Liver Cancer: Best treatment options and global hospitals

According to the world’s statistics provided by the World Cancer Research Fund, liver cancer takes fifth place among the most commonly diagnosed cancer types in men. This is mainly connected with the wide spreading of the disease risk factors, including alcohol consumption and obesity.

A high incidence of the disease requires the elaboration of the new therapeutic options – more efficient and safer sparing the same time. In addition to atypical liver resections (more individualized surgical interventions), nowadays doctors are able to destroy oncological foci with high-energy radio waves or ethanol. Chemotherapy can be supplemented or substituted by the immunotherapy or targeted therapy.

Certain therapeutic options are already available worldwide, while others are still applied only in limited numbers in leading hospitals.

Causative factors for liver cancer

The exact cause of liver cancer development changes (mutations) in the liver cells DNA that make them grow and reproduce unstoppably. The uncontrolled atypical cells eventually form a malignant neoplasm.

A number of conditions can affect liver cells in such a manner. They are called risk factors.

The most important risk factors include:

• Being infected with chronic viral hepatitis (HBV, HCV). These viruses contain own DNA and, thus, can damage the DNA of hepatic cells.
• Liver cirrhosis, including non-alcoholic fatty liver disease. Replacement of the normal liver tissue with the non-functioning connective tissue creates a basis for cancer development.
• Excessive alcohol consumption. Alcohol has a direct toxic effect on the hepatic cells, changing their structure irreversibly.
• Exposure to aflatoxins, thorium dioxide, and vinyl chloride has a similar direct toxic effect.
• Being overweight or obese. These conditions often lead to fatty liver disease or cirrhosis.
• Type 2 diabetes mellitus. In patients with this condition, the liver works hard in order to cope with the excessive blood sugar level. In addition, certain hypoglycemic drugs can affect the liver negatively.
• Inherited liver diseases and metabolic disorders like Wilson's disease, hemochromatosis, and porphyria cutanea tarda.
• Avoiding risk factors significantly lowers the chance of having liver cancer. Additional protective measures, like being vaccinated against hepatitis B, can also be applied.

How can I know that I have liver cancer?

At the early stages, hepatic cancer does not cause any worrying symptoms. As the disease becomes more advanced, the following signs may arise:

• Unexplainable weight loss.

• Loss of appetite, feeling full after a few pieces of food.

• Mild or severe nausea, vomiting.

• Pain in the upper abdomen (usually on the right side, under the ribs).

• The yellow color of skin and eyes, skin itching (signs of liver dysfunction).

• Enlarged, visible veins on the abdomen.

Even having all the above-mentioned symptoms does not mean that you have liver cancer.

The precise diagnosis is made only after a number of additional tests and histological verification.

First, you should see your general practitioner, who will ask you about the symptoms and perform a physical examination. After that, the laboratory and instrumental diagnostics start:

• Blood tests for alpha-fetoprotein, viral hepatitis B and C, liver function tests.

• Ultrasound examination.

• MRI or CT scan.

• Angiography.

• Biopsy, either a needle, laparoscopic or surgical one.

Once all the tests are done, a doctor has comprehensive information about the tumor size, localization, blood supply, and histological type. This data allows for careful planning of the treatment scheme.

What are the most efficient treatments for liver cancer?

According to the data of the World Cancer Research Fund, over 840,000 new liver cancer cases were diagnosed in 2018. High disease incidence stimulates the search for new options for the treatment of liver cancer. These include a variety of effective techniques, from surgical removal of the tumor to the destruction of cancer cells with the chemotherapeutic agents. Physicians of the best hospitals in this sphere may choose between:

