Hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer and is a significant cause of morbidity and mortality, especially in patients with chronic liver disease. As a reflection of geographical variations in India, there is significant variation in the prevalence and etiological factors of HCC. In contrast to previous studies reporting viral hepatitis as the most common etiology, recent data indicates a changing etiological pattern of cirrhosis and HCC, with alcohol and metabolic dysfunction-associated steatotic liver disease (MASLD) emerging as the foremost cause.

Risk factors for liver cancer :

When you have Hepatitis B, C or liver cirrhosis of any cause, the risk of getting liver cancer is about 50-100 times than of someone without these risk factors.

Chronic infection with hepatitis B and C
Excessive alcohol intake
Fatty liver
Family history of liver cancer
Certain chemicals and toxins exposure
Long-term use of anabolic steroids
Inherited disorders that cause damage to the liver.

When you have Hepatitis B, C or liver cirrhosis of any cause, the risk of getting liver cancer is about 50-100 times than of someone without these risk factors.

Most liver cancers can be prevented by lifestyle modifications and health measures that reduce the risk and/or exposure to known risk factors.

Liver Cancer Screening

These are silent tumors most of the time. When liver cancer is detected early, it is small, localised, and easier to treat. Survival rates are also better when liver cancer is detected early
Consult liver specialist if you are at high-risk e.g. liver cirrhosis, chronic hepatitis B/C infection, healthcare workers
Regular screening may involve blood tests for Hepatitis B/C, alpha-fetoprotein (AFP) and liver function, as well as an ultrasound scan every 6 months.

What are the Symptoms of Liver Cancer?

Loss of appetite or weight, fatigue, or general weakness
Persistent or deep pain in the upper abdomen
Swelling or fluid build-up in the abdomen
Yellowing of the skin and the whites of the eyes (jaundice)
Generalized Itching, tea colored urine
Nausea and vomiting

How is Liver Cancer Diagnosed?

When liver cancer is suspected, a series of tests may be necessary to confirm and stage the disease e.g.

What Are The Treatments For Liver Cancer?

Treatment options depend on stage of the tumor that includes many factors such as age, general health, location and extent of the tumor. Broadly, surgery, loco-regional therapy, chemotherapy, and radiation therapy are the main methods of liver cancer treatment.

1. Liver Cancer Surgery

Surgery is the treatment of choice for liver cancer if possible. However, as liver cancer is often associated with liver cirrhosis, surgery for liver cancer is not always possible or safe. Liver transplantation is another surgical option for curative liver cancer treatment, in selected cases.

2. Loco-regional therapy

Ablation – to “burn” the tumour – Microwave, Radiofrequency, Ethanol, Cryotherapy Embolization – to reduce blood flow to the tumour and/or, or deliver anticancer agents to the tumour-

3. Systemic therapy

Targeted therapy – these block cell signals and proteins involved in tumour and blood vessel growth Immunotherapy- these turns our body’s immune system against cancer cells Chemotherapy – these destroy cancer cells but are not very effective in liver cancer Clinical trials- new investigative medicines or different combination of drugs

4. Radiation

External beam radiation therapy (EBRT)
Stereotactic body radiation therapy (SBRT)

5. Combination

Some of the above liver cancer treatments may be used in combination or staged to achieve optimal outcomes.

There is no single best method for every situation, we advise patients to discuss these options with a liver cancer surgeon who will explain the role and of each approach. The best treatment strategy requires a thoughtful balance of the associated risks and benefits, and should be personalized to each individual.

FAQ

FAQ HCC

My father/mother has a liver cancer. Am I at higher risk of developing liver cancer?

Hepatitis B carriers who have blood relatives diagnosed with liver cancer have a higher risk of developing liver cancer themselves. They should be screened regularly by a liver surgeon.

Can liver cancer be cured?

Yes, if picked up early, surgery offers the best chance of cure, either with removal of the tumor (liver resection) or liver transplantation. Unfortunately, while some may be diagnosed at advanced stages, these patients can still benefit from good control of the disease with the various treatments, e.g. locoregional, systemic or radiation therapy.

Are there traditional medicines recommended to treat liver cancer?

The term “traditional” or “herbal” remedies or Ayurveda medicine can represent thousands of compounds, many of which are not well known. Unfortunately, most are not rigorously tested or well regulated by the companies that produce them. Some are likely safe but many more may be very harmful. More importantly, there is no current evidence of any of these “remedies” work for liver cancer. It is recommended that patients considering these alternative forms of medication discuss this with their liver surgeon.

What are the major risks of Liver Cancer Surgery?

Risks Associated with Liver Cancer Surgery

Liver cancer surgery, like any major surgical procedure, carries certain risks, which vary depending on the type of surgery, the individual's overall health, and more. Risks associated with liver cancer surgery include:

Bleeding: The liver has a rich blood supply, and surgery may lead to bleeding but most of the bleeding will be well controlled. In rare cause, excessive bleeding might then require additional procedures to control it.
Infection: As with any surgical procedure, there is a risk of developing an infection at the wounds or within the abdomen.
Liver Failure: In extensive surgeries, there is a risk of insufficient remnant liver function leading to liver decompensation and failure, especially if the remaining liver tissue cannot regenerate sufficiently.
Bile Leakage
Damage to Nearby Organs or Structures: Given the liver's proximity to other organs and blood vessels, there is a risk of injuring nearby structures during surgery.
Delayed Recovery: Recovery from liver cancer surgery in the minority of cases be lengthy and challenging, and some people might experience slow wound healing or prolonged recovery periods. Minimally invasive liver surgery can ameliorate many of these short-term issues.

Recovering from Liver Cancer Surgery

Liver cancer surgery is a major operation and can take several weeks for full recovery. To ensure a smoother recovery, be sure to follow these advice:

Follow Medical Guidance: Adhere to post-surgery instructions regarding medication, wound care, diet, and activity levels.
Pain Management & Monitoring: Take prescribed pain relief, watch for signs of infection, and know when to seek medical attention.
Gradual Activity Resumption: Slowly reintroduce daily activities and follow the advice of your liver cancer doctor.
Healthy Lifestyle: Maintain a balanced diet, stay hydrated, engage in light exercise, and avoid alcohol and smoking.
Attend Follow-up Appointments: Attend your scheduled follow-ups to monitor your recovery progress.

Enhanced Recovery Approach

Enhanced Recovery approach Patients undergoing major surgery have been shown to benefit from measures and prehabilitation prior to and early after surgery to improve their physical condition and better tolerate and recover from the surgery. This multimodal perioperative care pathway starts a few weeks prior and immediately after the surgery, designed to achieve early recovery for patients undergoing major surgery and minimise complications. These include:

Excerises to improve strength and mobility – physiotherapy, prehabilitation
Lung excerises - deep breahting and incentive spirometry
Diet optimisation – nutritional supplements to boost immune system and provide an optimal diet to boost physiological reserves especially in patients who has loss of weight and appetite
Others e.g., - Preoperative smoking and alcohol cessation, medications review, Anti-thrombotic prophylaxis
Post-operative - Early mobilisation, early oral intake, nutritional supplementation, nausea and vomiting (PONV) prophylaxis, judicious fluid and pain management etc.

“Many people with liver cancer do well and survive the disease. Here, our goal is to cure your cancer and help you have best possible quality of life. At every step, we will work with you to determine the best treatment approach. Our team has vast experience and expertise in treating liver cancer and work together with other experts to achieve a comprehensive and personalized treatment strategy for the best outcome for you.”