In recent times, the liver has been under serious threat owing to various liver damaging diseases. Liver diseases are of different kinds and very common. One in five Indians is affected by liver disorder every year. Approximately 2.5 lacs people in India are suffering from them. The most common type of liver infection is caused by viruses, such as Hepatitis A, Hepatitis B, and Hepatitis C. The patients suffering from underlying chronic Hepatitis B (HCB), Hepatitis C (HCV), Fatty liver disease and Cirrhosis can easily fall victim to liver cancer which is called Hepatocellular Carcinoma (HCC). HCC is now the third leading cause of cancer deaths across the world, with over 500,000 people affected. In the coming years, the threat of HCC is expected to grow significantly. HCC involves high-mortality rate due to late diagnosis. There is a huge lack of proper screening facility for early diagnosis in India. Thus, most of the patients suffer due to late diagnosis as the last stage liver disease treatment is still at an evolving stage world-wide, particularly in India.
In India only 20% of the population are diagnosed early, while 80% of them go undetected till the last stage. Unfortunately, owing to the absence of proper screening facility the ailment is mostly unidentified during its nascent stage. At this stage the tumour is potentially curable and the survival rate of the patient is fairly high. Whereas, at the advanced phase, we only find inoperable tumours which are fully developed and beyond any permanent cure. It is no wonder that the mortality rate of liver cancer is soaring in our country and it will undoubtedly persist as a vital problem given the diversified mushrooming causes like obesity, diabetes, hypertension, excessive smoking, sustained alcohol consumption etc.
Globally, there are a few specific set of guidelines for treatment such as European, American and Japanese guidelines in Asia. In India, there is nothing as such in particular, hence, either American or European guideline is followed, where doctors can screen patients who have chronic Hepatitis B and Hepatitis C, as well as patients suffering from non-alcoholic fatty liver disease. The screening process enables to identify the potentially early stage tumours, generating survival at large for patients.
Plan of treatment At an early stage the plan for cure has two options â surgery and liver transplant. Partial Hepatectomy surgery is performed on those patients whose cancer is at premature stage and a portion of the liver is damaged. When the entire liver affected by the cancer, then transplant is the only viable option. Nonetheless, generally the patient for liver transplant has to wait for a long time in order to obtain a new liver. During this time, the patient is often provided with other treatments, such as Ablation or Embolization, to check on the cancer.
The doctors also resort to Ablation or Embolization when the patient is not fit for either surgery or transplant. The Ablation treatment destroys liver tumours without removing them. This particular treatment is done on small tumours and during initial stage of cirrhosis, through intervention radiology where a needle is inserted to burn the tumour. The survival rate is up to 90% for the next 5 years, if the disease has been detected at an early stage and post-surgery the survival rate remains at 50%.
In case of late detections, the most effective method of treatment is Interventional Radiology. Usually, Liver Angiography is done to reach the artery which is supplying blood to the tumour where a chemotherapeutic agent is used to terminate the tumour. The maximum toxicity of the chemotherapeutic agent will destroy the tumour with minimum side-effect. This is called Transarterial Chemoembolization (TACE). It is a minimally invasive surgery that blocks the hepatic artery by prohibiting blood supply to the tumour without damaging the rest of the liver. Apart from all these, there are some novel drugs like Sorafenib (Nexavar), a targeted one that works in 2 ways. Sorafenib helps in blocking tumours from forming new blood vessels leading to terminate tumoursâ growth. It also targets some of the proteins on cancer cells that normally help tumours to grow, thus impeding tumours to spread further. However, most of these methods are palliation which can only increase life expectancy but cannot cure the disease completely.
There are a few multi-speciality hospitals in India that offers stringent screening for high risk patients. At CMRI, there is a data bank for patients with Hepatitis B and Hepatitis C, where the rigorous screening process for early detection is ensured and the patients are counselled accordingly for curative surgery and liver transplant. Armed with the most equipped team of medical practitioners and support staffs, CMRI renders holistic services to its patients before and after surgery with maximum customized treatment facilities. For late detection, the Transarterial chemoembolization (TACE) method is primarily used. A systematic Interventional Chemotherapy, Radiology or both treatments with minimum side effect mostly provides the best result at the end-stage of liver cancer. It is pertinent to remember that early diagnosis always helps to prolong and improve the quality of life through safe treatments along with taking optimum chance of survival. Post-surgery the patients usually stay for 2-3 days at the hospital and then they return back to normal life. While chemotherapy and radiation treatments are done at regular intervals as prescribed by the doctors. On a brighter side, the micro- surgeries are not cost incurring. Treating liver diseases requires a hospital to provide a total panacea to its patients. CMRI has constantly endeavoured to use the state of the art and cutting-edge technology for providing comprehensive care to the patients suffering from such malignant diseases.
Suggested by Dr. Avik Bhattacharya
-Dr. Avik Bhattacharya is a Consultant Interventional Radiologist at CK Birla Hospitals – CMRI, Kolkata.
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