Liver Cancer (Hepatocellular Carcinoma)
In this article, we have covered the following:
- Best Hospitals in India for Treatment of Liver Cancer
- Top Oncologists expertised in Liver Cancer Treatment
- Cost of Liver Cancer Treatment
- Understanding liver cancer
- Treatment of Liver Cancer- Medical Management, Surgery, Chemo, Cyberknife etc
Best Doctors and Hospitals in India for Treatment of Liver Cancer
Following is a list of the most reputed specialists in India for the treatment of Liver Cancer.
Please click the ‘contact doctor‘ button on the right side for seeking opinion or requesting an appointment with your chosen specialist.
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|Doctor Image||Dr. Name||Specialty||Hospital Associated||Contact Doctor||City|
|Dr. Vinod Raina||Medical Oncologist||Fortis Memorial Research Institute||Gurgaon|
|Dr. Ashok Kumar Vaid||Medical Oncologist||Medanta - The Medicity||Gurgaon|
|Dr. Rakesh Chopra||Medical Oncologist||Artemis Hospital||Gurgaon|
|Dr Rajasundaram||Medical Oncologist||Global Hospitals||Chennai|
|Dr Bellarmine Vincent Lawrence||Medical Oncologist||Global Hospitals||Chennai|
|Dr. Niti Raizada Narang||Medical Oncologist||Fortis Hospital||Bangalore|
|Dr. Boman Nariman Dhabhar||Medical Oncologist||Wockhardt Hospitals||Mumbai|
|Dr. Amit Agarwal||Medical Oncologist||BLK Super Specialty Hospital||Delhi|
Cost of Liver Cancer Treatment
Unfortunately, we are not able to share the cost of this treatment as we are still awaiting response from few hospitals before publishing the cost. However, you may share your medical reports and we will share the cost of treatment from the hospital recommended for you.
Understanding Liver Cancer
Simply speaking, liver cancer also known as hepatic cancer is the abnormal growth of cells in the liver. It is of three types:
- Hepatocellular carcinoma (HCC) –Most common type, abnormal growth in the liver cells, two types – primary (starts in the liver) and secondary liver cancer (starting somewhere else in body and spreads to liver)
- Cholangiocarcinoma – also called bile duct cancer, starts in bile ducts of liver, very rare
- Angiosarcoma – starts in the blood vessels of the liver, grows very quickly, very rare type
Here we will deal with Hepatocellular carcinoma (HCC), the most common type of liver cancer, as about 90% of the liver cancer diagnosed are of this type.
Few Key Points about Hepatoellular Carcinoma
- Primary malignancy of hepatocytes
- Frequently seen in cirrhotic patients
- Uncommon, comprising only 2% of all malignancies
- Worldwide incidence of hepatocellular carcinoma varies according to the prevalence of hepatitis B and C infections
- Median survival from time of diagnosis is approximate 6 months. Length of survival depend on extent of cirrhosis. Portal vein occlusion in addition to cirrhosis further lowers the survival
- Common among Asian population,common in men than in women
Causes of Liver Cancer
- Cirrhosis liver(80% )
- Hepatitis C
- Hepatitis B
- Aflatoxin(byproduct of fungus)
- Other rare conditions like primary biliary cirrhosis,steroids,cholangitis etc
Symptoms of Liver Cancer
Unfortunately, there are no specific early symptoms of liver cancer. It is mostly diagnosed in its later stages. If you have above risk factors, a screening is advisable for early detection or to rule out the disease. Some common later stage symptoms may be:
- Pruritus(itching of skin)
- Spleen enlargment
- Variceal bleeding
- Cachexia(significant loss of weight)
- Increasing abdominal girth (portal vein occlusion by thrombus with rapid development of ascites)
- Hepatic encephalopathy(altered level of consciousness due to liver failure)
Physical findings are as follows:
- Pedal edema
- Visible Periumbilical collateral veins
- Enlarged hemorrhoidal veins
- Liver function tests
- Prothrombin time with INR
- Alpha feto protein
- DES-gamma-carboxy prothrombin (DCP)-it is a marker for early diagnosis of HCC
- USG whole abdomen
- CT Scan
- Routine use of PET scan for diagnosis or staging of hepatocellular carcinoma is not recommended
Biopsy is frequently necessary in order to make the diagnosis. In general, tissue biopsy is favored over fine needle aspiration cytology since larger amounts of tissue, often with normal surrounding parenchyma, can be obtained.
