Liver cancer (hepatocellular carcinoma) is a proliferation of cancer cells in the largest gland in the human body which performs important functions such as removal of toxic substances from the body, the synthesis of the proteins contained in the blood and the production of bile and enzymes essential for digestion.
Liver cancer may be primary, when born within the liver (the most frequent is the hepatocellular carcinoma) or, more often, secondary, when derived from cancer that has developed in another organ and has expanded to the liver (liver metastasis).
More rarely this tumor can develop in the hepatic ducts, ducts that carry bile from the liver to the gallbladder (cholangiocarcinoma).
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What are the causes of liver cancer?
Liver cancer may occur due to chronic hepatitis, primarily when it is associated with cirrhosis.
Other causes can be environmental situations with continuous exposure to toxic substances that are metabolized by the liver.
Some patients, such as those with long-standing cirrhosis caused by hepatitis B or C or excessive alcohol consumption, are at higher risk of developing hepatocellular carcinoma.
What are the symptoms of liver cancer?
The symptoms of liver cancer generally occur at an advanced stage and are extremely non-specific (i.e., they can also be found in other conditions) and include tiredness, weight loss, appetite, a yellow coloring of the skin, pain in the right side and to the upper part of the abdomen.
How can liver cancer be detected?
If the doctor finds symptoms that may indicate the presence of a liver tumor, several tests may be prescribed –
- abdominal ultrasound
- computerized tomography
- magnetic resonance
- endoscopic retrograde cholangiopancreatography (ERCP ) and echoendoscopy
- percutaneous transhepatic cholangiography (PTC)
- liver biopsy
- hepatic elastography.
The objectives are twofold – to determine the stage of the tumor and its characteristics (i.e., to understand if it is primary or a metastasis, with the appropriate radiological investigations and, possibly, with a small sample).
Only once the stage and the characteristics of the tumor have been determined will it be possible to plan the therapy.
How can liver cancer be treated?
The treatment of liver cancer is complex and requires the intervention of several specialists. The type of treatment used depends on the quantity and the tumor masses present, their location, the presence or absence of metastases (when the tumor spreads to nearby organs).
It is also essential to evaluate the patient’s general condition and health, especially when it comes to adopting a surgical procedure.
The classification of the hepatocellular carcinoma, decisive for identifying the intervention to be adopted, is the following –
Localized and resectable tumor – Surgery can be performed by removing the part of the liver affected by cancer. In extreme cases (selected with utmost care) it is possible to foresee the total removal of the organ, proceeding with a transplant.
Unresectable localized tumor – Non-resectability may depend on tumor extension. Sometimes the general condition of the patient (and his liver) does not allow to tolerate an operation. In this case, different approaches are used – thermoablation, percutaneous ethanol injection, chemotherapy infusion in the hepatic artery, radioembolization and transplantation. The technique to be used will be evaluated based on the location and size of the tumor.
Advanced tumor – In an advanced stage, the therapy depends on the general condition of the patient. Chemotherapy is not used frequently in hepatocarcinoma. If the patient (and the liver) is in good general health, it is possible to take targeted therapy. In patients with uncompensated cirrhosis or in complex general conditions, the treatments are limited to controlling the most annoying symptoms for the patient.
The treatment cost would depend on the type of treatment chosen as outlined above. Surgery and radiotherapy are all used either alone or in combination. Surgery to remove the tumor is relatively inexpensive. At state-run facilities, the cost rarely goes above INR 50,000 or USD 700 while at private hospitals it might cost INR 2 lakhs or USD 2,800. The cost of chemotherapy depends on the number of cycles and can cost up to INR 2.5 lakhs per cycle or USD 3,500. The number of cycles depends on the decision of the oncologist. The best cancer treatment facilities in India are Tata Memorial Hospital at Mumbai and Kolkata as well as Max Institute of Oncology at Delhi.