Liver Cancer Surgery in India

Symptoms of Liver Cancer:
Most people do not have signs and symptoms in the early stages of primary liver cancer. When symptoms do appear, they may include:

• Losing weight without trying
• Loss of appetite
• Upper abdominal pain
• Nausea and vomiting
• General weakness and fatigue
• An enlarged liver
• Abdominal swelling
• Yellow discoloration of your skin and the whites of your eyes (jaundice)

Types of Liver Cancer:
There are two broad categories of liver cancer: Primary and Secondary

• Primary Liver Cancer
  Primary liver cancer starts in the cells, bile ducts, blood vessels or connective tissue of the liver . There are different types of primary liver cancer that include:
  
  
  1. Hepatoma: This is the most common type. It is sometimes called hepatocellular carcinoma (HCC). This type of cancer originates from a liver cell (hepatocyte) which becomes cancerous. The bulk of the liver is made up from hepatocytes. A hepatoma most commonly develops as a complication of liver diseases such as cirrhosis or types of hepatitis (liver inflammation).
     
     
  2. Fibrolamellar: This hepatoma is a rare sub-type of hepatoma. It typically develops in a liver that was previously healthy.
     
     
  3. Cholangiocarcinoma: This is uncommon. It develops from cells which line the bile duct.
     
     
  4. Hepatoblastoma: This is a very rare cancer that occurs in some young children.
     
     
  5. Angiosarcoma: This is very rare. It develops from cells of blood vessels within the liver.
     
     
     
• Secondary Liver Cancer:
Secondary liver cancer is a cancer that first develops elsewhere in the body and then spreads (metastasizes) to the liver. It is sometimes called metastatic cancer.

When a cancer forms in a part of the body, a few cancer cells may break off and find their way into the bloodstream. Because your liver filters your blood, any cancer cells in the bloodstream have a high chance of settling in the liver to form a cancer nodule (metastasis).

People who are most at risk of secondary liver cancer are those with cancers of the large bowel (colon), pancreas, stomach, lung or breast. It is important to know where the cancer started as this will determine the type of cells which are causing the cancer and affect which treatment is best suited for you.  Secondary cancer diagnosed in the liver may be a sign of cancer in other organs. Sometimes, secondary cancer is found in the liver and yet, even with thorough medical tests, it’s not possible to find out where the cancer started. This is sometimes known as cancer of unknown primary.

Causes of Liver Cancer:
No one knows the exact cause of liver cancer. Doctors can seldom explain why one person gets liver cancer and another person does not. However, research has shown that people with certain risk factors are more likely than others to develop liver cancer.

Diagnosis of Liver Cancer:

• Triphasic Helical CT Scans:  Triphasic CT scans produce images during three different phases of blood flow through your liver, making it easier to detect tumors that have spread into the bile ducts, nearby lymph nodes or other organs.
  
  
• Magnetic Resonance Cholangiopancreatography:  It uses magnetic fields and radio waves to produce detailed images of your liver and bile ducts. This noninvasive test is especially helpful for diagnosing bile duct obstructions and staging liver tumors.
  
  
• Magnetic resonance Elastography (MR Elastography): This helps detect fibrosis — scarring of liver tissue that can lead to cirrhosis, a major risk factor for liver cancer.
  
  
• Ultrasound: This painless, noninvasive test uses sound waves to produce images of your liver. Ultrasound is excellent at providing information about the shape, texture and location of tumors and can help distinguish a cancerous mass from a benign one. It is also used in conjunction with the alpha-fetoprotein test to screen people at high risk of liver cancer, including those with cirrhosis, hepatitis B, hepatitis C or alcoholic fatty liver disease.
  
  
• Endoscopic Ultrasound (EUS): This helps guide the removal of a sampling of cells from the liver and nearby lymph nodes using a thin, hollow needle (fine-needle aspiration). EUS combined with fine-needle aspiration is an effective and minimally invasive alternative to surgical biopsies. It may also help detect metastasized cancers that can't be found using other methods.
  
  
• Cytology: To diagnose cancer in biliary strictures - abnormal narrowing in the common bile duct - and is particularly beneficial for patients with primary sclerosing cholangitis.
  
  
• Blood Test: The test used most often measures the blood level of a substance produced by some tumors called alpha-fetoprotein (AFP). Not all malignant tumors make AFP, however, and certain conditions, including pregnancy, viral hepatitis and some types of cancer can increase AFP levels.

Staging of Liver Cancer:
There are a number of different systems that can be used to stage liver cancer. Many liver cancer specialists use combination-staging systems that include features of both the cancer and liver function to stage a person’s condition.

One combination system for staging liver cancer is known as the Barcelona Clinic Liver Cancer (BCLC) staging system that consists of the following five stages.

• Stage 0 – the tumour is less than 2cm (20mm) in diameter and the person is very well and has normal liver function
  
  
• Stage A – a single tumour has grown but is less than 5cm (50mm) in diameter, or there are three or fewer smaller tumours that are less than 3cm (30mm) in diameter and the person is very well with normal liver function
  
  
• Stage B – there are multiple tumours in the liver, but the person is well and their liver function is unaffected
  
  
• Stage C – any of the above circumstances, but the person is not so well and their liver function is not so good; or where the cancer has started to spread into the main blood vessel of the liver, into nearby lymph nodes or into other parts of the body
  
  
• Stage D – where the liver has lost most of its functioning abilities and the person begins to have symptoms of end-stage liver disease, such as a build-up of fluid inside their abdomen.

