Dr Joy Varghese, Director of Hepatology, Gleneagles Hospital Chennai
Liver cancer remains to be the sixth most common cancer worldwide in 2024. It is the fifth most common cancer in men and ninth most common cancer in women. India is one among the 10 countries with highest rates of liver cancer and cancer related deaths. The incidence is still on the rise due to lack of awareness and many evolving new conditions leading to liver cancer.
The painful truth is that almost 70 – 80% of patients with liver cancer are diagnosed with advanced stage of disease. It is because of the silent nature of the disease in early stages and they do not manifest any symptoms. Early stages of liver cancer can be identified only by screening with abdominal scan and certain cancer specific blood tests.
There are various types of liver cancer, among which hepatocellular carcinoma remains the most common. The risk factors for development of liver cancer are patients with pre-existing liver disease, cirrhosis, certain viral infections like hepatitis B, hepatitis C, over- weight/ obese, alcohol consumption and certain genetic diseases. It can also run in families like other malignancies. In recent days, with the changing lifestyle and dietary habits, more people are prone to develop fatty liver (Non-alcoholic fatty liver disease/ Metabolic Associated Fatty Liver Disease), which when severe and unattended, might progress to develop liver cancer.
The symptoms of liver cancer usually appear in quite advanced stages of the disease. Common symptoms include abdomen pain, weight loss, poor appetite, jaundice, nausea, vomiting, fatigue, etc. Some patients might also develop blood vomiting, abdomen and leg swelling and breathing difficulty.
The only way to identify liver cancer at early stages is by proper screening for those with risk factors for the same. Hence it is recommended for all patients with cirrhosis, hepatitis B/C infection, alcohol related liver disease and family history of liver cancer to undergo screening tests. The tests performed for screening are usually simple blood tests specific for cancer and abdomen ultrasound scan/CT scan / MRI scan.
There exists a universal myth that liver cancer is almost always fatal. If identified at early stage, liver cancer can be completely cured by surgery- surgical removal of tumor alone (liver resection) or liver transplantation. Sometimes, surgery might not be feasible due to other reasons like older age, heart/ lung disease or any high risk for anaesthesia. In such situations, the next best curative option for small tumors include burning/ charring the tumor (radiofrequency ablation/ microwave ablation/ cryotherapy).
The newer techniques introduced for treatment of liver cancer, even for advanced stage of the disease is really appreciable. The primitive advantages are: require minimal anaesthesia (iv sedation), have least side effects, have quick recovery and can be performed as daycare procedures. These procedures include- injecting chemotherapy drug directly into the blood vessel (artery) supplying the tumor (TACE- Trans Arterial Chemo Embolization), focused radiation to the tumor ( SBRT- Stereotactic Body Radiation Therapy) and TARE- Trans-Arterial Radio Embolization. In TARE procedure, an imported (from US/ Australia) substance by name Yttrium is injected into the tumor which will slowly destroy the tumor by emitting beta rays.
A number of newer oral medications for destroying the cancer cells with lesser side effects have come into use. Also, medicines which modify and boost the patient’s immunity against cancer cells, resulting in cancer cell destruction called Immunotherapy, has also been a major breakthrough in treating liver cancer recently.
The key note is to encourage those with above mentioned risk factors to undergo proper screening for liver cancer, as early stages can be completely cured with surgery. With newer techniques in treatment of liver cancer and their combination, successful treatment of liver cancer has drastically hiked. Even in patients with advanced stages, cancer progression can be controlled with improvement in overall survival. Unlike the scarry and dreadful traditional chemotherapy, current drugs for liver cancer provide better quality of life with least side effects.
