#1 Doctor For Liver Cancer in Gurugram

• Hepatocellular Carcinoma: most common
• Cholangiocarcinoma
• Hepatoblastoma: rare, mainly in children

 Cirrhosis: damage of liver parenchyma from chronic insult by alcohol, hepatitis or other causes

 Hepatitis: Chronic infection with hepatitis B or C

 Alcohol

 Alfatoxin exposure: produced by mold/ fungi that grow on food grains, peanut, corn.

  Fatty Liver Disease

  Chemical exposure like arsenic, viny chloride, hemochromatosis

  Older age >50 years

  Male are more predisposed than females

There are no general screening guidelines for liver cancer. Those patients who are at risk because of cirrhosis are advised to remain in close followup and screening with ultrasound and S. Alfa-fetoptotein (AFP) every 6 months.

Most of the time liver cancer is detected in late staged because it keeps on growing without any symptoms. There are certain symptoms which if present, consultation should be done with doctor and get checked to find the exact cause.

  Enlarged liver- swelling in ride side upper abdomen

  Swelling because of fluid in abdomen (Ascites)

  Abdominal pain

  Feeling full/ loss of appetite

  Nausea/ vomiting/itching

  Unexplained weight loss/ weakness/ fatigue

  Signs and symptoms of liver failure

 Liver Functions tests, tumor markers like AFP, CA 19-9, PIVKA

  Triphasic CECT/ MRI: very accurate test for diagnosis, staging and treatment planning

  Bone scan

  Ultrasound is many times initial investigation

  Biopsy is required sometimes when diagnosis is not clear

 I: single tumor in the liver only.

 II: single tumor with vascular involvement or multiple tumor or multiple tumors of < 5cm.

 III: multiple tumors with one at least >5 cm or involvement of major branch of portal vein or hepatic vein.

 IV: involve lymph nodes or distant organs.

Treatment depends on-

 Number/ size and location of the tumor within the liver

 Functional reserves of liver

  Underlying liver parenchyma normal or cirrhosis

  Involvement of other organs

  Surgery :Treatment is planned considering all these parameters. Surgery is the only curative treatment in localized liver disease. Resection and transplant are two curative options and these are advised and planned by considering function liver capacity and underlying cirrhosis grade.

  Hepatectomy : removes a portion usually right or left half of liver. The remaining healthy liver regrows. Sometimes extended liver resections are also done to completely clear the disease where only 25% of liver is left. Proper assessment of underlying liver parenchyma reserve is very important. Sometimes PTBD to decrease jaundice is required before major surgery. Sometimes tumor side portal vein embolization is done to increase function capacity of remaining liver.

  Liver transplant : replaces the entire diseased liver with a healthy liver from a suitable donor. Multiple cancers and patients with underlying cirrhosis of grade B and C are suitable candidates for this surgery.

  Ablation : Heat (Radiofrequency ablation) or ethanol injections are used to destroy the cancer cells. They useful in small tumors in patients who are not fit for surgery.

  Targeted therapy : medications are designed to hit/ target cancer cells with specific receptors. It decreases the tumor growth. Targeted therapy can be helpful for people where disease has spread beyond liver to other organs.

  Embolization and chemoembolization : Embolization and chemoembolization block off the hepatic artery supply to tumor. Small particles are used for this to reduces blood flow to the tumor. In chemoembolization, chemotherapy drugs are embolized into the hepatic artery. This procedure is used in patients where there are multiple tumors in both lobes of liver and disease has not spread beyond liver.

  Immunotherapy is also helpful to some extent in metastatic patients