UNDERSTANDING
LIVER CANCER

Good to know facts about Hepatocellular
Carcinoma (HCC)

Hepatocellular Carcinoma (HCC) is the 5th most common Cancer in the world. Owing to the paucity of symptoms and designated screening programmes, only 25% of patients can be offered curative therapies.

What are the predisposing factors for HCC and who needs screening?

• • Cirrhosis of Liver: All patients with
     Liver Cirrhosis secondary to Hepatitis
     B or C infection, alcoholic liver
     disease, Non-alcoholic Fatty Liver
     Disease (NAFLD) and other causes
     need routine screening for early
     diagnosis of HCC
• • Hepatitis B infection without Liver
     Cirrhosis
• • Patients treated for chronic viral
     Hepatitis
• • Alcohol consumption, exposure to
     aflatoxin and genetic syndromes
     like glycogen storage disease,
     alpha-1-antitrypsin deficiency,
     metal storage disease and chronic
     cholestatic syndromes

The screening can be done with blood levels of alfa-fetoprotein (AFP) and sonography of the abdomen every 6 months. If there is any suspicion, further confirmation can be done with CT scan / MRI scan / biopsy (if both are inconclusive)

What are the symptoms of Liver Cancer?
Hepatocellular Carcinoma is often diagnosed during the routine surveillance of risk patients. Generally, Liver Cancers are diagnosed on routine screening. However, common symptoms can be abdominal pain or upper abdominal discomfort associated with loss of appetite and weight. Other possible symptoms also include abdominal lump or rarely as jaundice or intra-abdominal bleeding.

What are the ways to diagnose HCC?
Diagnosis of HCC is established with typical imaging findings of early arterial

phase enhancement and portal phase washout of contrast from the lesion in triphasic CT scan or MRI with gadolinium contrast. Diffusion MRI especially helps in lesions not diagnosed on CT / MRI. In doubtful cases, a biopsy can be done

What are the curative treatment options available?
Treatment of HCC is individualised depending upon the characteristics of the Tumour, Liver Function and clinical condition of the patient.

Surgery: HCC can be treated with liver resection provided that adequate liver remnant is available. This is the first choice of treatment even for cirrhotic patients with preserved liver function. Varied types of Liver Resections can be offered depending on the location and size of the Tumour

Ablation: Percutaneous or intra-operative techniques for ablation like Radio-Frequency Ablation (RFA) or Microwave Ablation (MWA) can be offered for small Tumours to provide curative treatment.

Liver Transplantation: Patients of advanced Liver Cirrhosis with Liver Cancer within milan criteria can also be offered a curative treatment in the form of Liver Transplantation.

What are the options if Liver Cancer cannot be cured?
TACE (Transarterial Chemoembolisation) is done percutaneously to give intratumoral Chemotherapy. TACE is useful to reduce the size of a Tumour so that surgical removal of the Tumour is possible. It can also be used as bridge therapy while waiting for Liver Transplantation. Intra-arterial delivery of radiotherapeutic agent can be given by TARE to reduce the Tumour size and increase survival. Chemotherapy with drugs like Sorafenib or Lenvatinib can be given to increase the survival chances in patients with metastatic HCC.