1. Surgery. During the intervention surgeons may remove half of the organ (unilateral hepatectomy), the full organ (extensive liver resection) or a certain part (atypical marginal or wedge liver resection).
2. Non-surgical interventions include a few procedures that destroy the tumor without opening the abdomen. The radiofrequency ablation uses high-energy radio waves; the percutaneous alcohol ablation uses ethanol (it is injected into the neoplasm) for the same purpose. Cryotherapy implies freezing atypical cells with cold gases.
3. Chemotherapy is killing cancer with drugs that are administered by mouth, through a vein or directly into the hepatic artery (the last one is a more technically challenging procedure that requires special skills from a doctor).
4. Immunotherapy is a more novel treatment option that stimulates the patient's own immune system and “teaches” it to recognize malignant cells. Opdivo (nivolumab) is successfully used for liver cancer treatment.
5. Targeted therapy is a suitable treatment for patients with unresectable tumors. Targeted drugs deprive neoplasms of nutrients by blocking the blood supply. Nexavar (sorafenib) is a first-line targeted drug and Lenvima (lenvatinib) is an alternative option.
6. Radiation therapy is not widely used as the liver tissue is highly susceptible to irradiation. Thus, healthy tissues are actively destroyed along with the affected ones. This causes numerous side effects and can lead to hepatic insufficiency development.

Medical programs in specialized liver cancer centers have a few aims.

The first one is removing the tumor (preferentially) or preventing its further growth and spreading. The second one is managing the disease symptoms and restoring patients' quality of life.

The second goal is achieved due to the comprehensive rehabilitation programs that always follow the treatment in the countries with a high level of healthcare systems.

What are the best hospitals for liver cancer treatment?

Choosing the appropriate healthcare facility for diagnostics and treatment of liver cancer is extremely important.

For instance, reliable histological verification of the tumor type is essential for treatment planning as cholangiocarcinomas, hepatocellular carcinomas and secondary tumors (metastases) require different medical tactics. In its turn, histological verification is possible only after the biopsy, which is technically complicated due to the liver localization and intensive blood supply.

Further, the healthcare facility should be equipped with apparatuses for conventional, minimally invasive and atypical surgeries; different types of ablation and embolization. Surgeons should be qualified enough for performing innovative procedures. Hospital should have access to all types of drugs. Only in this case doctors will not be restricted in their choice and will apply the most efficient techniques for restoring patient’s health.

The list of the best liver cancer hospitals in the world includes:

1. University Hospital of the Ludwig Maximilian University of Munich, Munich, Germany. The Department of Gastroenterology and Hepatology.
2. Charite University Hospital, Berlin, Germany. The Department of Hepatology and Gastroenterology.
3. University Hospital Duesseldorf, Duesseldorf, Germany. The Department of Gastroenterology, Hepatology, and Infectology.
4. University Hospital Ulm, Ulm, Germany. The Department of Gastroenterology and Hepatology.
5. Primus Super Speciality Hospital, New Delhi, India. The Department of Gastroenterology and Hepatology

The list of the best-specialized hospitals is renewed every year, according to the updated information on hospital’s success rates, qualification of the healthcare professionals, updates of the equipment, participation in clinical trials and scientific research, etc.

Is it possible for a foreigner to undergo treatment in a world-famous hospital?

As a rule, large international hospitals are ready to admit foreign patients and have special quotas for this. The size of the quota and waiting period typically depends on the hospital level and type of the required medical service (e.g. the waiting list for the chemotherapy will be shorter than the waiting list for minimally invasive robotic surgery).

In addition, international patients need to receive the official invitation for treatment, prepare a full package of medical and administrative documents, issue visa, take care of flight and accommodation, find an interpreter, etc.

In case you do not have any experience in undergoing treatment abroad, it is better to use the help of Booking Health. Booking Health takes care of arranging treatment abroad for patients from 75 countries. The company has an international quality control certificate ISO 9001:2015 in the field of medical tourism.

Booking Health offers help in such important aspects:

• Choosing the most appropriate liver cancer center.
• Preparing a medical program in advance, considering the necessary diagnostic and curative procedures.
• Providing favorable costs for medical services, without additional coefficients for foreign patients (saving up to 50%).
• Booking the appointment, including urgent doctor’s consultations.
• Communication with the clinic after treatment completion, receiving all medical reports.
• Financial control, return of unspent funds.
• Organization of additional procedures or rehabilitation, if necessary.
• Full-package of the non-medical service of the highest level: booking accommodation and plane tickets, transfer, and services of an interpreter.

To start planning your treatment, please leave a request on the website of Booking Health. Our patient case manager or medical advisor will contact you on the same day to discuss the details of the most beneficial medical program.