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Beat Liver cancer with Advanced treatment protocols

Are you also concerned about what treatment is appropriate for liver cancer?

Whenever you meet different doctors, you get to hear different opinions on liver cancer treatment plans. When you meet a Hepatologist or medical oncologist or Surgical oncologist, or Radio oncologist, there are fair chances of overlapping opinions and driving a holistic view is always a challenge. In addition to that, worrying about the patient’s future makes the judgement even more complex and confusing.

First of all, your confusion and worry is typical, and every patient crosses this journey. 

However, be assured that with advancements in liver cancer treatment technology, skills and experience, along with the proper protocol, the results and outcome these days are much more promising than what they used to be a decade ago. You can also be back in control of your life and health and plan to fulfil your dreams.

What you essentially need is proper hand-holding and guidance to make informed decisions with a holistic view.

Before moving ahead on this discussion, let’s understand from the experience of one of our patients Robert, a 44-year-old I.T. Professional from Lagos, Nigeria.

Liver-Cancer-treatment in india
what is liver cancer

Robert was a busy I.T employee having a happy married life with two kids. One day, he had severe abdominal pain on his right side with nausea and vomiting while getting ready for his office. 

Robert’s wife realized that it was an abnormal pain and severe discomfort. She immediately decided to visit the nearby hospital. After giving the first aid, the Doctor advised him to undergo a detailed evaluation, including an abdominal C.T scan to diagnose the problem. The intelligent and educated family followed the advice and completed all the investigations, including the C.T scan. When the reports were presented to the treating doctor the next day, there was a shock waiting for Robert. The Doctor called Robert’s wife and shared the tragic news that he had been diagnosed with Liver cancer. 

The family was shell-shocked with this news because he never had any symptoms and even minor liver disease history.

Lisa, Robert’s wife, was so worried that she couldn’t hold her emotions and tears. She didn’t want her loving husband to suffer from pain, and at the same time, numerous questions, situations and outcomes started coming to her mind. 

However, after a couple of days of initial shock, the family decided to fight cancer and defeat it permanently.

The next big question was where to go for her husband’s treatment. Which country could be the best choice for Liver cancer treatment?

They decided to meet a few oncologists in Lagos. Oncologists in Nigeria came up with different treatments that failed to convince Lisa and Robert. 

They were so confused when it came to the choice of treatment. The radiologist just wanted them to take radiotherapy. The surgeon wanted her husband to have liver surgery first. 

Parallelly Robert’s wife started searching on the internet and got to understand the concept of tumour board. As a result, they could not have a holistic view of the treatment. And that’s the time the family got in touch with MedicoExperts and requested a holistic view of the solution.

The MedicoExperts team presented the case to the tumor board. The board recommended a tentative protocol with a combination of surgery, chemotherapy, and targeted therapy and suggested the final protocol can be arrived at after thorough evaluation, including PET Scan. The family also had a video call with the head of the board and understood the tentative protocol thoroughly.

As soon as Robert’s family got excellent clarity from the head of the tumour board that had all the specialists, including hepatologists, radiologists, medical oncologists, surgeons, and Psychologists, they decided to come to India. With the full support of the MedicoExperts panel, logistics support, visa support and psychological counselling, Robert and his wife Lisa landed in India within a month after the decision. 

He was admitted to one of the empanelled hospitals that were also NABH and JCI accredited. After investigations, the protocol was modified a bit due to some new findings. 

The family spent two months in India and returned happily with a feeling of victory against cancer.

It’s been two years now, and Robert is leading a happy life with his family. 

This can be your experience as well. 

Before we move ahead in the discussion, let’s first understand what the Liver is and why it’s so essential for the body. 

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What is Liver and its primary functions?

The Liver is your secondary digestive organ that produces bile, an alkaline fluid containing cholesterol and bile acids, which breaks the fat.

The Liver eliminates toxins from your body’s blood supply, keeps blood glucose levels healthy and performs many other vital functions. It is situated under the rib cage in the upper right abdomen.

What is Liver Cancer?

Liver cancer begins in the cells of the Liver. Many types of cancer can form in the Liver. Amongst Liver cancer, the most prevalent one is hepatocellular carcinoma. 

 

What are the causes of liver cancer?

Excessive alcohol intake can seriously affect the Liver. There are numerous proven studies on the association of alcohol with liver cancer.

Being overweight or having diabetes also leads to an increased risk of developing non-alcoholic fatty liver disease, leading to liver cancer.

Two toxins can cause liver cancer.

