Liver is the largest internal organ of the body responsible for essential functions such digestion, nutrient absorption, waste removal, blood clotting, and metabolism of fats, proteins, and vitamins. The liver is made up of many cells that line its blood vessels and small tubes, which makes it susceptible to several types of malignant (cancerous) and benign (non-cancerous) tumours. Because all the blood in the body passes through the liver, it is unusually accessible to cancer cells in the bloodstream that can lead to liver cancer. If the cancer cell formation starts in the liver, it is termed as primary liver cancer (hepatocellular carcinoma) whereas cancer spread from other body part to the liver is known as secondary liver cancer.

Risk Factors

Certain conditions or behaviour can make an individual more vulnerable to developing a disease. Having cirrhosis can increase the chances of developing hepatocellular carcinoma, the most common form of liver cancer in adults. Cirrhosis is a type of chronic liver disease that occurs due to severe scarring of the liver, primarily due to overconsumption of alcohol. Hepatitis B and C can also cause permanent damage to liver and lead to liver failure. Some of the other factors responsible for liver cancer include:

·         Excessive smoking

·         Consumption of herbicides and chemicals

·         Exposure to Aflatoxins

·         Anabolic steroid use

·         Family history

·         Inherited metabolic diseases

·         DNA mutations

Symptoms

Signs and symptoms do not usually appear in the earlier stages of primary liver cancer. However, an individual may experience following symptoms.

·         Upper abdominal pain

·         Nausea and vomiting

·         General weakness and fatigue

·         Abdominal swelling

·         White/chalky stools

·         Unexplained weight loss

·         Back pain

·         Swollen veins visible under abdominal skin

·         Yellowing of skin and whites of the eyes

·         Pain near the right shoulder blade

Diagnosis of Liver Cancer

The diagnosis of liver cancer may start with a physical examination and analysis of medical history of the individual. Other tests and procedures might include:

·         Blood tests

To detect any abnormal functionality in the organ.

·         Imaging tests

Imaging tests such as ultrasound, CT scan and MRI to visualize the internal parts of the body.

·         Liver Biopsy

·         The biopsy can be performed to remove a piece of liver tissue, which can be further used for laboratory testing to make a definitive diagnosis of the problem under the microscope to look for cancer cells.

Cancer Stages

Cancer stage determines the extent to which the cancer cells have spread in the body and the kind of treatment required.

·         Stage 1

A single tumour of 2 cm of less which may or may not include blood vessels is present. However, the tumour may have grown into veins, arteries, or bile ducts but has not spread to lymph nodes or other parts of the body.

·         Stage 2

A single tumor larger than 2 cm grown into veins, arteries, or bile ducts is present. There might be multiple tumors less than 2 cm however, the cancer does not spread to lymph nodes or other parts of the body.

·         Stage 3

A person might have single tumour larger than 5 cm or multiple tumors of any size involving a major branch of portal or hepatic vein or tumor that involve nearby organs.  Cancer may not have spread to other the lymph glands.

·         Stage 4

The person can have a tumor of any size and more than one tumor in the liver. Cancer spread to lymph nodes but not the other parts of the body.

Liver Cancer Treatments

The earlier the liver cancer is detected, the better are the prevention measures available. Generally, there are two types of treatment option.  

·         Local Therapy

Local Therapy involves treatment on a certain area that include surgery, ablation, radiation therapy and embolization.

·         Systemic Therapy

The systematic therapy is more focused for treatment throughout the body that include chemotherapy, immunotherapy, and targeted therapy.

According to TechSci research report on “Global Liver Cancer Therapeutics Market By Cancer Type (Hepatocellular Carcinoma, Cholangiocarcinoma, Liver Metastasis, Hepatoblastoma, Angiosarcoma), By Therapy (Targeted Therapy, Radiation and Chemotherapy Therapy, Immunotherapy, Others), By Equipment (Computed Radiography, MRI, Sonography, Others), By Age (0-18, 18-35, 35-50, 50+), By Factors (Non-Alcoholic Fatty Liver Disease, Cirrhosis, Excessive Liver Consumption, Others), By Route of Administration (Oral, Intra-Venous, Others ), By Distribution channel (Hospital Pharmacies, Retail Pharmacies, Online Pharmacies), By Region, Competition, Forecast & Opportunities, 2025”, global liver cancer therapeutics market is projected to grow at a CAGR of 7.24% and reach a market value of USD11.52 billion by 2025. The growth can be attributed to factors like rising incidences of liver cancer globally, mainly due to increasing alcohol consumption and poor lifestyle habits. Growing investment by both public and private sector in research and development activities for effective therapeutic treatment for cancer and rapidly evolving healthcare infrastructure in developing economies to drive global liver cancer therapeutics market growth.

