Liver Cancer Surgery in Delhi

Risk Factors for Liver Cancer in India

Understanding your risk factors is the first step toward early detection — and early detection saves lives. The following significantly increase the risk of developing hepatocellular carcinoma:

• Chronic Hepatitis B infection: The leading cause of HCC in India; risk persists even without cirrhosis.
• Chronic Hepatitis C infection with cirrhosis: HCV-related cirrhosis carries a 2–5% annual HCC risk.
• Liver cirrhosis (any cause): All cirrhosis patients require 6-monthly cancer surveillance.
• Non-Alcoholic Fatty Liver Disease (NAFLD/MASLD): Increasingly recognised as a risk factor, even without cirrhosis.
• Alcoholic cirrhosis: Long-term heavy alcohol use with cirrhosis significantly elevates risk.
• Aflatoxin exposure: Contamination of groundnuts and corn in parts of India with the Aspergillus mould.
• Diabetes and obesity: Metabolic risk factors independently associated with HCC risk.
• Family history of liver cancer

Symptoms of Liver Cancer

Like many liver conditions, liver cancer often produces no symptoms in its early stages — which is why surveillance for high-risk patients is so critical. When symptoms do appear, they may include:

• A new lump or heaviness in the upper right abdomen
• Unexplained weight loss and loss of appetite
• Persistent fatigue and weakness
• Jaundice — yellowing of skin and eyes (in advanced cases)
• Abdominal swelling or bloating
• Nausea and vomiting
• Fever without a clear cause
• Sudden worsening of known cirrhosis symptoms — new onset ascites, encephalopathy, or variceal bleeding

If you have known liver disease and notice any sudden change in your condition, please see your liver specialist immediately — these symptoms can indicate HCC development.

How Liver Cancer Is Diagnosed & Staged

Blood Tests

• AFP (Alpha-Fetoprotein): Elevated in many HCC patients; used in combination with imaging.
• Liver function tests, viral hepatitis markers, and full metabolic panel.

Imaging

• Triphasic CT scan or MRI with liver protocol: The standard for diagnosing HCC based on characteristic contrast enhancement patterns.
• Ultrasound: Used for surveillance and initial detection.
• PET-CT scan: For assessing metastatic spread in certain cases.

Staging Systems

• Barcelona Clinic Liver Cancer (BCLC) staging: The most widely used system, guides treatment allocation.
• MELD score: Quantifies underlying liver function, critical for transplant planning.
• Milan Criteria & UCSF Criteria: Define which HCC patients are candidates for liver transplantation.

Treatment Options for Liver Cancer

The treatment of liver cancer is highly individualised — the right approach depends on tumour size and number, degree of vascular invasion, underlying liver function (BCLC stage), and the patient's overall health. At liversurgeons.com, every patient is discussed by a multidisciplinary team before a treatment plan is finalised.

1. Surgical Resection (Hepatectomy)

• Surgical removal of the tumour-bearing portion of the liver is the treatment of choice for patients with early-stage HCC who have adequate underlying liver function (preserved liver reserve).
• Dr. Ashish George performs both anatomical resections (removing defined liver segments based on blood supply) and non-anatomical resections, using open, laparoscopic, and robotic-assisted techniques.
• Best for: Single tumours in patients without significant cirrhosis or portal hypertension
• Aim: Complete tumour removal with clear surgical margins — R0 resection
• Recovery: 7–14 days hospital stay; return to normal activity in 4–6 weeks
• The liver's regenerative capacity means even major resections (removing up to 70% of the liver) are survivable when the remaining liver is healthy.

2. Liver Transplantation

• Liver transplantation offers a unique advantage in HCC — it simultaneously removes the cancer and cures the underlying cirrhosis, eliminating the cirrhotic 'soil' in which new tumours can develop.
• Milan Criteria: Single tumour ≤5cm or up to 3 tumours each ≤3cm, with no vascular invasion or distant metastasis
• UCSF Criteria: More expanded criteria used by some centres for selected patients
• Bridge therapy: Ablation or TACE used to prevent tumour progression while awaiting transplant
• 5-year survival post-transplant for HCC within Milan Criteria: 70–75%

3. Tumour Ablation (RFA & Microwave Ablation)

• Ablation destroys liver tumours using heat energy generated by radiofrequency (RFA) or microwave (MWA) technology — delivered via a needle inserted directly into the tumour under CT or ultrasound guidance.
• It is minimally invasive, preserves healthy liver tissue, and can be repeated if new tumours develop.
• Best for: Tumours ≤3–5cm, patients who are not surgical candidates, or as bridging therapy before transplant
• Procedure time: 30–60 minutes; typically done under sedation or general anaesthesia
• Recovery: 1–2 days hospital stay; return to normal activity within 1–2 weeks

4. Transarterial Chemoembolisation (TACE)

• TACE is an interventional radiology procedure that delivers chemotherapy directly to the tumour via the hepatic artery, followed by embolisation that cuts off the tumour's blood supply — causing tumour necrosis while minimising systemic side effects.
• Intermediate HCC: Used for patients with multiple tumours not amenable to resection
• Bridge to transplant: Controls tumour progression while awaiting a donor organ
• Can be repeated multiple times

5. Systemic Therapy

• For advanced HCC with vascular invasion or extrahepatic spread, systemic therapies including Sorafenib, Lenvatinib, Atezolizumab + Bevacizumab (immunotherapy), and other targeted agents are used.
• These are managed in coordination with our oncology colleagues.