Types of Liver Cancer Surgery:
In cases of liver cancer, surgery may be used to treat the disease when the cancer is only in the liver and it has not spread. The following types of surgery may be used to treat liver cancer:

• Liver Resection: The best treatment for cancer that hasn't spread beyond the liver is surgical resection, which removes the part of the liver containing the tumor.
  
  
• Laparoscopic Liver Resection:  Instead of a long abdominal incision, laparoscopic resection requires just three or four small "keyhole" incisions, similar to those routinely used in gallbladder operations. People treated laparoscopically have much less post-operative pain, a shorter hospital stay and a faster return to their normal activities than do patients who undergo traditional open surgery.
  
  
• Partial Hepatectomy: Removal of the part of the liver where the cancer is found. The part removed may be a wedge of tissue, an entire lobe, or a larger portion of the liver, along with some of the healthy tissue around it. The remaining liver tissue takes over the functions of the liver.
  
  
• Total Hepatectomy or Liver Transplantation: In some cases, people with small, early-stage tumors confined to the liver or bile ducts that cannot undergo resection may be considered for a liver transplant. During transplantation, surgeons remove the diseased liver and replace it with a healthy, donated organ.

• Ablative Therapies - These use a needle to deliver substances directly into cancer cells to kill them. Ablation therapy is most effective with smaller tumors but can be used for cancers up to 5 cm. It is usually reserved for situations where the underlying liver disease makes surgery prohibitively dangerous. Methods of ablation include the following:
  
  
• Radiofrequency Ablation - The doctor uses a special probe (using CT scan, MRI or Ultrasound) that contains tiny electrodes to kill the cancer cells with heat. Radiofrequency ablation is a type of hyperthermia therapy.
  
  
• Percutaneous Ethanol Injection - The doctor uses ultrasound to guide a thin needle into the liver tumor. Alcohol (ethanol) is injected directly into the tumor and kills cancer cells. The procedure may be performed once or twice a week.
  
  
• Photodynamic Therapy - PDT is a relatively new technique that aims to destroy cancer cells while minimising damage to normal tissue. The drug is used to attack the nearby cancerous tissue and thus improve the drainage of bile from the liver.
  
  
• Embolization - Hepatic artery embolization is a procedure that cuts off blood flow to liver tumors by injecting small particles into the hepatic artery that supplies tumors with nutrients and oxygen. Hepatic artery embolization is for patients who have inoperable disease.
  
  
• Targeted Therapy - Targeted drugs work differently from standard chemotherapy drugs .They often have different and less severe side effects. These drugs work systemically, which makes them potentially useful against cancers that have spread to distant organs.


• Chemotherapy - Chemotherapy for liver cancer is usually put into the body by inserting a needle into a vein or artery. This type of chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the liver. In another type of chemotherapy called regional chemotherapy, a small pump containing drugs is placed in the body.

Benefits of Liver Cancer Surgery:
Surgery for liver cancer focuses on relieving the symptoms of pain and discomfort, rather than attempting to slow down the progression of the cancer. Many liver cancer patients are diagnosed late and frequently treated only with chemotherapy. The liver cancer patient has the best chance for cure and for longest survival if a surgeon dedicated to the liver cancer patient is involved in the decision making process early on. The team of specialists that work together to make decisions about the best way to proceed with your treatment.

Surgical techniques offer a real chance for cure and should be available to the liver cancer patient. The advantage of using a living donor liver transplant is that the person receiving the transplant can plan the procedure with their medical team and relative, and they will not usually have to wait very long. Chemoembolization has the advantages of exposing the tumor to high concentrations of chemotherapy and confining the agents locally since they are not carried away by the blood stream. At the same time, this technique deprives the tumor of its needed blood supply, which can result in the damage or death of the tumor cells. Other non surgical therapies has its own advantages which can help patient to lead a better life.

Liver Cancer Surgery in India:
Indian hospitals offer the latest advances in Liver cancer surgery. The oncologists work together with clinicians from a variety of specialties to develop a personalized, aggressive treatment plan tailored to one’s needs, including therapies that help you preserve your quality of life.

The hospitals in India use advanced, minimally invasive techniques to detect cancer anywhere in the body. Then a customized treatment plan is developed, and the same diagnostic tools are used to monitor your progress during the liver cancer surgery and treatment. Many hospitals in India have multidisciplinary teams  to treat liver cancer.
Hospitals in India also offer a wide range of complementary therapies to help relieve pain and the side effects of chemotherapy, including yoga, accupuncture, massage therapy, etc. The benefits of these treatments may extend beyond pain relief, helping the patient feel calmer.

Cities in India that offers Lung Cancer Surgery at some of the best and renowned cancer hospitals are as follows;

Cost of Liver Cancer Surgery in India:
India has earned a reputation of being one of the hottest medical tourist destinations in the world. High quality medical care and facilities await those arriving from around the world to benefit from Indian cancer experts, physicians and surgeons. India provides the same quality of medical care with similar technological solutions and a cost saving of over 50%..