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Overview

The liver continuously filters blood that circulates through the body, converting nutrients and drugs absorbed from the digestive tract into ready-to-use chemicals. The liver can be affected by primary liver cancer, which arises in the liver, or by cancer which forms in other parts of the body and then spreads to the liver.

Warning signs

  • Nausea & Vomiting
  • Abdominal bloating
  • Loss of appetite
  • Weakness & fatigue

Some other symptoms are swelling of abdomen (fluid in abdomen), upper abdominal pain, itching, passing white coloured stools, etc.

Risk factors

  • Men are more likely to get hepatocellular carcinoma than women
  • Obesity can increase the risk for hepatocellularcarcinoma
  • Studies have suggested a link between diabetes and liver cancer. This is likely due to the link between diabetes and fatty liver disease
  • Diseases that disrupt the normal metabolism of the body have been shown to increase your risk of liver cancer
  • Long-term alcohol use has been linked to an increased risk of liver cancer. Regular, heavy alcohol use can damage the liver, leading to inflammation. This, in turn, might raise the risk of liver cancer
  • Studies have found a link between liver cancer and some rare diseases like alpha -1-antitrypsin deficiency, tyrosinemia, and Wilson's disease, haemochromatosis
  • Patients with known cirrhosis, chronic liver disease (Hepatitis B/C, ETOH related), chronic infection HBV, HCV
  • Exposure to Aflatoxins

Progression

Primary liver tumour

May develop new symptoms like jaundice and mass or fluid tummy from solitary to multiple, from one side to another side, or diffuse involvement of entire liver. It spreads to lungs, bones, blood vessels and lymph nodes.

Secondary (Metastatic) tumour

Generally Stage IV tumours can involve the liver. Site of origin could be GI tract or other organ (lung, thyroid, breast, biliary tract, and pancreas). Patient with chronic liver disease should undergo screening to detect tumour at an early stage.

Diagnosis

Primary diagnosis

Physical examination and medical history, blood tests

Advanced diagnosis

Imaging tests, removing a sample of liver tissue for test, ultrasound, CT scan, angiography, bone scan, MRI, laparoscopy and biopsy (only for inoperable cases or before adjuvant, new adjuvant CT chemotherapy), PET scan. Tumour markers (AFP, CEA, CAIG-G), Endoscopy (UGI and Lower GI) to rule out metastasis

Treatment in a nutshell

Surgery

If the cancer is small, has not spread outside the liver and the rest of the liver is healthy, Hepatectomy is a possibility. A liver transplant is another option but only suitable for a small number of cases.

Treatments options

Thermal ablation, Percutaneous ethanol injection, Cryosurgery, Immunotherapy, radioembolization etc.

For tumours / inoperable tumours

Ablative therapy

In India, out of 25,000 patients with liver failure, only 1,100 patients undergo liver transplant. Of this, only 5 per cent is performed in Western India due to the lack of a comprehensive facility. To bridge this gap, Kokilaben Dhirubhai Ambani Hospital has started a comprehensive liver transplant programme, transplanting livers both from living donors and cadavers. It is the first-of-its-kind, state-of-the-art comprehensive liver transplant centre in Western India.

Primary liver tumour

Continued to liver, surgical removal (liver resection). In the presence of chronic liver diseases, they are best treated by liver transplant.

Secondary tumours (metastasis)

Best treated by surgery if liver is only site of spread. In selected cases, surgery offered, best outcomes in others (radiotherapy and chemotherapy can be offered).

Patients with multiple tumours (primary/secondary) are offered conserved modality in the form of surgery with Ablative therapy.

Milestones

11 per cent of liver transplant patients were operated for primary liver tumour.For massive tumour involving portion of liver, staged hepatectomy is being offered as a curative option.

Top tips

  • Avoiding tobacco—or deciding to stop using it—is one of the most important health decisions you can make
  • Base your diet on fruits, vegetables and other foods from plant sources — such as whole grains and beans
  • Eat lighter and leaner by choosing fewer high-calorie foods, including refined sugars and fat from animal sources
  • If you choose to drink alcohol, do so only in moderation
  • Avoid exposure to the hepatitis B and C viruses. Vaccines for hepatitis B are commonly available for children and adults. If you are at risk for hepatitis B or C infection, consider undergoing a screening test
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