If you are vomiting blood, passing black tarry stools, or have become confused and drowsy, seek emergency care now. Bleeding from varices and liver failure are emergencies. Also seek urgent care for severe abdominal pain with distension or fever.
Most liver cancer arises in a liver already damaged by chronic hepatitis or cirrhosis. That is what makes it different from other cancers — the treatment must consider both the tumour and the liver it grows in.
Hepatitis B and C remain widespread across several of the countries our patients travel from, and both are now treatable. A number of people who contact us about liver cancer turn out to need antiviral treatment and surveillance rather than cancer treatment.
Hepatocellular carcinoma is the commonest primary liver cancer and typically develops in a liver scarred by long-standing hepatitis B, hepatitis C, alcohol or fatty liver disease. Cholangiocarcinoma arises from the bile ducts and behaves differently. Cancer that has spread to the liver from elsewhere — most often from the bowel — is a separate situation with a separate treatment path.
What distinguishes primary liver cancer from most other cancers is that the organ is usually already failing. Removing a section of a healthy liver is well tolerated; removing the same section from a cirrhotic liver may precipitate liver failure. Treatment decisions therefore depend on two assessments — the tumour, and how much functional reserve the liver has.
This is why scoring systems for liver function are used alongside tumour staging, and why the same tumour may be resectable in one patient and not in another.
The encouraging part is prevention. Hepatitis B can be suppressed with tablets and prevented by vaccination. Hepatitis C is curable in most cases with a course of direct-acting antivirals. Both reduce the risk of liver cancer substantially, and both are available and increasingly affordable.
Chronic hepatitis B suppressed with antiviral tablets, and hepatitis C cured with a course of direct-acting antivirals, both substantially reduce the risk of liver cancer. And where cirrhosis is already present, six-monthly ultrasound surveillance detects cancers at a stage when they can still be cured. A number of patients who contact us about a liver mass turn out to need antiviral treatment and surveillance rather than cancer treatment — and that is a far better outcome.
Liver cancer is unusual in that imaging alone can often make the diagnosis, without a biopsy.
Two patients with identical tumours can need entirely different treatment depending on how well their livers are working. We need bilirubin, albumin, INR or prothrombin time, platelet count, and whether there is fluid in the abdomen or any history of confusion. Together these determine what can safely be done. A scan without them tells only half the story.
Options depend on tumour size and number, and on liver function. Several are catheter-based rather than surgical.
Removing the segment of liver containing the tumour. It offers the best outcome where the tumour is confined and the liver has enough reserve to tolerate losing part of itself. In a well-preserved liver the remaining tissue regenerates substantially over the following weeks.
Destroying the tumour with heat delivered through a needle placed under imaging guidance — radiofrequency or microwave ablation. For small tumours it can achieve results comparable to surgery with far less physiological stress, which matters greatly in a cirrhotic liver.
A catheter delivers chemotherapy or radioactive microspheres directly into the artery feeding the tumour while blocking its blood supply. It controls disease rather than curing it, and is often used for multiple tumours or as a bridge while awaiting other treatment.
For selected small tumours in a cirrhotic liver, transplant treats both the cancer and the underlying liver disease and offers the best long-term outcome. For foreign nationals in India, this requires a living donor who is a near relative, with the relationship certified by your embassy and the case approved by a hospital Authorisation Committee. We cannot find, source or arrange a donor, and nobody legally can.
A single small tumour has many options. Multiple tumours or invasion of the portal vein narrow them considerably.
Child-Pugh and MELD scores determine what the liver can survive. This is why the blood tests matter as much as the scan.
For transplant, this is decided by law before it is decided by medicine. Read the transplant page before making any plans.
Where the underlying hepatitis has not been treated, treating it is part of treating the cancer — and occasionally it turns out to be the main thing that was needed.
Decompensated liver disease — bleeding, confusion, or uncontrolled fluid — needs stabilising locally first. Flying with it is not safe and no assessment here can proceed until it is controlled.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
Yes, in the right circumstances. A single small tumour in a liver with good function can be cured by resection, ablation, or transplant. The difficulty is that many liver cancers are found late, in livers already failing, which narrows the options. Surveillance scanning in people with cirrhosis is what finds them early enough to cure.
Only with a living donor who is a near relative, whose relationship is certified by your embassy, and with approval from a hospital Authorisation Committee. Deceased-donor organs are not accessible to foreign nationals. We cannot find or arrange a donor for you — that is illegal and anyone offering it should be avoided. Where you do have an eligible family donor, living-donor liver transplant is performed to a high standard in Delhi NCR.
Almost certainly yes, and it should be discussed as part of your cancer plan. Curing hepatitis C improves liver function, reduces the risk of new tumours developing, and may make other treatments safer. Direct-acting antivirals cure most patients with a course of tablets and are far more affordable than they once were.
It is a score combining bilirubin, albumin, clotting, fluid in the abdomen and any history of confusion, and it grades how well your liver is functioning. It matters because it determines what treatment your liver can survive. Two patients with identical tumours may need completely different treatment because of it.
Yes, and it is often correct. Hepatocellular carcinoma has a characteristic appearance on triple-phase CT or MRI — enhancing in the arterial phase and washing out later — which in a patient with cirrhosis is diagnostic without a biopsy. Biopsy carries a small risk of seeding and is reserved for cases where imaging is not conclusive.
Hepatitis B vaccination is highly effective and should be given to all close family members who are not already immune. Anyone in the family with chronic hepatitis B or C should be assessed for treatment, and those with cirrhosis should have six-monthly liver ultrasound surveillance. These measures prevent far more liver cancer than any treatment cures.
Send the triple-phase CT or MRI together with liver function tests and your hepatitis status. All three are needed before anyone can advise you properly.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
WhatsApp +91 83035 86344 · Phone +91 83035 86344 · Email tibhind@gmail.com
Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.