If you are diagnosed with liver cancer...
You have been told that you have a liver cancer (HCC or Hepatocellular Carcinoma). That is an unfortunate news indeed. Now, it is time for you to understand the disease, the options of treatment and the way forward. I have attempted to put together in this post, the broad over view of treatment, the specifics of treatment available for you and the gains you may have. I have also put in the side effects of treatment along with the risks. I hope this is useful to you in these times.
The next step in our evaluation protocol is to assess the type of tumour. The treatment modality has to be decided first, prior to deciding the actual execution of the process. We have employed established clinical data to use a simple algorithm to establish what a bad type of 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 coming back at other sites.
We have used a size of > 5 cm and number >3 to denote a bad lesion. It does not mean that all treatment options are closed. But one should consider using multiple treatment modalities. The four groups are offered different treatment structures in our institute.
The patient with a "good tumour" and a "good liver"
Obviously, these patient receive the best treatment which is resection of the entire liver. Most of these patients can be planned for surgical resection. Once this decison 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 Milan criteria which is used to choose the patients who will have the maximal benefit from liver transplantation. This is the group of patients who can go for 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 good 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 treatments.
Such is our treatment protocol. We have tried to provide the best to every patient. But every surgeon desires an understanding patient. These are difficult treatment regimens. And requires all the possible cooperation from the patient and the family.
And certainly we wish you good health even in these difficult times. Have hope. Liver cancer is treatable.
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 with a complex treatment protocol. None of these treatments are easy, both the surgical and non surgical. In our clinic, we have made slight modifications of the BCLC protocol and applied it successfully.
The treatment options available for the patients are Liver resection, Liver transplantation, Radiofrequency ablation, Ethanol injection, Transarterial chemoembolistation, radioembolistation and chemotherapy. Like every treatment that has many choices, it just means that we actually do not know what is the best.
We made up a our evaluation simple to apply so that we get 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 tumour. We assess these elements and classified them as good or bad, based on certain criteria. Like every patient assessment in 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 and you are active and 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 treatment.
Once treatment can be given, we look into the treatment options for the patient.
The curative options are liver resection (cutting the tumourous portion of the liver) and Liver transplantation ( Replacement of the entire liver). Liver cancer treatment is based on the tumour and the status of the liver. Most of the liver cancers occurs in a background of cirrhosis of the liver. Of course, there are patients who get liver cancers without cirrhosis. The simplest way of assessing the liver status is to use the Child Pugh score.
| Criteria | 1 point | 2 points | 3 points |
|---|---|---|---|
| Total bilirubin (mg/dl) | <2 | 2-3 | > 3 |
| Serum albumin, g/dl | >3.5 | 2.8-3.5 | < 2.8 |
| PT INR | <1.7 | 1.71-2.3 | > 2.3 |
| Ascites | None | Mild | Moderate to Severe |
| Hepatic encephalopathy | None | Treatable | Refractory |
The next step in our evaluation protocol is to assess the type of tumour. The treatment modality has to be decided first, prior to deciding the actual execution of the process. We have employed established clinical data to use a simple algorithm to establish what a bad type of 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 coming back at other sites.
We have used a size of > 5 cm and number >3 to denote a bad lesion. It does not mean that all treatment options are closed. But one should consider using multiple treatment modalities. The four groups are offered different treatment structures in our institute.
The patient with a "good tumour" and a "good liver"
Obviously, these patient receive the best treatment which is resection of the entire liver. Most of these patients can be planned for surgical resection. Once this decison 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 Milan criteria which is used to choose the patients who will have the maximal benefit from liver transplantation. This is the group of patients who can go for 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 good 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 treatments.
Such is our treatment protocol. We have tried to provide the best to every patient. But every surgeon desires an understanding patient. These are difficult treatment regimens. And requires all the possible cooperation from the patient and the family.
And certainly we wish you good health even in these difficult times. Have hope. Liver cancer is treatable.
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