WHEN TO OPERATE PRIMARY LIVER CANCER (HEPATOCELLULAR CARCINOMA)

Primary liver cancer (hepatocellular carcinoma)

In my previous posts I have discussed about cancer spread to the liver, now l will try to explain primary liver cancer or hepatocellular carcinoma.

In healthy liver same thing applies here also i.e 20-30% of normal healthy liver should be left after resecting hepatocellular carcinoma.

But there is some difference is hepatocellular carcinoma.Hepatocellular carcinoma most commonly arises in background of diseases liver.It can arises in healthy liver but such cases are infrequesnt.

So it is mostly seen when entire liver is diseased or cirrhotic.Liver disease in the background can be anything i.e. hepatitis b,hepatitis c,alcholoic or non alchoholic fatty liver disease.

Now ,as you might have realied we do not have mendatory 20-30% healthy liver commonly.

So do we have any options?

 Yes we have.

 We have mainly 3 options

1.     Resection

2.     Transplantation

3.     Bridiging and downstaging therapy like chemoembolization or radioembolization

I will takle all the option one by one.Today I will try to adress to issue When to remove (resect) primary liver cancer (hepatocellular carcinoma).

Primary liver cancer can be removed (surgical resection) if

·      liver function is resanablly preserved. (i.e billirubin, platlet count,albumin, and PT/INR should be nearrly normal) Medically we call it child A cirhorrsis.

·      Here remaining liver should be atleast 40-50% of total liver volume

·      Main vessels (portal vein,hepatic artery etc) should not be involved how ever if their branches are involved liver tumour still can be removed.

·      Some time other test to detect liver function like ICG test (Indigo carmine) or Hepatic artery wedge pressure (HVPG) etc are indicated when confusion about liver status is there

There are some debate as weather to do transplant or resectionin these group of patient with well preserved liver function. Studies have shown that transplant gives little bit better results then resection but in countries like india where brain dead donors are rarely available and liver donations are only option and cost involved with transplants, resection should always kept in mind.

Transplantation for hepatocellular carcinoma will be discussed tomorrow.