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Liver cancer

Liver cancer

About liver cancer

Liver cancer can be primary or secondary. Cancers which begin in the liver are called primary liver cancer. Cancers which arise in the other parts of the body and spread to liver are called secondary liver cancer or metastasis. Primary liver cancer includes

     
  • Hepatocellular carcinoma(HCC)
  •  
  • Intrahepatic Cholangiocarcinoma (arising from the bile duct inside the liver )

Primary liver cancer (hepatocellular carcinoma) tends to occur in livers damaged byalcohol abuse, or chronic infection with diseases such as hepatitis B and C or rare birth defects. More than half of all people diagnosed with primary liver cancer have cirrhosis

The male : female ratio for HCC in India is 4:1. The age of presentation varies from 40 to 70 years.

Secondary liver cancer or metastasis liver is the most common cancerous condition of liver. It depends on the location of the original cancer. Primary cancers that are most likely to spread to the liver are cancers of the:

  • Colon
  • Rectum
  • Stomach
  •  
  • Esophagus/ Stomach Pancreas 

Even if the primary cancer is removed, liver metastasis can still occur years later. If you’ve had cancer, it’s important to learn the signs of liver metastasis and get regular checkups.

Liver cancer signs and symptoms may include:

  • Jaundice - yellowish discolouration of skin and eyes
  • Abdominal pain - often on the right upper abdomen
  • Loss of weight and appetite
  • Hepatomegaly - enlarged liver, the abdomen may appear swollen
  • Fatigue
  • Nausea and vomiting
  • Back pain
  • General itching
  • Fever
Liver cancer

Diagnosis of liver cancer

  • Physical examination: Your doctor will examine your abdomen to look for any in the upper abdomen. He also examine your eyes and skin to look for the evidence of jaundice
  • Blood tests: complete blood count, LFT, RFT, Serum electrolytes, coagulation profile, HIV, HCV &HBV testing, tumor markers like AFP, CEA , Ca19-9.
  • Radiological imaging USG Abdomen, Triple phase CT Scan of the abdomen, MRI Abdomen, CT Angiography, PET Scan as required
  • Biopsy : Liver biopsy is some times required but not always. Your cancer surgeon will be the best person to decide if it is needed.
Liver cancer

Treatment Options

There are various modalities of treatment for HCC and IHC.

Surgery

A surgical resection is the best curative option for a primary liver cancer. It involves removal of the tumor with an adequate margin of normal liver. At times when the underlying liver is too unhealthy , a resection may not be possible. Liver transplantation is an option in select cases .

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Ablation

Loco regional ablative techniques like Radiofrequency ablation (RFA) or Microwave ablation (MWA) can be used in smaller tumors with good results. We perform this routinely with our interventional radiology team.

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Liver Directed Therapy

When the tumors are not amenable for surgery or ablation , liver directed therapies like Transarterial chemoembolization (TACE) and Transarterial radioembolization (TARE) are performed. These are performed by the interventional radiology team.. Treatment options depend on the stage of the disease, General condition of the patient and associated comorbidities.

TACE involves blocking thearterial supply to the tumor and instilling a chemotherapy agent inside it. TARE involves instilling radioactive beads into the tumor.

Portal vein embolisation (PVE) can be considered for increasing remanant liver volume in cirrhotic patients with FLR<40%, but otherwise eligible for surgery

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Medical Management

If the tumors are multiple or patients are not eligible for any of these treatments , we refer them to the medical oncologists for certain oral immunotherapy or targeted therapy agents which may halt the rate of spread of these tumors.

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Treatment of metstasis in liver

The liver is the most commonly involved organ in patients with metastatic colorectal cancer.

Colorectal and neuroendocrine are the cancers where it is worthwhile aggressively treating these liver metastasis since many patients do well .

 
Liver cancer

Treatment options for liver metastasis

 

Surgery

 Agressive surgery to resect these liver metastasis is the best way to cure these patients. Patients with solitary metastasis have a more than 60% 5 year survival. At times , we give chemotherapy to downsize the lesions before embarking on surgery. 

Ablative techniques for liver metastasis  

Radiofrequency ablation(RFA) and Microwave ablation(MWA) for liver metastasiscan be used in cases where surgery is not possible of the lesions are too deep seated.

Chemotherapy

 

Chemotherapy is used to help stop or slow the growth of cancer and relieve symptoms. Chemotherapy may also be used to shrink the cancer so surgery can be done, or it may be given after surgery to lower the risk of the cancer coming back. Chemotherapy is sometimes used along with other treatments such as targeted therapy.

Surgery For Liver Cancers

There are various types of resections for liver tumors .

  • Right or Left hepatectomy- involves removal of the right or left half of the liver. These are major surgeries which need a proper preoperative planning.
  • Extended right/ left hepatectomy- involves removal of more than 60-70 % of the liver. Needs a volumetric assessment to preserve enough liver tissue.. these are the most complex liver surgeries
  • Segmental resection- removal of only one or two segments .
  • Non anatomical resection- usually for liver metastasis.
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Related Videos
Related FAQ's
1. what is cirrhosis? Does it cause liver cancer?
Cirrhosis is due to do long-term injury to the liver. The most common causes are hepatitis and alcohol abuse. Cirrhosis by itself is not cancer but increases the risk of liver cancer.
2. Can liver cancer be prevented?
Once cirrhosis (or scarring of the liver) has set in, it is generally not reversible. Therefore, the best way to prevent liver cancer is to avoid liver damage by treating any underlying hepatitis and avoiding excess alcohol use. Treating hepatitis B and C promptly also reduces the risk of HCC.
3. What is the survival rate after the surgery for HCC?
In general survival rates are higher for people who can have surgery to remove their cancer, regardless of the stage. Overall survival of over 50-70% has been seen in patients with small resectable tumors who do not have cirrhosis or other health issues. For early-stage HCC with cirrhosis who have a liver transplant, 5-years survival rate is 60-70%
4. What will be the follow up duration after the treatment?
You have to consult your doctor maybe every 3 to 6 months for the first 2 years, then every 6 to 12 months. Then, the longer you’re cancer-free, the fewer often the visits are needed. After 5 years, they may be done once a year.
5. What are the side effects of chemotherapy?
 Side effects of chemotherapy include nausea, vomiting, hair loss, infection, and loss of appetite. These symptoms will settle down once the patient has completed chemotherapy.
6. What are the complications of major liver resection?
 Bile leak wound infection and intraabdominal collection. Most of the complications are managed conservatively. In case of complications hospital stay and expense may increase. The morbidity rate of major liver resection is 5-10% while the mortality is less than 1% in high volume centers.
7. What is the survival rate in colorectal metastasis after surgery?
In solitary and resectable liver metastasis, the survival rate is 60-70%, in multiple resectable liver metastases, the survival rate is 25-30%. This is a very encouraging number and hence metastatic colorectal and neuroendocrine tumors must be aggressively treated.
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