  1. Arsenic: This toxic chemical sometimes occurs in well water.
  2. Vinyl chloride: This chemical is used in several plastics.

Chronic viral hepatitis

Around the world, the most common risk factor for liver cancer is chronic (long-term) infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). These infections cause cirrhosis of the Liver and make liver cancer the most common cancer in many parts of the globe.

Tobacco use

Smoking leads to an increased risk of liver cancer. Those who have smoked and quit are at lower risk than those who continue to smoke, but both groups are at higher risk than those who have never smoked.

Obesity

Obesity (highly overweight) increases your risk of developing liver cancer.

Anabolic steroids

Anabolic steroids are masculine hormones used by certain athletes to increase their strength and muscle mass. Prolonged use of anabolic steroids may slightly increase the risk of hepatocellular cancer.

What is the first sign of liver cancer?

Many of the symptoms which we’re going to discuss can also be caused by other conditions. Predominantly, if there are one or more symptoms, it’s better to have a doctor’s consultation!!

There are instances where symptoms of liver cancer do not show up till its final stage, but sometimes it might show up earlier.

Suppose there is a pain in the abdomen and right shoulder blade with loss of appetite. It can be considered as a symptom of liver cancer, particularly when they feel full after taking a small meal, they should feel alarmed.

These are the five essential symptoms of liver cancer

When one notices underlying conditions, they should be aware of symptoms like

  1. Rapid weight loss (unplanned)
  2. Jaundice
  3. Abdominal swelling
  4. White stools
  5. Fatigue

You can go for biopsy and imaging tests to determine the liver cancer stages.

Types of liver cancer

Primary liver cancer is cancer that begins within the Liver. There are five major types. The type is dependent on the type of cell in which cancer began.

Hepatocellular carcinoma (HCC)

Hepatocellular carcinoma (HCC) is the most common kind of early liver cancer. Hepatocellular carcinoma arises in inflamed chronic Liver and is most closely related to chronic viral hepatitis.

Fibrolamellar carcinoma

Fibrolamellar carcinoma, or FLC, is a rare liver cancer that typically develops in adolescents and adults younger than 40. This type of cancer is different from other variants of liver cancer, as it happens in people with a healthy liver. 

They are well differentiated and well defined, with a dense fibrous background. The cancer cells are arranged in cords that are distinguished by sheet-like fibrous bands arranged in a parallel distribution.

Bile duct cancer 

A network of tubes referred to as ducts connect the Liver, gallbladder, and small intestine. This network starts in the Liver, where many small ducts collect bile (a liquid made by the Liver to break down fat during digestion). Cancer of the bile ducts is a rare condition where malignant cells (cancer) form in the bile ducts.

Angiosarcoma

Angiosarcoma is cancer that develops in the lining of blood vessels and lymphatic vessels. It often affects the skin and may appear as an injury similar to a bruise that grows with time. Angiosarcoma is a rare form of cancer that develops in the lining of blood vessels and lymphatic vessels.

Hepatoblastoma

Hepatoblastoma is the most prevalent liver cancer among children. It affects children within the first three years of life and usually occurs as an abdominal mass that causes pain and discomfort.

Hepatoblastomas arise from immature liver precursor cells and may metastasize.

Secondary liver cancer occurs when cancer that originated elsewhere in the body has spread to the Liver. 

Stages of liver cancer

Liver cancer stages are denoted by numbers that range between 0 to 4; starting stage indicating cancer that is limited to the lung is denoted by 0. For stage 4 is considered advanced and has spread to other distant areas of the body.

Stage 1

The single primary tumour (any size) did not develop in your blood vessels. Cancer has not spread to your adjacent lymph nodes or remote sites.

Stage 2

Only one primary tumour (any size) has developed in your blood vessels, or several tumours are present (less than 5 cm). Cancer has not spread to your adjacent lymph nodes or remote sites.

Stage 3 

This stage has two subcategories.

Stage 3A: Multiple tumours have been found, and at least one is more prominent than five cm. Cancer has not spread to your nearby lymph nodes or distant sites.

Stage 3B: Several tumours have been discovered, and at least one tumour develops in a branch of the liver vein. Liver cancer did not spread to your adjacent lymph nodes or distant sites.

Stage 4: Cancer may have spread to your neighbouring lymph nodes and or distant sites in the body. Advanced liver cancer does not metastasize frequently, but it is more likely to spread to your bones and lungs when it does.

In contrast to other cancers, liver cancer is complicated because most patients have damage that restricts the functioning of the organ. The Liver provides an essential service to the body, helping with digestion and detoxification. Reduced liver function can lead to severe or fatal illnesses. Reduced liver function can also impact the choice of treatment options. 

