Liver Tumour Cancer

Liver cancer is broadly categorised into five types:

• Hepatocellular carcinoma (HCC)
• Fibrolamellar Hepatocellular Carcinoma (FHCC)
• Cholangiocarcinoma
• Angiosarcoma
• Secondary liver cancer

Factors that increase the risk of primary liver cancer include:

• Chronic infection with Hepatitis B/Hepatitis C virus
• Cirrhosis
• Certain inherited liver diseases (Haemochromatosis & Wilson’s Disease)
• Diabetes
• Non-alcoholic fatty liver disease
• Exposure to aflatoxins (Aflatoxins are poisons produced by moulds that grow on crops that are stored poorly. Crops such as corn and peanuts can become contaminated with aflatoxins, which can end up in foods made of these products.)
• Excessive alcohol consumption

Most people do not show signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include:

• Weight loss
• Loss of appetite
• Abdominal pain
• Nausea
• Vomiting
• General weakness and fatigue
• Abdominal swelling
• Jaundice
• White, chalky stools

Max Institute of Cancer Care (MICC) at Max Hospitals, India, is one of the leading facilities in India, which offers the latest treatments under surgical oncology, radiation oncology, and medical oncology. It is one of the largest Cancer Centres in North India, with presence in Saket, Patparganj, Shalimar Bagh, Vaishali, Mohali and Bathinda. It offers high-end treatments like cone-beam CT and ExacTrac.

Diagnostic tests and procedures for liver cancer include:

• Blood Tests
• Liver function tests
• Imaging Tests (Sonography, CT Scan and MRI)
• Hepatic arteriography
• Liver biopsy

Tumor Board

At Max Institute of Cancer Care, we know that cancer treatment involves multiple specialities (Surgical, medical and radiation oncology, molecular oncology, pathology, radiology, palliative oncology, psycho-oncology, onco rehabilitation, etc.), and the best outcome in any patient can be ensured only if all decisions are taken collectively by all specialists involved. Therefore, a Tumor Board of such specialists who meet periodically and discuss the best approach to the management of cancer patients is facilitated. It ensures that many heads are planning holistic management of a patient.

Liver cancer is treated by involving complete medical history and physical examination, and diagnostic procedures. A series of physical examinations, medical tests, or both methods can be used as follow-up care by the concerned physician.

For a liver cancer patient, the right treatment is determined based on the age, overall health, medical history, extent of the disease, tolerance of specific medicines, procedures, or therapies, expectations for the course of the disease and the patient’s opinion or preference.

The doctor will also evaluate the side effects of the treatment. Whatever changes you feel in your body post the treatment, let your physician be aware of it, so that a proper follow-up care routine is designed.

Max Institute of Cancer Care is the first facility in northern India to acquire Novalis Tx for Intensity Modulated Radiation Therapy (IMRT) with Image Guided Radiosurgery (IGRT), Hyperthermic Intraperitoneal Chemotherapy (HIPEC), and Stereotactic Radiosurgery (SRS) and Stereotactic Radiation Therapy (SRT). Additionally, it is equipped with an advanced Da Vinci XI Robotic System for treating complex conditions like cancer and heart tumour. This is next-frontier technology for minimally invasive surgery. The instrument is equipped with a 3D vision system that bends and rotates faster than the human wrist.

At Max Institute of Cancer Care, we offer the following treatment options for liver cancer:

A) Surgery

Operations used to treat liver cancer include:

1. Surgery to remove the tumour: In certain situations, your doctor may recommend an operation to remove the liver cancer and a small portion of healthy liver tissue that surrounds it if your tumour is small and your liver function is good. Whether this is an option for you also depends on the location of your cancer within the liver, how well your liver functions and your overall health.
2. Liver transplant surgery: A surgical treatment option where the entire liver is replaced by a healthy one from a donor. It is only an option for a small percentage of people with early-stage liver cancer. It is divided into two types:
   • Deceased Donor Liver Transplantation (DDLT): In this case, the diseased liver of the patient is replaced with a healthy liver from a donor who has died recently.
   • Living Donor Liver Transplantation (LDLT): In this case, the patient with a diseased liver receives a part of the liver from family or a friend. Patient’s damaged liver is replaced with the healthy one, which eventually grows on later to its normal size.

C) Radiotherapy: This treatment uses high-powered energy from sources such as X-rays and protons to destroy cancer cells and shrink tumours. Doctors carefully direct the energy to the liver, while sparing the surrounding healthy tissue. During external beam radiation therapy treatment, you lie on a table, and a machine directs the energy beams at a precise point on your body.

D) Targeted Drug Therapy: This involves using targeted drugs to interfere with specific abnormalities within a tumour. They have been shown to slow or stop advanced Hepatocellular Carcinoma from progressing for a few months longer than with no treatment.

E) Localised Treatment: Treatment is administered directly to the cancer cells or the area surrounding the cancer cells. Options include:

• Heating cancer cells: Using ultrasound or CT scan as a guide, your surgeon inserts one or more thin needles into small incisions in your abdomen. On reaching the tumour, the needles are heated with an electric current, destroying the cancer cells.
• Freezing cancer cells: Cryoablation uses extreme cold to destroy cancer cells. During the procedure, your doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumours. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells.
• Injecting alcohol into the tumour: During alcohol injection, pure alcohol is injected directly into tumours, either through the skin or during an operation. Alcohol causes the tumour cells to die. Injecting chemotherapy drugs into the liver:
• Injecting chemotherapy drugs into the liver: Chemoembolization is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver. Placing beads filled with radiation in the liver:
• Placing beads filled with radiation in the liver: Tiny spheres that contain radiation may be placed directly in the liver where they can deliver radiation directly to the tumour.