Liver Cancer — Hepatologist and Liver Transplant Dr.Pathik Parikh

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The liver is one of the largest internal organs in the body. It is the only internal organ that can regenerate. The liver functions can be broadly divided into following tasks

• To filter toxic substances from the blood
• To help digest food that by bile formation.
• To store vitamins and fat which can be utilised during starving
• To produce proteins, sugars and substances used for clotting

Types of Primary Liver Cancer:

The two most common types of primary liver cancers are –

• Hepatocellular carcinoma — Most common; 3rd leading cause of death worldwide
• Cholangiocarcinoma

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Risk factors for liver cancer:

• Chronic Viral hepatitis B and C
• Fatty Liver
• Cirrhosis due to any cause
• Toxic substance — Alcohol or aflatoxins
• Some rare disease –
• Hereditary hemochromatosis
• Alpha-1 antitrypsin deficiency
• Glycogen storage disease
• Porphyria cutanea tarda
• Wilson disease

Hepatitis B is the most common cause of liver cancer in India. Hepatitis B, Hepatitis C and Fatty Liver disease can cause liver cancer even without development of cirrhosis. So it is very difficult to pick them up at early stage.

Clinical Features:

• Discomfort on the right side just below the chest (ribcage)
• Occasional — Patient may feel a lump
• Fluid may get accumulated in stomach — Swollen abdomen
• Jaundice
• Fatigability
• Decreased appetite
• Decreased weight
• Nausea and Vomiting
• Fever

Most often, patient may be asymptomatic and can present only when an ultrasound (sonography) is done for other reasons.

Investigations:

1. USG Abdomen — Sonography
2. CT scan/MRI of liver
3. Alpha Fetoprotein
4. Routine Blood Investigations
5. CT Scan of Chest/Bone Scan/PET scan

Biopsy is often required if the diagnosis is in doubt after above investigations.

Staging

Like all the tumours, liver cancer also requires staging for treatment planning. The staging system used is Barcelona Clinic Liver Cancer (BCLC) staging system or Hong Kong Liver Cancer (HKLC) staging system. These two are most often used although many more systems have been tried.

The BCLC staging system has five stages:

• Stage 0: Very early
• Stage A: Early
• Stage B: Intermediate
• Stage C: Advanced
• Stage D: End-stage

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Treatment

There are different types of treatment for patients with liver cancer. Patients with liver cancer are treated by a team of specialists who are experts in treating liver cancer. Usually, the treatment decisions are taken by multidisciplinary teams. The team includes Hepatologist (specialist in liver disease), Cancer surgeon, Transplant surgeon, Radiation oncologist, medical oncologist and even Interventional radiologist. The treatment is not just chemotherapy but has many curative options.

• Eight types of standard treatment are used
• Surveillance
• Surgery
• Liver transplant
• Ablation therapy
• Embolization therapy
• Targeted therapy
• Immunotherapy
• Radiation therapy

The latest 2022 guidelines for treatment with treatment options and prognosis is mentioned below.

(Courtesy Journal of Hepatology Nov 2021)

To know more about treatment options and liver cancer, kindly contact your liver specialist, hepatologist

Dr Pathik Parikh
Liver Specialist / hepatologist in Ahmedabad
Contact no.: +91 86521 19730