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 judgment even more complex and confusing.
First of all, your confusion and worry are 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 outcomes 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 fulfill 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.
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 tumor 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 tumor 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 counseling, 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.
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 with the cells of the Liver.
Many types of cancer can form in the Liver. Amongst Liver cancer, the most prevalent one is hepatocellular carcinoma.
We should understand the triggers of Liver cancer.
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) 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, 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.
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 is a 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 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.
The single primary tumor (any size) did not develop in your blood vessels. Cancer has not spread to your adjacent lymph nodes or remote sites.
Only one primary tumor (any size) has developed in your blood vessels, or several tumors are present (less than 5 cm). Cancer has not spread to your adjacent lymph nodes or remote sites.
This stage has two subcategories.
Stage 3A: Multiple tumors 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 tumors have been discovered, and at least one tumor develops in a branch of the liver vein. Liver cancer did not spread to your adjacent lymph nodes or distant sites.
Cancer may have spread to your neighboring 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.
What are the causes of liver cancer?
- Excessive alcohol: 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: It also leads to an increased risk of developing non-alcoholic fatty liver disease, leading to liver cancer. Two toxins can cause liver cancer.
- Arsenic: This toxic chemical sometimes occurs in well water.
- 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 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 alarming.
These are the five essential symptoms of liver cancer
When one notices underlying conditions, they should be aware of symptoms like
- Rapid weight loss (unplanned)
- Abdominal swelling
- White stools
You can go for biopsy and imaging tests to determine the liver cancer stages.
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.
You will be prescribed this test that helps show the growth of tumors 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.
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 tumors. It can provide doctors with specific information on the size, shape, and location of any tumor in the Liver or elsewhere in the abdomen, along with nearby blood vessels.
To determine if your tumor 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.
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.
If you have a persistent cough with sputum, microscopic analysis of sputum can identify abnormal cells.
To examine abnormal areas in your Liver, a lighted tube will go through your throat and Liver.
To analyze the tissue samples from your lymph nodes. An incision will be made in the middle of your chest.
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.
A hollow needle will be inserted via the skin into the abdomen and Liver. The skin is first numbed by local anesthesia before positioning the needle. This type of biopsy is typically performed using an ultrasound or C.T. scan.
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.
An incisive biopsy (remove a piece of the tumor) or an excision biopsy (remove the entire tumor and specific surrounding normal liver tissues) can be done with surgery.
Surgery will be beneficial when you have a good liver function and tumors safely removed from a limited portion of the Liver. It is about removing the tumor and some of the surrounding tissue. Surgery may not be an option if the tumor is too big within your Liver, the tumor has spread out of the Liver, or if the patient has other serious problems.
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 tumors and leave behind other sections of the Liver to perform routine functions.
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.
R.F. ablation will be suggested if you have difficulties with surgery or tumors less than an inch and a half in diameter. RFA uses image guidance to place a needle through the skin in a liver tumor.
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 tumors is above 85 percent.
You will be recommended with percutaneous ethanol injection if you fall within the following parameters.
- Well defined (separate margins)
- The diameter is smaller than 3cm.
- Enclosed is a shell of scar tissue (fibrous encapsulation)
- Not next to the surface of the Liver.
In this technique, 100% alcohol is injected into cancer tumors of the Liver to kill cancer cells. This worked better against tumors made up of hepatocellular carcinoma or primary liver cancer.
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 tumors, including liver cancer. Protons are positively charged particles that produce high energy and can kill cancer cells.
The doctors recommend TrueBeam STx treatment for you to decrease the amount of radiation on the healthy tissue surrounding the tumor.
TrueBeam STx can modify the shape of the radiation beam according to the shape of your tumor. It is an advanced linear accelerator and radio surgical treatment system that allows doctors to target difficult access tumors.
The CyberKnife system is a non-invasive surgery for both cancerous and non-cancerous tumors. This advanced surgery is recommended for you if you have inoperable tumors or surgical complexities. CyberKnife treatments generally take 1 to 5 sessions.
