Liver Cancer Treatment in India
Liver cancer, also known as hepatic cancer is the type of cancer that begins when the healthy cells of your liver change and grow out of control forming a tumor. These cancer cells can become destructive to adjacent normal tissues, and spread to other areas of the liver as well as to organs outside it.
There are basically two types of tumors- malignant and benign. Malignant ones are cancerous tumors that need immediate medical attention. Treatment for liver cancer of such kind include surgery, chemotherapy and radiation therapy. Benign tumors, on the other hand aren’t cancerous. Such tumors do not spread to other parts of the body and can be easily removed with a surgery.
Liver and its functions
Liver is the largest organ in the human body located in the upper right side of the abdomen, just below the ribs. Liver’s main function is to produce bile, a substance that helps in digestion of fats, vitamins, and other nutrients. It also helps in breakdown of drugs, and other toxins in the blood, which are then removed from the body through urine and faeces.
When cancerous cells develop in the liver, it interferes with the liver’s ability to function normally. There are basically two types of Liver cancer- Primary and Secondary. Primary liver cancer begins in the cells that make up the liver. Secondary Liver cancer, also known as metastatic cancer happens when cancer spreads to the liver from other body parts such as lungs or pancreas.
- Hepatocellular Carcinoma (HCC)
Hepatocellular Carcinoma is the most common form of liver cancer that develops from the main liver cells called hepatocytes. Most cases of hepatocellular cancer are the result of either hepatitis B/C infection, or cirrhosis caused by alcoholism.
About 80 percent of cancers that start in the liver are HCC.
2. Intrahepatic Cholangiocarcinoma
Cancer that occurs in the liver cells that line the small bile ducts is known as intrahepatic cholangiocarcinoma or bile duct cancer. 10 to 20 percent of the cancers that start in the liver are of this type.
3. Angiosarcoma or Hemangiosarcoma
These cancers begin in the blood vessels of the liver and account for about 1 percent of all liver cancers. Angiosarcoma or hemangiosarcoma is quite rare and only people who have been exposed to vinyl chloride or thorium dioxide are most likely to develop this cancer. In some cases it can be hereditary too.
As these tumors grow very quickly, they are often diagnosed at an advanced stage.
Most patients don’t experience any kind of signs or symptoms in the early stages of liver cancer. But when they do appear, these may include:
- Unexplained weight loss
- Upper abdominal pain
- Loss of appetite
- Nausea Vomiting
- Weakness and fatigue
- Yellow discoloration of skin and the whites of the eyes
- White chalky stools
Treatment for liver cancer varies from stage to stage. It is also dependent on other major factors like how much liver is affected? Has it spread to other organs? What does patients prefer and his/her overall health. Various kinds of Liver cancer treatments include surgery, tumor ablation, tumor embolization, radiation therapy, targeted therapy, immunotherapy, and chemotherapy.
If the cancerous tumor is detected in the initial stage with a healthy liver condition, doctors try to remove or eliminate the cancerous cells using a surgery. However, if the tumor has reached an advanced stage, treatment for Liver cancer includes a combination of options like chemotherapy, radiation treatment and may be a surgery.
Surgery is the primary treatment for Liver cancer when the tumor is in the initial stage and hasn’t much affected liver’s overall health. Surgical procedure involves removal of the tumor along with the surrounding healthy tissue.
Surgeries are of two types:
- Hepatectomy: This type of surgery is performed only if the cancer has affected only one part of the liver while the other part is working well. The procedure involves removing a portion of liver. Over time, the remaining healthy tissue regrows and replaces the missing part.
Doctors do not recommend Hepatectomy as the treatment for liver cancer if the patient is having advanced cirrhosis issues.
2. Liver transplant: This is the second type of surgical treatment for liver cancer that involves replacing the diseased liver with a healthy liver from a donor. A transplant is usually done if the cancer hasn’t spread to other organs. Treatment for liver cancer with a transplant is rare due to low availability of donors.
It is important to note that transplant doesn’t guarantee a successful treatment for liver cancer. Doctors keep a close check on the patients for the signs of rejection of the new liver by the body. The patient is advised to take the medication properly to prevent the rejection. Also, there are chances of re-growth of the tumor.
The word ablation means clinically destroying or removing the body tissue/tumor with the help of surgery or introducing the cancer killing substance directly into the tumor.
- Radiofrequency ablation or RFA:
In this kind of treatment for liver cancer, electric current is used to destroy cancer cells with CT scan or ultrasound as a guide. This is done using small needles that the surgeon inserts through multiple incisions in abdomen to reach the tumor.
- Percutaneous ethanol injection:
An Alcohol injection is directly injected into the liver tumor which is smaller than 3 cm, to kill the cancer cells.
- Cryoablation or cryosurgery:
In this treatment for liver cancer, cancer cells are destroyed by freezing the tumor with the help of thin metal probe. Ultrasound images are used for guidance while the doctor places the cryoprobe (an instrument) containing nitrogen liquid directly on the liver tumor.
