Liver Cancer — Early Detection Saves Lives

Liver cancer (hepatocellular carcinoma / HCC) is among the most common cancers in Punjab and India, largely driven by the high prevalence of hepatitis B and C infections. When detected early, liver cancer is highly treatable with excellent survival outcomes. Dr. Raman Garg, an experienced hepatobiliary surgical gastroenterologist at Bombay Gastro & Cancer Institute, Bathinda, provides cutting-edge liver cancer care — from surveillance and early diagnosis to complex laparoscopic liver resection and coordination of multimodal therapy.

Types of Liver Cancer

Hepatocellular Carcinoma (HCC)

Most common (75–85%). Arises from hepatocytes. Usually in cirrhotic liver. Elevated AFP.

Cholangiocarcinoma: Overview and Assessment

Bile duct cancer. Intrahepatic (within liver) or extrahepatic (outside liver). Presents with jaundice.

Hepatoblastoma: Overview and Assessment

Rare, mainly in children under 3 years. AFP markedly elevated. Treated with chemotherapy + surgery.

Secondary (Metastatic)

Cancer spread to liver from colon, breast, lung, stomach. More common than primary liver cancer.

Risk Factors for Liver Cancer

Chronic Hepatitis B infection — most common risk factor in Punjab/India
Chronic Hepatitis C infection — high risk especially with cirrhosis
Liver cirrhosis — from any cause (viral hepatitis, alcohol, NASH)
Alcoholic liver disease — heavy, long-term alcohol use
Non-alcoholic fatty liver disease (NAFLD/NASH) — obesity, diabetes, dyslipidaemia
Aflatoxin exposure — from contaminated grains/nuts
Family history of liver cancer
Haemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency

Symptoms of Liver Cancer

See a liver specialist immediately for:

Unexplained weight loss and loss of appetite
Upper right abdominal pain or fullness
Jaundice (yellow skin/eyes), dark urine
Abdominal swelling (ascites)
Fatigue and weakness
Nausea and vomiting
Palpable mass in right upper abdomen
Sudden deterioration in a cirrhosis patient

Liver Cancer Staging (Barcelona Clinic Liver Cancer)

Stage	Description	Treatment
Very Early (0)	Single <2cm, PS 0, Child-Pugh A	Resection or ablation — Curative
Early (A)	Single or 3 tumours ≤3cm, PS 0, Child A/B	Resection, ablation, transplant — Curative
Intermediate (B)	Multinodular, PS 0, Child A/B	TACE — Palliative
Advanced (C)	Vascular invasion/extra-hepatic spread	Sorafenib, immunotherapy
Terminal (D)	End-stage liver disease, PS 3–4	Best supportive care

Liver Cancer Treatment Options and Care Planning

Curative Intent Treatments:

Laparoscopic Liver Resection (Hepatectomy) — surgical removal of the tumour-bearing liver segment. Dr. Garg performs this minimally invasively where possible.
Liver Transplantation — curative for HCC within Milan criteria; referral coordinated
Radiofrequency Ablation (RFA) — heat-based destruction of small tumours
Microwave Ablation (MWA) — faster, larger ablation zones than RFA

Palliative Treatments:

TACE (Transarterial Chemoembolization) — delivers chemotherapy directly to tumour via hepatic artery
SIRT (Selective Internal Radiation Therapy) — Yttrium-90 microspheres
Sorafenib / Lenvatinib — targeted molecular therapy
Immunotherapy — Atezolizumab + Bevacizumab (first-line for advanced HCC)

Surveillance — Who Should Be Screened?

6-monthly AFP blood test + Ultrasound liver recommended for:

All cirrhotic patients (any cause)
Hepatitis B carriers with high viral load or family history of HCC
Hepatitis C with advanced fibrosis
Patients with NASH/NAFLD and cirrhosis

Frequently Asked Questions

What is the most common type of liver cancer?

Hepatocellular carcinoma (HCC) is the most common primary liver cancer, accounting for 75–85% of cases. It usually arises in a cirrhotic liver (from hepatitis B/C or alcohol).

Who is at highest risk for liver cancer?

High-risk groups include people with chronic hepatitis B or C, liver cirrhosis, alcoholic liver disease, NASH, haemochromatosis, or family history of HCC. Regular 6-monthly AFP + ultrasound surveillance is recommended.

Can liver cancer be cured with surgery?

For early-stage liver cancer (single tumour, preserved liver function, no vascular invasion), surgical resection offers the best chance of cure with 5-year survival rates of 50–70%.

What are non-surgical options for liver cancer?

Options include Radiofrequency Ablation (RFA), Microwave Ablation (MWA), TACE, SIRT, Sorafenib/Lenvatinib (targeted therapy), and immunotherapy (atezolizumab + bevacizumab).

Liver Cancer Specialist in Bathinda