Primary Cancer of the Liver - Hepato Cellular Carcinoma - most commonly arise in the background of a cirrhotic liver.
90% of all liver tumours, develop in the background of Cirrhosis. Approximately 2-7% of all patients with cirrhosis have an annual risk of developing HCC. 1/3rd of all cirrhotics will develop HCC in their lifetime.
Hence patients with cirrhosis, should be carefully screened for development of cancer. The screening tests include a good quality ultrasound done at regular intervals apart from a blood test (AFP) - which is specific for HCC [LIVER CANCER].
Upon diagnosis of liver cancer - detailed and dedicated imaging including CT scan of the liver needs to be performed. Additionally MRI liver and PET scans may also be required.
The above factors along with general condition of the patient help in choosing the exact nature of the treatment.
Treatment modalities for Hepato Cellular Carcinoma : HCC
Removal of part of the liver bearing the tumour. This is usually done when the tumour is small and the liver function is preserved. Presence of advanced cirrhosis is a contraindication. Liver Resection (removal of part of the liver) would involve either removal of small portion of the liver or a single segment if the tumour is small (minor hepatectomy) or a larger portion of the liver amounting to either a right or left hepatectomy (major hepatectomy). Surgery where possible is a curative.
Liver transplantation is a curative and a definitive treatment option for patients with hepatocellular carcinoma in the presence of cirrhosis. Presence of advanced cirrhosis and portal hypertension do not permit liver resection, as the risks of liver failure after surgical removal of the tumour are high. Liver transplantation therefore allows removal of the tumour, and also takes away the diseased (cirrhotic) liver thereby alleviating the portal hypertension. It eliminates all other known complications of cirrhosis and portal hypertension which include bleeding / encephalopathy (coma due to liver disease) among others. Further more as liver cancer develops in a cirrhotic liver, by removal of the entire cirrhotic liver - the risks for a future recurrence of liver cancer are also minimised. Liver transplantation can be done using liver (grafts) from either deceased (Cadaveric) organs (DDLT) or part of the liver donated by related living donors (Living Donor Liver Transplant - LDLT).
Radio frequency Ablation : RFA - destruction of the tumour using very high electricity current which generates intense heat, resulting in destruction of the tumour. The procedure is done under either CT or Ultrasound (US) guidance and works best in tumours < 3 cm in size.
Microwave Ablation : MWA - an alternate form of heat destruction of the liver tumour, similar to RFA above
Trans Arterial Chemo Embolization : TACE - instillation of chemotherapy medications directly into the liver tumour via angiography (injecting the drug directly into the artery feeding the tumour). The blood vessel feeding and supplying blood to the tumour is blocked leading to control of the tumour.
TARE : Trans Arterial Radio Embolization : direct delivery of internal radiation to the liver tumour, through angiography.
combination of the above methods can be done.
In patients where in the tumour is spread out and can’t be controlled with any of the above modalities, systemic chemotherapy through tablets is given.
The treatment modality for the tumour is chosen after carefully evaluating the patient and review of all scans / blood tests among others.