer does not cause symptoms in its early stages. The symptoms below could be caused by liver cancer, but they can also be caused by other cancers or conditions. Weight loss (when you’re not trying to lose weight)
- Lack of appetite
- Feeling very full after a small meal
- Nausea or vomiting
- A swollen liver or a mass that can be felt under the ribs on the right side
- A swollen spleen, felt as a mass under the ribs on the left side
- Pain in the belly (abdomen) or near the right shoulder blade
- Swelling in your belly
- Yellowing of the skin and eyes (jaundice)
- Swollen veins on the belly that can be seen through the skin
- Becoming sicker if you have chronic hepatitis or cirrhosis
Some liver tumors make hormones that act on organs other than the liver. These hormones may cause:
- High blood calcium levels that can cause nausea, confusion, constipation, weakness, or muscle problems
- Low blood sugar levels, which can make you feel very tired or faint
- Breast enlargement and/or shrinking of the testicles in men
- High counts of red blood cells which can cause someone to look red and flushed
- High cholesterol levels
Stages of Liver Cancer
Stage I: This is the earliest stage of HCC. The tumor has not spread to the blood vessels, lymph nodes, or other parts of the body (T1, N0, M0).
Stage II: The tumor involves nearby blood vessels, but it has not spread to the regional lymph nodes or other parts of the body (T2, N0, M0).
Stage IIIA: The cancer has not spread beyond the liver, but the area of the cancer is larger than stage I or II (T3a, N0, M0).
Stage IIIB: The cancer involves a major vein around the liver, but it has not spread to nearby lymph nodes or other parts of the body (T3b, N0, M0).
Stage IIIC: Any tumor that has spread to the organs near the liver (except the gallbladder), or if the tumor has broken through the visceral peritoneum. There is no spread to nearby lymph nodes or other parts of the body (T4, N0, M0).
Stage IVA: Any tumor that has spread to the regional lymph nodes but not to other parts of the body (any T, N1, M0).
Stage IVB: Any tumor that has spread to other parts of the body (any T, any N, M1).
Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer has returned, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.
Diagnosis of Liver Cancer
The following tests may be used to diagnose. This list describes options for diagnosing this type of cancer, but not all tests listed will be used for every person.
- Physical examination. If a person has symptoms of HCC, the doctor will feel the abdomen to check the liver, spleen, and other nearby organs for lumps, swelling, or other changes. The doctor will also look for an abnormal buildup of fluid in the abdomen and for signs of jaundice, which include yellowing of the skin and whites of the eyes.
- Blood tests. At the same time as the physical examination, the doctor will most likely do a blood test to look for a substance called alpha-fetoprotein (AFP). The doctor will also test the patient’s blood to see if he or she has hepatitis B or C. Other blood tests can show how well the liver is working.
In addition, other tests are commonly needed to diagnose HCC and to find where the tumor is located in the liver and if it has spread to other parts of the body. After the physical examination and blood tests, the doctor may recommend one or more of the following tests:
- Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. The sound waves bounce off the liver, other organs, and tumors. Each creates a different picture on a computer monitor.
- Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow..
- Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.
- An angiogram is an x-ray picture of the blood vessels. A dye is injected into the bloodstream so the blood vessels of the liver show up on an x-ray.
- Laparoscopy. This test allows the doctor to see inside the body with a thin, lighted, flexible tube called a laparoscope. The person is sedated as the tube is inserted through a small incision in the abdomen. Local anesthetic to numb the area is also used.
- Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.
- Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy
Treatment of Liver Cancer
Disease-directed treatments to eliminate HCC
These treatments are generally recommended when the tumor has been found at an early stage. Many doctors will not use these treatments if the tumor is larger than 5 cm.
Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is likely to be the most successful disease-directed treatment, particularly for patients with a tumor smaller than 5 cm
Two types of surgery are used to treat HCC:
- 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. A hepatectomy may not be possible if the patient has advanced cirrhosis, even if the tumor is small.
- Liver transplantation. Sometimes, a liver transplantation can be done. This procedure is possible only when the cancer has not spread outside the liver, a suitable donor is found, and very specific criteria are met in terms of tumor size and number
- Thermal ablation
Radiofrequency ablation (RFA) and microwave therapy both use heat to destroy cancer cells. They may be given through the skin, through laparoscopy, or during a surgical operation while a patient is sedated
Percutaneous ethanol injection
Percutaneous ethanol injection uses alcohol injected directly into the liver tumor to destroy it. The procedure is simple, safe, and particularly effective for a tumor smaller than 3 cm
Disease-directed treatments to improve survival
This is a type of chemotherapy treatment that is similar to hepatic arterial infusion,. During this procedure, drugs are injected into the hepatic artery, and 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 destroys cancer cells.
Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells.
There are two types of radiation therapy used to treat HCC:
- Stereotactic body radiation therapy (SBRT). SBRT is a term that describes several methods of delivering high doses of radiation to a tumor while limiting the amount of radiation exposure to healthy tissues. This is important because healthy liver tissue can be damaged by radiation as well. SBRT effectively treats tumors that are approximately 5 cm or smaller
- During radioembolization, a doctor places radioactive beads into the artery that supplies the tumor with blood in a way that’s similar to chemoembolization . The beads deliver radiation directly into the tumor when they become trapped in the small blood vessels of the tumor.
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 healthy cells.