Management of Liver Cancer

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is one of the trickiest diseases to manage. This is because of varied etiologies and presentations, imaging options as well as multiple treatment options across its various classifications.

The current diagnosis and management of primary liver cancer are based on the Barcelona clinic for liver cancer or the BCLC classification. With the ever-growing medical field, there have been multiple advancements in the management of liver cancer and this has increased the difficulty in selecting one option. This is why multimodality management with discussion in a multidisciplinary tumor board is very important to understand each option as well as to give the best possible treatment option to the patient.

This webinar is planned with a similar multi-disciplinary team that manages HCC at a tertiary care center in Mumbai, India.

CLINICAL SPECTRUM AND SCREENING: It begins with a detailed description of the commonly asked question “what causes liver cancer?” to the common liver cancer symptoms and signs to its screening protocols as well as liver cancer survival rate. This is a difficult area but, an important one to understand as far as the basics of the HCC disease are concerned and it has been very well covered in this crisp and clear talk by Dr. Aniruddha Phadke. He also discusses the role of ultrasound and AFP in disease screening and diagnosis. This talk is a must-listen for all students as well as patients of NASH/NAFLD/liver cirrhosis as they will get an idea of screening protocols.

IMAGING: This talk is followed by a nice overview of the imaging patterns and role of imaging in liver cancer diagnosis, CT, and MRI liver protocols as well as a detailed discussion of the LI-RADS. Dr. Amar Suri gives a nice overview of the CT/MR algorithm and then discusses the major and minor features of the LI-RADS with the help of a few case studies of HCC with liver MRI and liver CT. MRI of the liver is very helpful and this is also highlighted in this talk. What are the key points to look for in a liver MRI or CT of the liver are also highlighted.

SURGICAL MANAGEMENT: The management implications of LI-RADS groups as well as the stage-wise management of HCC as per the BCLC are then taken up by Dr. Gunjan Desai. This is the first of the talks to discuss liver cancer treatment based on its staging by BCLC. It also focuses on the advances in terms of the role of biological criteria in selecting the patients for a liver transplant to factors helpful in the identification of refractoriness to transarterial chemo-embolization (TACE) procedure for liver cancer. Management of cancer of the liver is discussed in this talk in a succinct manner.

LIVER RESECTION VERSUS LIVER TRANSPLANT FOR HCC IN CHILD CLASS A CIRRHOSIS: This is an interesting debate on what is the optimal treatment for localized HCC in Child A cirrhosis where the literature points in both directions and this point is highlighted by Dr. Prasad Pande for liver resection and Dr. Rajvilas Narkhede for a liver transplant. They provide convincing evidence for the feasibility and safety of both these options as well as the liver cancer prognosis for the selected treatment and the conclusion again points to the fact that a multi-disciplinary team approach is very important to select an appropriate treatment for the appropriate patients.

INTERVENTIONAL RADIOLOGY IN LIVER CANCER MANAGEMENT: Dr. Rahul Sheth takes us on a wonderful journey in this exciting field where he discusses radiofrequency ablation (RFA), microwave ablation (MWA), TACE procedure, Trans-arterial radioembolization (TARE) with case studies and real-life examples. Based on stages of liver cancer as per BCLC, these treatment options can be selected at appropriate times and this is nicely described in this excellent talk. He takes us to treatment response from concept to actual protocol and summarizes each of his sub-specialties in a very simplified manner.

SYSTEMIC TREATMENT IN HCC: This excellent talk by Dr. Mohan Menon summarizes the evidence and the selection criteria for Sorafenib, lenvatinib, regorafenib, ramucirumab, and also explains what is immunotherapy, immunotherapy drugs as well as the role of immunotherapy in liver cancer.
His talk also gives an overview of advanced treatments for liver cancer and this talk is followed by a small question-answer session.