Liver Cancer Treatment in Gurgaon India

Onco experts is a premier provider of best liver cancer treatment in Gurgaon. Contact our experienced and friendly doctors/specialist to find out more about our cancer treatment services in Gurgaon. Liver cancer (and intrahepatic bile duct cancer) is assessed to be the fifth most frequently diagnosed cancer and second leading cause of cancer-related deaths, worldwide. Majority of the incidences and deaths from the disease are observed in less developed countries of the globe. The disease is relatively less common in the United States (US) accounting for about 2.4% of all new cancer cases and about 5.0% of all cancer-related deaths. The overall incidence and mortality rate of liver cancer has been increasing during the last few decades, which is postulated to be due to the increasing incidence of hepatitis B and hepatitis C infections during this time. Liver cancer is more common among men than women and mostly occur at an age of 55 to 64 years.  

The liver is the largest glandular organ in human body weighing about 1.4 kilograms in a healthy adult. It sits below the diaphragm and beneath the right ribs in the abdominal cavity. It is divided into two lobes by the falciform ligament, with right lobe being larger than the left one. Major functional cells of the liver are known as hepatocytes (specialized epithelial cells). It receives blood from two main sources – oxygenated blood from the hepatic artery and deoxygenated blood containing absorbed nutrients (and other substances) from the hepatic portal vein. Liver performs many functions that include: secretion of bile (that help in digestion of fat); metabolism of carbohydrate, lipid, protein, and many drugs; excretion of bilirubin; storage of vitamins and minerals; phagocytosis; removal of worn out WBCs and RBCs; and activation of vitamin D. 

Hepatocellular carcinoma (HCC) (affecting hepatocytes) is the most commonly encountered (about 90% of the cases) liver cancer. Intrahepatic cholangiocarcinoma (bile duct cancer) is also generally grouped with liver cancer, which affects cells lining the bile ducts (tubes that carry bile secreted by hepatocytes to the gallbladder and to the intestine) within the liver. Angiosarcoma, hemangiosarcoma (affecting cells lining the blood vessels of the liver), and Hepatoblastoma (that usually occur at younger age wherein cells resemble fetal liver cells) are some less common type of liver cancers. 

How do I know if I am at risk for Liver Cancer? What are the causes of Liver Cancer?

Several epidemiological studies have revealed a number of risk factors that can predispose liver cancer. Following is the list of such risk factors, if you have one or more of the following, you may be at risk.

Hepatitis B/C infection

Chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) is the well-recognized major risk factor for the liver cancer development. HBV is responsible for high incidences of liver cancer in Asia and Africa, while HCV is responsible for the high incidences of the disease in Europe, Japan, and North America. Alcohol intake may act synergistically with these infections and can further increase the risk of developing liver cancer.

Liver cirrhosis

Patients with liver cirrhosis remain at high risk of developing liver cancer. The cirrhosis may result from any of the following cause: excessive alcohol intake, chronic liver injury, inherited error of metabolism (for example, hemochromatosis – a condition characterized by increased absorption of iron due to mutation in HFE gene), Wilson’s disease, schistosomiasis (infection caused by a blood fluke), or alpha-1 anti-trypsin deficiency. All these disorders have been reported to be the independent risk factor for liver cancer development.

Metabolic Disorders

Many studies have suggested that presence of certain metabolic disorders like obesity, diabetes, impaired glucose metabolism, and non-alcoholic fatty liver are associated with increased risk of developing liver cancer.

Environmental Exposure

Exposure to aflatoxin (produced by Aspergillus fungus that commonly contaminates peanuts, wheat, soybeans, groundnuts, corn, and rice), arsenic or microcystin in drinking water, vinyl chloride, and thorium dioxide have also been reported to increase the risk of liver cancer development.

Anabolic Steroids

Individuals with prolonged use of anabolic steroid are generally at higher risk of developing liver cancer.

Male gender

Liver cancer is about 2 to 3 times more common in men compared to women, worldwide. This disparity is postulated to be related to the differential effect of androgen on the hepatocytes.

Ethnicity

According to different epidemiological studies, incidences of liver cancer are highest in Asians followed by African Americans and then Caucasians.

Chronic cigarette/tobacco smoking and prolonged use of oral contraceptives are some less important risk factor for the development of liver cancer.

What are the Symptoms and Signs of Liver Cancer? How do I know if I have Liver Cancer or not?