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.
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.
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 tumors who require liver transplantation. Radiotherapy uses highly energetic radiation (or particles) to kill cancer cells.
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.
Usually, during the early stage of liver cancer, the cancer is localized and has not propagated anywhere else in the body. Therefore, to avoid further growth and spread of liver cancer, your doctor may advise you to remove the cancerous liver cells surgically.
Typically your surgeon uses laparoscopic or robotic surgery to remove the cancer cells from your liver.
During stage 2 liver cancer, there is an elevated chance for the transmission of the cancer to neighboring structures.
Generally, doctors use surgical intervention to remove the cancerous cells. Sometimes your doctor may advise liver transplant to avoid the spread of cancer.
Some studies indicate that surgery followed by chemotherapy can increase the efficacy of the treatment.
Treatment for stage 3 liver cancer depends on various factors like location of the cancer, the functioning of the liver and the overall well-being of the person having liver cancer.
Based on the factors your doctor may suggest you chemoembolization, radiofrequency ablation, targeted or immunotherapy.
Unfortunately the fourth stage of liver cancer is an advanced stage during which the treatment of cancer is not possible. However doctors may try to relieve symptoms that affect the quality of life.
Sometimes your doctor may suggest targeted therapy or immunotherapy to destroy cancer cells to relieve symptoms to give you a good life.
Which country is best for liver cancer treatment?
Living with liver cancer can be overwhelming and stressful. While we all try hard to look for the best treatment alternatives to treat this condition, you must consider a country that offers world-class treatment at a reasonable price.
Here are a few tips which can help you select the best country for liver cancer treatment:
- Consider a country that has modern health-care facilities with other advanced technologies for the treatment.
- Check the success rate of liver cancer treatment in that country
- Ensure the survival ratios of the people who underwent liver cancer treatment in that country
- Ascertain to check the cost of treatment, and stay in that country
Also, while you check the above criteria for selecting a country for treatment of your liver cancer, you must also consider logistic factors like:
- Easy availability of connecting flights,
- Ease of local transportation, and
- Safety of the chosen country.
While people generally consider western nations for their treatment, the cost of the treatment in those countries are usually high when compared to India.
The cost of treatment in India is almost half when compared to western nations. Also India offers you world-class facilities, at an affordable price.
India has emerged as one of the leading countries that provide the best healthcare facilities with high success and survival ratios at an affordable price.
The availability of world-class treatment, well-trained and board certified doctors, and the dedicated post-care facility has attracted many foriegn nationals to India to get their liver cancer treatment done in India.
How to choose the best hospital for liver cancer treatment in India?
Picking a good hospital for liver cancer treatment is very crucial. When choosing a hospital for liver cancer treatment, you must ensure that the selected hospital is equipped with the latest equipment used for cancer treatment. Also ensure that the hospital offers a multidisciplinary approach.
The multidisciplinary approach gives you access to specialists surgeons, medical oncologists, radiation oncologists, and well-trained nurses who work together to provide you with the best treatment.
Moreover, you should ensure that the hospital you have selected has a dedicated unit for cancer treatment with a well-trained post-care team that ensures high success and survival rate.
How to choose the best oncologist for your liver cancer treatment in India?
Choosing an oncologist for liver cancer treatment is essential because a good doctor helps you provide the necessary care to reverse or manage the symptoms of cancer efficiently . Here are a few tips to help you select the best doctor for you:
- Confirm that your doctor is tumor board-certified
- Ensure that your doctor’s has adequate experience and expertise in treating liver cancer
- Enquire if your doctor has a team of specialists for treating cancer which includes specialist surgeons, medical oncologists and radiation oncologists.
- Always choose a doctor with whom you are comfortable with
Please do not hesitate to seek a second opinion before undergoing liver cancer treatment.
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 (347543 – 377764 INR) for liver resection (Hepatectomy), While the cost of liver transplantation in India varies from USD 38000 to USD 42000 (2871010 – 3173221 INR).
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.
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.