Effective liver cancer management involves accurate diagnosis and timely treatment. Before arriving at a conclusive diagnosis, the doctors will recommend a battery of tests, ranging from blood tests to imaging scans. Upon arriving at a definitive diagnosis, the doctors devise a personalized treatment plan, which may include surgery, radiation therapy, chemotherapy, immunotherapy, and targeted therapy. Once the treatment is complete, the patient will be on follow-up for efficient monitoring.
The success of liver cancer treatment largely depends on the stage at which the disease is diagnosed and treated. Depending on the stage, the treatment goal will vary too. Early-stage liver cancers have a better prognosis than advanced-stage cancers.
Patients may be asked to undergo several examinations before a conclusive liver cancer diagnosis is made. Most recommended liver cancer tests include blood tests, liver biopsies, and imaging.
When patients present with symptoms that indicate liver cancer, the doctor will recommend a thorough physical examination. The doctor may check the abdomen for the presence of a lump. Further, the skin and the eyes are examined to check for signs of jaundice. The left lower part of the abdomen is examined to check for an enlarged spleen. The doctor may also ask the patient when the symptoms developed, their severity, and their progression.
The medical history of the patient is also evaluated, and the doctor may particularly check if the patient has congenital liver diseases such as hemochromatosis and Wilson's disease. If liver cancer is suspected, the patient is advised to undergo further examinations.
Blood tests for the liver are recommended to evaluate the liver's health status. The liver secretes several chemicals, including enzymes, into the blood. Alterations in the levels of these chemicals may indicate liver disease.
The alpha-fetoprotein tumor marker test detects the level of alpha-fetoprotein in the blood. The alpha-fetoprotein level may rise in the presence of various cancers, such as liver, lung, and ovarian cancer. However, this test is not a confirmatory test for cancer, as elevations in alpha-fetoprotein levels may also be due to other medical conditions, such as hepatitis and cirrhosis. Further, a negative alpha-fetoprotein marker test does not confirm the absence of cancer either.
These tests are used to determine the overall health of the liver. The enzymes secreted by the liver, such as alkaline phosphatase (ALP), aspartate transaminase (AST), and alanine transaminase (ALT), are usually examined in liver function tests.
If the doctor finds an abdominal swelling or strongly suspects the presence of liver disease, they may advise the patient to undergo various imaging tests, including:
Ultrasound is usually the initial test recommended for patients suspected of liver disease. Liver cancer ultrasound involves the use of sound waves to create images of the liver. Conventional ultrasound may assist the doctor in determining the morphology, location, size, boundary, and flow of blood to tumors. However, ultrasound may miss small tumors and cannot differentiate between malignant and benign tumors.
Computed tomography is recommended as the second-line diagnostic test for examining the presence of liver tumors after the primary evaluation tests, such as alpha-fetoprotein or abdominal ultrasound. The technique uses X-rays to obtain images. It is also used for assessing the stage of cancer. Further, it also assists the doctors in guiding the needle during a biopsy (a CT-guided biopsy). CT is preferred over ultrasound and MRI as it effectively evaluates the extrahepatic abdomen.
An MRI provides detailed information about liver cancer. Unlike a CT scan, an MRI scan uses strong magnets and radio waves to obtain detailed images of the liver. This imaging method helps in differentiating between malignant and benign tumors. It also provides information about the blockage in the blood vessels in and around the liver due to the tumor. It helps oncologists determine whether liver cancer has spread to other body parts.
It is an advanced imaging technique that involves the use of a radiotracer. The radiotracer comprises the radioactive glucose analogs that are taken up by the rapidly dividing cells. The radiotracers are then traced through specialized instruments. A PET scan provides detailed information about the presence of cancer, its location, and the stage of liver cancer. It also scans the entire body to determine liver cancer metastasis.
A biopsy is generally the confirmatory test for diagnosing cancer. The doctor obtains a small sample of abnormal tissue from the liver and sends it to the laboratory to examine the sample for malignancy. Different liver biopsy procedures are available to diagnose liver cancer, including:
In this procedure, the doctor inserts a long, hollow needle into the abdomen and guides it to the liver to obtain the sample. Sometimes, the needle is guided with imaging techniques such as CT or ultrasound. The doctor applies local anesthesia to the skin before the procedure.