Following are some common signs and symptoms of liver cancer:

• Fever or malaise
• Unexplained weight loss
• Abdominal pain
• Loss of appetite or early satiety
• Nausea and vomiting
• Liver or spleen enlargement
• Abdominal ascites
• Jaundice and skin itching

What are the Tests or Investigations to be done to confirm the diagnosis of Liver Cancer?

If a person is suspected to have liver cancer due to the presence of signs and symptoms, some investigations are required to confirm the diagnosis of the disease. Further, these investigations can help in determining the extent of locoregional invasion or spread of the disease to other body parts, which in turn help in choosing an appropriate treatment option. Following are some commonly used diagnostic tools for liver cancer:

Ultrasound

This is a test recommended to be used for screening of high-risk individuals. In this technique, a transducer is used which directs very high-frequency sound waves towards the tissue to be examined. The sound waves are reflected off the internal structures depending on their ability to reflect these waves. The reflected sound waves are collected by a special detector (fixed near the transducer) to produce a real-time image of the internal tissues on a computer screen. This helps the doctor to examine the liver tissue for any abnormality. This test can detect solid tumor masses (cancerous) within the liver of high-risk patients, which can be further evaluated with the help of other diagnostic tools. This technique can sometimes be used to guide a biopsy needle to collect biopsy samples from the affected area to establish the diagnosis of liver cancer. 

Blood Tests

Blood tests cannot confirm liver cancer themselves but these tests can provide certain important information that can provide direction to the diagnostic workup of liver cancer. Following are commonly employed blood test for this purpose:

Alpha-fetoprotein (AFP)

This is another test recommended to be used for screening of high-risk individuals. AFP is glycoprotein generally produced by the immature liver cells of a fetus. The level of AFP decreases significantly after birth and approaches to normal by 1 year of birth. Abnormally high level of AFP in adults is usually associated with liver disease, liver cancer, or some other conditions. Thus, in the high-risk individual abnormally high level of AFP may signal the development of liver cancer.

Monitoring of AFP level can be helpful in assessing the efficacy of the treatment/surgery (that should bring down the AFP level in patients with high AFP levels detected before treatment start) and to assess disease progression/recurrence.

Liver function tests (LFTs)

These are a group of blood tests which give an estimate of overall liver functionality as a function of the blood levels of certain substances. These tests include prothrombin time (PT), albumin, bilirubin (direct and indirect), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and others. These tests are employed for the assessment of suitability for liver resection.

Imaging Tests

These tests are generally employed after the establishment of the pathological diagnosis. They help to detect the spread of disease to distant body parts and assess the stage of the disease so that an appropriate treatment option can be selected. Alternatively, these tests are employed after treatment to evaluate the treatment efficacy and to detect disease response, progression, or recurrence.

Computed tomography (CT) scan

In this technique, detailed cross-sectional images of body organs are generated using x-rays, with or without a contrast medium. It can help diagnose the spread of disease to nearby/distant lymph nodes and other organs, and may also be used to guide a biopsy needle into the affected area. Triple phase CT scan is used if there is a suspicion of hepatocellular cancer. Contrast enhancement in the arterial phase and washout in the delayed venous phase may be suggestive of hepatocellular cancer.

Magnetic resonance imaging (MRI) scan

This technique provides detailed images of tissues inside the body using radio waves, strong magnetic field, and gadolinium contrast. It can accurately diagnose the extent of invasion and spread of disease to nearby/distant body parts.

Positron emission tomography (PET) scan

This technique uses a radioactive substance (e.g.fluorodeoxyglucose [FDG]) that is given intravenously prior to the procedure. Cancer cells absorb larger amounts of the radioactive substance than normal cells. The areas of higher radioactivity indicate cancerous tissue on the PET scan. Thus, this technique can diagnose spread of disease to distant body parts. It is usually combined with CT scan (PET/CT)

Bone Scan

This test is performed for patients with symptoms suggesting the spread of disease to bones, for example, pain in bones and an elevated serum level of alkaline phosphatase. In this test, a radioactive material is first injected into the vein of the patient, which gets accumulated in the areas of bones affected by the disease and such areas are then detected with the help of radioactivity detectors.

