Liver Cancer

 

Question. How did I develop liver cancer?

Answer.  Liver cancer includes hepatocellular carcinoma as well as bile duct carcinoma. There are many risk factors for liver cancer such as cirrhosis  (fibrosis of liver due to any reason), poisonous mushroom consumption, cigarette smoking, hepatitis B and C infection . If you have any of these risk factors present then chances of liver cancer increases, however a significant proportion of patients can develop liver cancer in the absence of these factors too.

There is another set of liver tumors which are common in  childhood, those will not be discussed here because the management is totally different and a good prognosis is expected despite advanced disease.

 

Question. What are the signs and symptoms of liver cancer?

Answer.  Fullness on the right side of the Rib cage and  upper abdomen, distension of abdomen, jaundice, discoloration of eyes, bleeding with or without injury, loss of appetite with nausea and vomiting, weight loss and dark urine. Sometimes liver tumors can cause unexplained fever because of release of cytokines.

Question.  What are the tests which I should do for diagnosis of liver cancer?

Answer.  Important is to undergo physical examination by trained hands. Serum tumor marker Alpha fetoprotein is often used as a screening tool. Other blood tests include liver function tests and coagulation profile. Radiological tests are also important like  triple phase CT scan of thorax, abdomen, pelvis and ultimately a biopsy may be required if triple phase CT is inconclusive.

Question.  How is the Staging of liver cancer different from other cancers?

Answer.  Staging in other cancers are independent of the patient and depends on the size and local extent of the tumour. However for liver cancer it is Barcelona Staging which is dependent on multiple factors, including the fitness of the patient and functional status of the liver. Since the liver is responsible for detoxification and production of coagulation pathway proteins in the body, these are also included in the  Barcelona Staging.

Obviously the treatment is also dependent on stage.

Also unlike other cancers barcelona staging is noted down as 0,A,B,C,D,E. Most other cancers are staged as 1,2,3,4.

Question.  Tell me something about treatment of liver cancer?

Answer.  For early stages that is stage 0, A and B only local treatment is enough. Local treatment is surgical removal of the primary tumor only. Liver transplantation also can be offered at this point of time. If surgical removal is not possible then we can go for radiofrequency ablation, cryoablation or percutaneous ethanol injection directly into the tumor.

For advanced disease that is Barcelona stage C and D we need to do TAC (transarterial chemoembolization) or we can offer targeted therapies like sorafenib or lenvatinib.

Immunotherapy has been proven useful in recurrent liver cancer.

-------------------------------

                                                                                         Gallbladder cancer

Question.  Is gallbladder cancer more common in certain areas of India?

Answer.  Strangely yes, gallbladder cancer is more common in basin of Ganga which includes Uttar Pradesh and parts of Madhya Pradesh.

Question. Treatment options for gallbladder cancer?

Answer.  Treatment of gallbladder cancer depends on if it is localised or it is unresectable.

For localised tumor we do a surgery with removal of the gallbladder and some tissues around it along with lymph nodes around the gallbladder. After surgery radiation or chemotherapy is offered depending on the surgery.

For unresectable gallbladder cancers we can do stenting to open up the bile ducts if jaundice is present.  If jaundice is not present then we can give chemotherapy to control the rate at which it is growing.