4 stages of liver cancer

Liver cancer

What are the major tests to identify Liver cancer?

Liver-cancers-causes

There are many advanced techniques to identify Liver cancer stages.

Blood tests: You may need a blood test to find a substance called AFP. AFP is found in high levels in the blood of about 50-70% of people with Hepatocellular carcinoma. The Doctor will also examine your blood to determine whether there is hepatitis B or C. Additional blood tests like ALT, AST and liver function panel tests can show how your liver functions.

Ultrasound: You will be prescribed this test that helps show the growth of tumours in the Liver, which can then be tested for cancer if required. Ultrasound is often the primary test used to examine the Liver. It uses sound waves to create a picture on a computer screen. 

C.T. scan: A C.T. scan is an X-ray test to get detailed images of your body. A CT scan of the abdomen may help you identify many types of Liver tumours. It can provide doctors with specific information on the size, shape, and location of any tumour in the Liver or elsewhere in the abdomen, along with nearby blood vessels.

MRI: To determine if your tumour is benign or malignant, MRI helps to obtain detailed images of the soft tissues in your body. But MRIs use high-powered radio waves and magnets instead of X-rays.

Bone scan: Doctors usually do not prescribe this test for you unless you have symptoms such as bone pain. A bone scan can help detect cancer that has spread (metastasized) to the bones. 

Sputum cytology: If you have a persistent cough with sputum, microscopic analysis of sputum can identify abnormal cells.

Bronchoscopy – To examine abnormal areas in your Liver, a lighted tube will go through your throat and Liver.

Mediastinoscopy – To analyze the tissue samples from your lymph nodes. An incision will be made in the middle of your chest.

Biopsy: Doctors take a sample of tissue from an abnormal area and identify it with the biopsy. If a biopsy is needed, it can be done in several ways.

Needle biopsy: A hollow needle will be inserted via the skin into the abdomen and Liver. The skin is first numbed by local anaesthesia before positioning the needle. This type of biopsy is typically performed using an ultrasound or C.T. scan.

Laparoscopic biopsy: Biopsy samples can also be collected during a laparoscopic exam. This allows the Doctor to look at the surface of the Liver and take samples of abnormal areas.

Surgical biopsy: An incisive biopsy (remove a piece of the tumour) or an excision biopsy (remove the entire tumour and specific surrounding normal liver tissues) can be done with surgery.

Liver cancer treatments

There are multiple ways to treat liver cancer, but significant treatments are

Surgery

Surgery will be beneficial when you have a good liver function and tumours safely removed from a limited portion of the Liver. It is about removing the tumour and some of the surrounding tissue. Surgery may not be an option if the tumour is too big within your Liver, the tumour has spread out of the Liver, or if the patient has other serious problems.

Hepatectomy

Hepatectomy is often performed in liver cancer patients. Partial Hepatectomy is the surgical removal of part of your Liver. This method is intended to remove areas of your Liver affected by cancerous tumours and leave behind other sections of the Liver to perform routine functions.

Liver Transplant

In your case, If liver cancer is discovered early, is small, and has not spread, you may be able to have a surgical procedure to remove a part of it. 

If the patient’s situation demands the Liver’s removal, a liver transplant will be required to replace your Liver with a donation. Recovery from surgery for liver cancer can take a while. The team of specialists in your care will discuss all the benefits and side effects.

Radiofrequency ablation (RFA)

R.F. ablation will be suggested if you have difficulties with surgery or tumours less than an inch and a half in diameter. RFA uses image guidance to place a needle through the skin in a liver tumour. High-frequency electric currents passed via an electrode into the needle, creating a small area of heat. Heat kills the Liver’s cancerous cells. The success rate of the complete elimination of small liver tumours is above 85 per cent.

Percutaneous ethanol injection

You will be recommended with percutaneous ethanol injection if you fall within the following parameters.

  • well defined (separate margins)
  • diameter smaller than 3cm.
  • enclosed in a shell of scar tissue (fibrous encapsulation)
  • Not next to the surface of the Liver.

In this technique, 100% alcohol is injected into cancer tumours of the Liver to kill cancer cells. This worked better against tumours made up of hepatocellular carcinoma or primary liver cancer.

Proton beam therapy

You will generally be offered proton therapy if cancer has not spread to essential parts of your body. Proton Therapy does not affect healthy cells and growing tissues.