Treatment depends on -:
- Size of tumor
- Number of tumors
- Location of tumor
- Presence or absence of cirrhosis
- Operative risk based on extent of cirrhosis along with comorbid diseases
- Overall performance status
- Patency of portal vein
- Presence or absence of metastatic disease.
Before starting definitive therapy, Primarily the complications of cirrhosis are treated with diuretics, paracentesis for ascites, lactulose for encephalopathy, pruritus treatment, sclerosis/banding for variceal bleeding, and antibiotics for spontaneous bacterial peritonitis.
Other local therapies
- Ethanol ablation
- Radiofrequency ablation(RFA)
- Radiotherapy .
Patients whose disease is localised following chemoembolization may be eligible for transplantation
Chemotherapy as treatment may be used for advanced disease
To achieve better tumor response rates combination of chemotherapy and immunomodulatory agents are used.
Encouraging results in patients with certain types of cancers such as renal cell carcinoma and melanoma are seen using Immunotherapy
It work by disrupting the formation of blood vessels that feed tumors, they are a new class of drugs.
Tyrosine kinase inhibitors
A multitargeted oral kinase inhibitor’s, has recently been shown in a various trials to prolong survival in patients
Surgical resection and liver transplantation are definitive treatment but are considered to have certain limitation
- Tumor size and liver function are the main prognostic factors for resectability
- Right hepatectomy -In general, solitary lesions localized to liver without vascular invasion with well-preserved liver function have the best outcomes
- Many patients are not candidates for partial hepatectomy due to extent of underlying liver disease
- Some patients are good candidates for liver transplantation since it has the potential for eliminating the malignancy as well as treating the underlying liver disease
Locally ablative therapy
Intratumor injections of ethanol or acetic acid, heat (via radiofrequency, microwave, or laser ablation), or cold (cryoablation with liquid nitrogen) are used to locally control tumors smaller than 4-5 cm. it is performed percutaneously . In general, these procedures are reserved for patients who do not meet criteria for surgical resection yet are candidates for a liver-directed procedure due to localized liver disease.
It is a new technology that is a combination of robotics and image guidance to deliver highly focused concentrated beam of radiation to the tumor with minimal radiation exposure to the surrounding healthy liver tissue.
CyberKnife stereotactic radiosurgery is a promising new treatment tool for localized hepatocellular carcinoma lesions. its availability is limited to a few tertiary care hospitals.
Chemoembolization is the delivery of high concentrations of chemotherapeutic agents directly to the tumor via the hepatic artery. The remaining liver may be spared because it can rely on the portal vein for its blood supply.
Radioembolization (or selective internal radiotherapy) uses 32-μm glass microspheres to carry yttrium-90 radioactive nuclide intra-arterially into the capillary beds of the tumor. This technique can cause excellent necrosis and tumor responses. This procedure may be considered for patients with portal vein thrombosis
Note (for foreign patients):
Besides South Asian countries (Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, Pakistan, Sri Lanka), every year, India gets thousands of medical tourists from African countries- Nigeria, Kenya, Ethiopia, Sudan, Uganda, Ghana, Somalia,Gambia etc and Middle Eastern countries like Iraq, Iran, Saudi Arabia, Oman, UAE, Yemen etc. Hence, if you are a citizen of any of these countries, there is good likelihood that you will be meeting some fellow citizens or same language speakers in the major hospitals in India. Almost all the top hospitals have translators for people of these region. Our patient support team is also well placed to assist you.