The cancers which start in the liver are classified as Primary liver cancers. The most common primary liver cancer is Hepatocellular carcinoma or HCC. The cancers which spread to liver after starting at a distant location are called secondary liver cancers.
Hepatocellular Carcinoma (HCC) is 5th most common cancer worldwide and 3rd leading cause of death. It has a high prevalence in Asian Countries and it is seen to be more aggressive as compared to west.
Most patients will have no symptoms pertaining to HCC. They may present with symptoms related to underlying cirrhosis or non-specific complaints of loss of appetite, weight loss, weakness etc. The patient may have symptoms related to decompensated chronic liver disease as: jaundice, ascites, etc.
The diagnosis of HCC is established by conducting blood tests and imaging studies.
Blood Tests: The blood tests not only help in establishing presence of liver cirrhosis (chronic liver disease) but also in identifying the reason of cirrhosis. Blood tests reveal if a person has viral hepatitis, which is a risk factor for HCC. Tumor markers are blood tests which are markers for presence of cancer. For HCC, Alpha-fetoprotein (AFP) is a tumor marker which may or may not be elevated.
Ultrasound (sonography), a procedure that transmits high-frequency sound waves through the body. It is generally the first screening tool for diagnosis of cirrhosis and any mass in liver.
Computed tomography (CT scan): A triple phase CT helps to establish the diagnosis of HCC in majority of individuals.
Magnetic resonance imaging (MRI): A contrast enhanced MRI can be utilized and tool to establish the diagnosis in cases which are equivocal on CT or otherwise.
Biopsy: A liver biopsy is generally not required and rather should be avoided to establish the diagnosis of HCC. The imaging studies are sufficient to establish the diagnosis. Biopsy should be resorted in select set of patients whose diagnosis is not clear on imaging. Most often it can be performed percutaneously under CT or ultrasound guidance. The risks of biopsy include tumor seeding along biopsy tract and bleeding.
HCC may be treated using one or more of three methods:
Interventional Radiology based ablative therapy: Radiofrequency ablation, TACE/ TARE are ablative treatment options available. The option has become very popular as initial therapy or in some cases the only treatment. The treatment is done without surgery using CT / Ultrasound guidance and conventional angiography to ablate the tumours.
Partial hepatectomy: This involves removal of tumor and a part of the normal liver, ranging from a smaller wedge to an entire lobe. This is performed only is selected patient who have preserved liver function (Childs A) and appropriate percentage of remaining liver post resection. This carries risk of decompensation of stable liver disease if above criteria are not met.
Total hepatectomy and liver transplant: This involves removing the whole liver and either transplanting a complete liver, as in deceased donor liver transplant or a partial liver (as in Living donor liver transplant). It is rated as best treatment modality for early cancer. There is a lot of medical evidence which has proved the superiority of transplant over other modalities.
Downstaging protocol followed by Liver transplant: This may be an option in select patient who have advanced HCC and cannot be offered transplant upfront.
The early cancers have very good prognosis. With the advancement of imaging we have been able to catch smaller cancers much earlier so that they can be treated in a timely fashion. The success varies as per modality utilized. Liver transplant offers offers > 90% success rate in terms of graft survival and over 80% chance of 5 year cancer free survival.
You are welcome to meet our patients who are cancer survivors and underwent Liver transplant for HCC under the care of Dr. Dhir.
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