Biopsy

Biopsy samples contain a small number of cells or a tiny piece of tissue collected from the affected area with the help of a biopsy needle or other biopsy instrument. These samples provide very useful information about the cancer cells such as the type of cancer, the severity of cancerous changes involved, and the presence of specific defective genes or proteins. Biopsy is not always required in hepatocellular cancer, as in some cases imaging and tumor markers may be sufficient for diagnosis.

How do I know my Stage of Liver Cancer?

Staging helps to determine the disease prognosis, and to select an appropriate treatment strategy. TNM is the most commonly used system for staging liver cancers in the US. “T” stands for “Tumor Size”, “N” for “Lymph Nodes”, and “M” for “Metastasis”. Numbers and/or letters after T (1a, 1b, 2, 3, and 4), N (0 and 1), and M (0 and 1) provide more details about each of these factors. Higher the number means higher the severity of the disease. Once T, N, and M categories are determined, this information is combined to assign an overall stage (from I to IV).

Stage IA - T1a N0 M0

A solitary tumor in the liver that measures </=2 cm in largest dimension and has not invaded any blood vessel. No spread of disease to nearby lymph nodes or distant body parts.

Stage IB - T1a N0 M0

A solitary tumor in the liver that measures >2 cm and has not invaded any blood vessel. No spread of disease to nearby lymph nodes or distant body parts.

Stage II - T2 N0 M0

A solitary tumor in the liver that measures >2 cm and has invaded a blood vessel OR multiple tumors but none measuring >5 cm. No spread of disease to nearby lymph nodes or distant body parts.

Stage IIIA - T3 N0 M0

Multiple tumors in the liver with at least one measuring >5 cm. No spread of disease to nearby lymph nodes or distant body parts.

Stage IIIB - T4 N0 M0

A solitary tumor or multiple tumors in the liver of any size with at least one tumor invading a large blood vessel (for example, portal or hepatic vein) or any adjacent organ except gallbladder or perforation of visceral peritoneum. No spread of disease to nearby lymph nodes or distant body parts.

Stage IVA - Any T N1 M0

A solitary tumor or multiple tumors of any size in the liver with or without invasion into a large blood vessel but with the spread of disease to nearby lymph nodes. No spread of disease to distant body parts.

Stage IVB -  Any T Any N M1

A solitary tumor or multiple tumors in the liver of any size with or without invasion into a large blood vessel and the disease might or might not has spread to nearby lymph nodes. The disease has spread to distant body parts such as lungs or bones.

Child-Pugh Score

Liver cancer doctor in gurgaon: Child-Pugh Score is used to assess liver function (or liver cirrhosis) in liver cancer patients. Most patients with liver cancer have accompanying liver cirrhosis or other liver disorder due to which liver function is generally diminished in such patients. An assessment of liver function help in selecting an appropriate treatment approach for liver cancer. The Child-Pugh scoring system is most commonly used for this purpose, which takes into consideration following 5 parameters: bilirubin level in blood, albumin level in blood, prothrombin time, presence or absence of ascites, and whether the liver disease is affecting brain function. Based on the status of above parameters liver cirrhosis/functioning is divided into 3 classes, that is, Class A, B, and C, where C represents the worse liver function. However, this system does not take into consideration any parameter of liver cancer itself. Thus, this system is used along with the TNM staging system for the assessment of overall disease.

Okuda staging system

This was the first validated system used for staging of liver cancer, which takes into consideration both cancer parameters and liver function parameters. Many other staging systems have been developed and used for staging of liver cancer that accommodated different parameters related to liver cancer and liver function. Examples for such systems include Cancer of the Liver Italian Program (CLIP) scoring system, Barcelona Clinic Liver Cancer (BCLC) system, Chinese University Prognostic Index (CUPI) scoring system, the Groupe d’Etude et de Traitement du Carcinoma Hepatocellulaire (GETCH) staging system, and the Japan Integrated Staging (JIS) system. These staging systems have their own advantages and disadvantages and are used in different geographical regions as per physician’s preference and local practice.

What is the Treatment for Liver Cancer? Where can I get the best treatment for Liver Cancer in Gurgaon?

The treatment of liver cancer depends on many factors including but not limited to the type of liver cancer, stage of the disease, liver function, performance status of the patient, along with other factors.

Oncoexperts is a best liver cancer treatment clinic in Gurgaon sec 46 for treatment for Liver cancer from our team of cancer experts that include surgical oncologists, medical oncologists, and radiation oncologists who are experts in treating all types of testicular cancer in Gurgaon.

