If you are diagnosed with liver cancer...

If you, or any of your close family members, have been diagnosed with liver cancer (HCC or Hepatocellular Carcinoma), please do not give up hope! No matter how gloomy you feel, there are new treatments which are very effective and can help you live your life as near to normal as possible.

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Now, it is important for you to understand the disease, the options for treatment and the way forward. I have attempted to put together in this article, a broad over-view of treatment, the specifics of treatment available for you and the possible benefits. I have also included the side effects of treatment as well as the risks. I hope this will be useful to you in these trying times.

One of the first things I tell my patients is that the treatment is prolonged and requires a commitment from the patient and their family to cooperate for a complex treatment protocol. None of these treatments are easy, neither surgical nor non-surgical. At our cancer clinic, we have made slight modifications to the BCLC protocol and applied it successfully.

There are 2 curative options for liver cancer - namely Liver resection and Liver transplantation. The non-curative treatments are - Radiofrequency ablation, Transarterial therapies and Chemotherapy. If the patient is not fit enough to undergo any treatment, supportive care is the best option.

We made up our evaluation simple to apply so that we can derive the best treatment option in resource-limited circumstances. The three elements that are assessed are the patient's general health, the status of the liver and the features of the cancer. We assess these elements and classify them as good or bad, based on certain criteria.

Like every patient assessment for cancers, we use the ECOG criteria to assess patient's ability to with-stand treatment. The simplest way of remembering this is how tired you feel. If you feel that you are not tired, you feel active, have minimal symptoms and are mentally up to it, you can undergo treatment that will focus on cure. We would label you as a good patient. On the other hand, if the patient is in bed most of the time, we would not be able to provide any reasonable curative treatment, so we shall instead focus on making the patient comfortable for the rest of his life.

Once treatment can be given, we look into the treatment options for the patient.

The curative options are liver resection (cutting the cancerous portion of the liver) and Liver transplantation (Replacement of the entire liver). Liver cancer treatment is based on the extent of cancer and the condition of the liver surrounding the cancer. Most of the liver cancers occur in a background of cirrhosis of the liver.

Of course, there are patients who can get afflicted with liver cancer, even without cirrhosis. The simplest way of assessing the liver status is to use the Child Pugh score.

The next step in our evaluation protocol is to assess the extent and aggressiveness of the cancer. The modality of treatment has to be decided first, prior to deciding the actual execution of the process. We have employed established clinical data to derive a simple algorithm to conclude how bad the liver tumour is. The key is the size of the liver tumour. As the size increases, the access to the blood vessel increases and you have the risk of disease forming at other sites.

We have used a size of > 6 cm and number >3 to denote a bad lesion. This does not mean that all treatment options are closed. But one should consider using multiple treatment modalities. The four types of patients are offered different treatment structures at our centre.

The patient with a "good tumour" and a "good liver"

Obviously, these patients receive the best treatment which is resection of the entire liver. Most of these patients can be planned for surgical resection. Once this decision is reached, the kind of surgery and the difficulties are assessed by looking at your CT scan. Most of the time, a resection can be planned.

The patient with a "good tumour" and a "bad liver"

Patients who have good tumours fall within the UCSF criteria which are used to choose the patients who will derive maximum benefits from liver transplantation. This is the group of patients who will benefit from liver transplantation.

The patient with a "bad tumour" and a "good liver"

Patients with bad tumours, but good liver status are good candidates for Transarterial therapies. We perform the transarterial chemoembolisation with doxorubicin to treat these patients. Transarterial radioembolisation with Theraspheres is another effective but costly option for these patients.

The patient with a "bad tumour" and a "bad liver"

These patients are offered palliative supportive treatments, as they may not be able to undergo any other treatment.

This in short is our treatment protocol. We have tried to provide the best option to every patient. But every surgeon desires an understanding patient. These are difficult treatment regimens and require the maximum extent of cooperation from the patient and his/her family.

And we certainly we wish you good health even in these difficult times. Have hope. Liver cancer is treatable.

Article by Dr. Ilango, M.S., M.Ch (GI Surgery)., ASTS Fellowship (USA)
Lead Surgeon Transplant and Liver Surgery, Kauvery Hospital

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