In some patients, the doctor requires a large sample for examination, and in such cases, a needle biopsy may not help. A surgical biopsy is performed in such cases. Further, if the tumor is very small, the entire tumor is removed during a surgical biopsy and sent for examination.
Endoscopic biopsy is a minimally invasive procedure to obtain a large number of samples or completely remove the tumor for further examination. The procedure is done under anesthesia and involves a few small incisions in the abdomen.
An angiogram is recommended to determine the health of the blood vessels and identify the vessels that supply blood to the tumor. In this process, the doctor injects a contrast agent into the artery, and the images are obtained through an x-ray. Angiograms also guide various non-surgical cancer treatments, like embolization.
Doctors perform laparoscopies with the help of a laparoscope. This long, flexible tube with a camera at the tip allows the doctors to view the organs of the abdomen to check for signs of cancer. Laparoscopy is rarely used in the diagnosis of liver cancer.
Several factors affect the choice of liver cancer treatment. These factors include the stage of the disease, location and size of the tumor, response to prior treatment, and overall health of the patient. Oncologists prescribe liver cancer treatment by stage.
Liver surgery to remove tumors or liver transplants are considered the best options for liver cancer treatment. The outcomes of liver cancer treatment are excellent when all the malignant cells are removed.
This procedure is recommended for patients who have liver cancer limited to the liver. The oncosurgeons perform several imaging tests, such as an MRI or CT scan, to evaluate if cancer can be surgically removed. Liver surgery types include hepatectomy and lobectomy.
A liver transplant is a procedure that involves replacing the diseased liver with a new, healthy one. It is a good option when the disease has spread to a significant part of the liver.
Chemotherapy for liver cancer treats the disease by killing the cancer cells or preventing their division with drugs. The drug is administered orally or through injection. Chemotherapy is also used with radiation therapy or surgery as an adjuvant therapy. It is also prescribed for the management of advanced liver cancer.
When radiation therapy is administered as a liver cancer treatment, radiation oncologists direct high-energy radiation at the cancer cells to damage them. The radiation can be delivered through an external radiation source or by placing radioactive seeds near or in the tumor. It may also be administered as adjuvant therapy along with chemotherapy or surgery.
Certain pathways and substances, such as enzymes and proteins, are specific to cancer cells, and they support the growth and proliferation of cancer cells. Liver cancer medications administered as a part of targeted therapy target these vital processes, pathways, and biocomponents and prevent the growth of cancer cells.
Immunotherapy for liver cancer involves stimulating the patient's immune system to kill the cancer cells. Immune cells normally identify and kill the abnormal cells. However, certain abnormal or cancerous cells hide from the immune system and form tumors. Liver cancer medicine administered as a part of immunotherapy makes the cancer cells vulnerable to the immune system, so they are identified and killed by the immune system.
Gene therapy is an advanced liver tumor treatment. Gene therapy involves introducing new genes into the cancer cells, resulting in their death. In a recent study, gene therapy involving microRNA-22 resulted in successful hepatocellular carcinoma treatment in mice. Further, this therapy also reduced liver inflammation.
HCG is one of the most advanced and superior centers for liver cancer diagnosis and treatment. It is one of the very few centers in India with all types of diagnostic and treatment facilities for liver cancer under a single roof. The technicians at the center are experts in performing imaging tests. At HCG, the treatment plans are devised based on individual case parameters, and this helps the team deliver personalized care to every patient and help them return to the best state of health possible.
Liver cancer should be managed with early diagnosis and timely treatment for favorable outcomes. Methods such as medical history and physical examination; imaging tests such as CT, USG, MRI, and PET scan; blood testing; and liver biopsy are used for diagnosing liver cancer. The treatment options for liver cancer are surgery, immunotherapy, chemotherapy, radiation therapy, targeted therapy, and gene therapy. Personalized care plays a pivotal role in the effective management of liver cancer.