Following are the treatment options for hepatocellular carcinoma of liver, but the final decision is taken by the oncologist on an individual patient basis.

Treatment Based on resectability

Potentially resectable or transplantable cancer

This category includes TNM stage I and II liver cancers that can be completely removed with surgery or treated with liver transplant and patient is healthy enough (sufficient liver function) to tolerate the surgical treatment.

In patients with potentially resectable liver cancer and adequate liver function, Surgery (partial hepatectomy) is considered the preferred treatment approach. For patients who are the candidates for liver transplantation, treatments like ablation or embolization are employed until as a bridge for transplantation.

Unresectable cancer

This category includes TNM stage III liver cancers that cannot be completely removed with surgery as they have invaded important blood vessels or other structures. The patient may or may not have sufficient liver function.

In patients with some advanced stage cancer that are considered unresectable due to invasion into blood vessels or large tumor size, treatments like ablation and/or embolization are generally preferred, depending on the location and the extent of invasion. Targeted therapy or chemotherapy may also be employed.

Inoperable with only local disease

This category includes TNM stage I and II liver cancers that have not invaded important structures but the patient is not healthy enough (liver function is significantly compromised or poor performance status) to tolerate surgery.

In some cases, the tumor is limited to a part of the liver (which can be removed with surgery) but patients cannot have surgery due to poor liver function or performance status. Thus, treatments like ablation or embolization are usually employed in such cases. Targeted therapy or chemotherapy may also be considered.

Advanced (metastatic) cancer

This category includes TNM stage IV liver cancers that have spread to distant body parts and cannot be surgically removed. The patient may or may not have sufficient liver function.

For patients with advanced liver cancer that has spread to distant body parts, targeted therapy or chemotherapy are generally considered. 

Role of Surgery

Surgery provides significantly longer survival and is considered as the treatment of choice for most early-stage liver cancers. Sometimes, surgery is employed to relieve symptoms of advanced stage disease like bleeding and pain. The following types of surgery may be used for the treatment of Liver cancer: 

Partial hepatectomy

In this surgery, only the liver tissue containing cancer and some of the nearby tissue is removed leaving the rest of the liver in place. This is generally preferred in case of early-stage disease where the tumor is limited to a part of the liver (not affecting major blood vessels) and when liver function is adequate. 

Liver transplant

Liver cancer surgeon in gurgaon: In this surgical procedure, the entire liver is removed and replaced by a liver donated by some other individual. This is generally used to treat patients with small tumors (either 1 tumor smaller than 5 cm across or 2 to 3 tumors no larger than 3 cm) that have not invaded nearby major blood vessels, with poor liver function. However, a patient who is a good candidate for transplantation may have to wait until availability of the donated liver, which may take too long. Thus, these patients generally receive other treatment(s) during this time to keep the liver cancer in check.  

Role of Ablation

Ablation is a technique in which tumors are destroyed without actual removal from the body. This technique is generally used for patients with small tumors (usually <3 cm) when surgery is not an option due to location of the tumor, poor performance status of the patient, etc. Ablation can destroy cancer cells along with some of the nearby tissue, and hence, it is not used for the treatment of tumors invading blood vessel or important structures. High-energy radio waves are utilized in radiofrequency ablation (RFA), microwaves are used in microwave ablation (MWA) technique, while very cold gases are used in cryoablation to destroy tumors. Imaging techniques are utilized along with these ablation techniques to accurately locate the target tumors. 

Role of Embolization

In this technique liver cancer is destroyed by blocking the blood supply to the cancer cells with the help of some inert tiny particles (particles are loaded with drugs in chemo-embolization and with a radioactive substance in radio-embolization) that are injected directly in the artery supplying blood to cancer cells. This technique is generally employed in patients who cannot undergo surgery and in those waiting for liver transplantation. Embolization can be employed for large tumors (>5 cm) and can also be used in conjunction with ablation. 

Best Liver Cancer Specialist in Gurgaon

Dr Sunny Garg is a renowned Medical Oncologist in Gurgaon with an experience of more than 10 years of treating liver cancer patients. He has treated liver cancer patients with Chemotherapy, Targeted Therapy and Personalized Cancer Treatment. He is currently practicing at Sanar International Hospital, Golf Course Road, Gurgaon.