Side effects of ablation
Like any treatment for Liver cancer, Ablation too has its own side-effects including:
- Bruising in skin due to insertion
- Damage to nearby organs in case of improper placement of the needle
- Life threatening damage to the arteries or veins in the liver or surrounding tissues
- Liver abscess
- Bloodstream infection
However, much of these can be cured with medication and cautious follow-up care. Your doctor will give you all the necessary information regarding the possible complications that may arise out of the treatment and also how they could be treated.
High-powered energy sources like X-rays and protons in the form of radiations are used in this treatment for Liver cancer to destroy cancer cells and shrink tumors. There are two ways to deliver radiation- external beam radiation or by internal radiation. While internal radiation involves a catheter to inject little radioactive spheres into the hepatic artery, in the external beam radiation, the radiation is aimed at the abdomen and chest. This treatment can be risky for the healthy tissue due to the charged radiation beams.
Stereotactic Body Radiation Therapy (SBRT): This radiation therapy involves several beams of high dose radiation coming from different angles to target precisely at one point in the patient's body taking a shorter time than above therapy.
While undergoing Radiation therapy, you need to get plenty of rest and follow a nutritious diet. Eating healthy during and after cancer therapy can help you manage all the side effects, fight infection, rebuild healthy tissue and maintain body weight and energy.
This is the type of treatment for liver cancer where strong anti-cancer drugs are directly supplied to the liver. The medicines could be taken either orally, or it may be delivered via a catheter or intravenous line directly into the bloodstream. In most cases, Chemotherapy is given in several cycles with a rest period of a few weeks between each cycle. This is to allow the body to recover from the side-effects of the treatment.
It is usually a repetitive process which is practiced over a long period of time. The patient may get prolonged side effect such as nausea, vomiting, loss of appetite and hair loss.
Embolization and Chemoembolization
These are surgical procedures aimed at blocking off the hepatic artery. During chemoembolization, drugs are injected into the hepatic artery because of which the flow of blood through the artery is blocked for that short period so the chemotherapy can stay longer in the tumor. This destroys cancer cells' ability to grow and divide.
In this treatment for Liver cancer, radioactive beads are placed directly into the artery that supplies the tumor with blood. Then radiations are passed directly to the tumor to destroy it.
This process is often referred to as ‘Trans-Arterial Embolization’ (or TAE), it basically involves inserting a thin, flexible tube called a ‘catheter’ into an artery through a small cut in the inner thigh and threaded up into the hepatic artery in the liver. Doctors use Angiography to monitor the path of the catheter by injecting a dye in the bloodstream. Small particles are injected after placing the catheter into the artery to plug it up.
Due to embolization, healthy liver tissue can be affected leading to worsening the liver function.
Side effects of Embolization:
Blisters on skin from where the radiation enters
Infection in the liver
Blood clots in the main liver blood vessels
Targeted Drug Therapy
Targeted drugs help slow down or stop the growth of the tumor and its ability to spread or multiply. The treatment for Liver cancer targets specific genes, proteins or the tissue environment of cancer that contributes to its growth and survival.
Immunotherapy as liver cancer treatment includes medication that will boost patient's immune system to attack cancer cells. Also known as biological therapy, it makes use of immune checkpoints which help the immune cells to identify normal cells and cancer cells and then plan for the response accordingly.
Side effects: Severe autoimmune conditions where the system can attack colon or lungs.
Follow up is very crucial part of any treatment for liver cancer. The aim of follow-up is to look out for signs of relapse and treatment complications. For the first year after your treatment for liver cancer, you’ll normally have a check-up every one to two months. Even if the cancer is treated, there are chances of the regrowth or the remaining undetected cancer cells in the body.
Patients are asked to do blood tests or imagining tests at regular intervals and to report any new signs or symptoms to your healthcare team so that they can investigate these.
India offers many hospitals that provide world-class treatment for liver cancer at affordable cost. Some of these names include Fortis, Medanta, Artemis Healthcare Institute, Wockhardt, BLK, Tata Memorial and Max healthcare.
These hospitals provide international level of healthcare and hospitality to patients complemented by high standard of medical facilities and technology.
The treatment for Liver cancer in India is amongst the world’s most advanced and also the cheapest.
Liver transplant in India can range from Rs 8,00,000 to Rs 25,00,000 (USD 12,500 to 39,075). Cost for ablation procedures starts from Rs 1,50,000 (USD 2300) whereas, cost for chemotherapy starts from Rs 15,000 (USD 230) for one cycle. Radiation therapy ranges between Rs 45,000 to Rs 75,000 (USD 700 to 1100). These costs are way less than liver cancer treatment costs in the countries like the US, UK or Singapore.
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top Liver Cancer Specialist in India
Dr Sudipto Pakrasi
A renowned ophthalmologist, with a career spanning three decades, Dr Sudipto Prakasi currently leads the Opthalmology division at Medanta – Medicity, Gurgaon as the Chairman. Dr Prakasi complView Details