Proton beam therapy is a type of radiotherapy that uses protons rather than X-rays and can treat a variety of solid tumours, including liver cancer. Protons are positively charged particles that produce high energy and can kill cancer cells.

TrueBeam STx radiosurgery

Doctors recommend TrueBeam STx treatment for you to decrease the amount of radiation on the healthy tissue surrounding the tumour.

TrueBeam STx can modify the shape of the radiation beam according to the shape of your tumour. It is an advanced linear accelerator and radio surgical treatment system that allows doctors to target difficult access tumours.

Cyberknife radiosurgery

The CyberKnife system is a non-invasive surgery for both cancerous and non-cancerous tumours. This advanced surgery is recommended for you if you have inoperable tumours or surgical complexities. CyberKnife treatments generally take 1 to 5 sessions.

Targeted therapy

You could get treatment with targeted medications for liver cancer if you can’t have surgery because you’re very ill, or cancer can’t be removed through surgery.

Targeted cancer medications are aimed at preventing cancer from developing.

Cancer has spread to other areas of the body.

Chemotherapy

You will generally get chemotherapy to help reduce cancer or to control and improve symptoms. This is done if you are unable to have surgery because you are very sick or cancer cannot be removed through surgery.

Chemotherapy uses medications to kill cancerous cells.

For liver cancer, chemotherapy is typically administered in the blood vessels of cancer. It focuses on stopping the growth of cancer. This is known as chemotherapy.

Radiation

If your Liver has been severely damaged by diseases like hepatitis or cirrhosis, radiation therapy won’t be advised. Radiation can be used in people with small tumours who require liver transplantation. Radiotherapy uses highly energetic radiation (or particles) to kill cancer cells. 

Immunotherapy

Immunotherapy will equip your immune system with certain medications to fight against Liver cancer, but this treatment will not be advised for patients with a history of hepatitis infection.

liver cancer sign and symptoms

How much does India's liver cancer treatment cost?

The cost of liver cancer treatment in India is between the U.S. $4,600 and US$5,000 for liver resection (Hepatectomy), While the cost of liver transplantation in India varies from USD 38000 to USD 42000.

For Hepatectomy, the hospital stay is around six days and ten days outside the hospital. For liver transplants, it’s 22 days in the hospital and 40 days outside the hospital. The exact cost varies from patient to patient and the type of surgical procedures and medications involved.

What is the success rate for liver cancer treatment in India?

Early cancers have an excellent prognosis. Thanks to the advancement of imaging, even small cancers have been identified much sooner to be treated promptly. Success varies by modality. Liver transplant provides a success rate of > 90% in transplant survival and more than 80% chance of cancer-free survival for five years.

Conclusion

Therefore, identifying liver cancer symptoms early in the process is key. It’s all about the mental stability of the patients to fight liver cancer. Although it is identified later, advanced therapies are available to make the patient’s way of life happy.

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Frequently Asked Questions and patient concerns:

1. Can liver cancer be cured at the final stage?

Treatment can help slow your cancer spread and relieve symptoms. Your Doctor will recommend treatment depending on where your cancer has spread and the extent to which your Liver continues to function.

2. Are Ayurvedic herbs advisable for liver cancer treatment?

‘Ayurvedic herbs’ may include thousands of compounds. Sadly, most are neither rigorously tested nor regulated by the companies that produce them.

Some are probably pretty safe, but some can be dangerous. I recommend that all patients taking this type of medication discuss it with their Doctor as they would with any other non-regulated drug or medication they may use.

 

3. How many doctors are going to treat my liver cancer treatment?

Depending upon the stage and grade of your tumour, you may be treated by one or more specialists as you undergo cancer treatment. For example, patients with liver cancer can be seen by hepatologists, gastroenterologists, surgeons, radiologists, radiation oncologists, and medical oncologists.

4. Will my cancer come back?

This is one of the most commonly asked questions from cancer survivors. In some cases, cancer can reappear, or new cancer can develop years or even decades after treatment or does not appear at all.

5. If a parent had liver cancer, is it more likely that their children will have it?

In some instances, yes, a parent who has liver cancer can increase your risk. However, this is not the case with most patients. It is always good to speak with your primary care physician about your concerns or questions.

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MedicoExperts is a Global virtual hospital which is established to offer quality healthcare services at affordable pricing without compromising the success rates of the treatment. MedicoExperts is having a network of highly experienced super specialist doctors and well equipped hospitals across the globe and offering second opinion through online video consultation and surgical interventions through its empanelled super specialist doctors at its network hospitals in 17 countries from 3 continents.
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