Local Therapy Options

1.    Surgery

The objective of the surgery is to eliminate all the cancer cells to reduce symptoms and provide supportive care. The type of surgery depends on size, location, number of tumors in liver, severity of cirrhosis (if present). Different types of surgery options may include tumor resection or partial hepatectomy.

      I.        Tumor resection

The tumor resection aims to remove all of the cancer from the area. However, the surgeon might remove some normal-looking tissue around its edge, called surgical margin. In R1 positive margin, the surgeon removes the visible tumor but the microscopic tumor cells might still be present around the edges. In R2 positive margin, the surgeon does not remove all of the visible tumor. The negative margin (R0) is when the surgeon removes all the cancerous cells found around the edge of the visible tumor and it generally tends to give the best result. An individual might require more than one surgery to prevent fluid collecting in the body after the surgery.

    II.        Partial Hepatectomy

During partial hepatectomy, the surgeon might remove an entire portion of the liver or a small wedge. The missing section will regrow in some time and the other part will continue its working. However, people with a fatty liver, cirrhosis or fibrosis might not be the suitable candidates for this kind of surgery due to increased complications.

2.    Liver Transplant

In a liver transplant, the surgeon removes the entire liver and replaces it with a healthy donor liver. The liver transplant depends on the severity of tumor, size limits and the tumor locations. Replacing the liver also requires reconnecting inferior vena cava, portal vein, hepatic artery, and bile ducts. Either the whole liver or a portion of the liver may be replaced during the liver transplant. However, there is still a probability that cancer might return after the liver transplant however, medicines may be prescribed to prevent rejection.

3.    Ablation

The technique utilizes extreme heat or cold, radio waves, microwaves, or chemicals to eliminate the destroy small tumors with little harm to surrounding tissues. Ablation requires a special needle, called a probe that is inserted into the tumour to destroy it. With cryoablation, a medical gas is passed through the probe to freeze the tumour and kill the cancer cells. With radio frequency ablation, the cancer cells are destroyed by heating them. Chemical ablation includes percutaneous ethanol injection or acetic acid to kill cancer cells. The ablation process can be done through the skin or using a large incision like surgery.

4.    Arterially Directed Therapy

The Arterially Directed Therapy treats tumours by injecting particles or radioactive beads directly into the blood vessels that supply the tumor(s). A catheter is used to insert into the arteries and once in place, the particles or beads are injected. The common types of arterially directed therapy includes Trans arterial Bland Embolization, Chemoembolization, DEB-TACE (Drug-Eluting Bead Trans arterial Chemoembolization) and Trans arterial Radio embolization. The therapy may be used as a bridging treatment before a liver transplant and the type of treatment largely depends upon the size, number, and location of tumors.

5.    Radiation Therapy

The Radiation therapy (RT) is an effective treatment for all the tumors irrespective of the location. The therapy utilizes high-energy x-rays, gamma-rays, protons, and other sources to kill or shrink the cancer cells. RT can be given as a primary treatment or in combination with other treatments or as a supportive care to help ease the pain caused by cancer or as an adjuvant treatment to kill any remaining cancerous cells. The different types of external beam radiation therapy include

·         Stereotactic body radiation therapy kills or ablate the tumor with either photons or protons.

·         Proton beam radiation therapy kills tumor cells with protons and reduce the dose of radiation to surrounding cells.

·         Three-dimensional conformal radiation therapy aims beams that aligns with the shape of the tumor.

·         Intensity-modulated radiation therapy uses small beams to limit the amount of radiation to normal tissues.
Image-guided radiation therapy create a picture of tumor and guide radiation beam during the treatment.

·         Intraoperative radiation therapy kills cancer cells during the surgery.

·         Palliative external beam radiation therapy helps to relieve the pain caused by cancer. 

Systematic Therapy Options

·         Chemotherapy

It is one of the widely used treatments aimed to destroy cancer cells spread throughout the body. It is a type of drug therapy which attacks rapidly dividing cancer cells and normal cells. The treatment can affect the information inside genes, which tell cancer cells how and when to proliferate and divide. The chemotherapy cannot cure or control the spread of cancer and is simply used to shrink tumours that often continue to grow back. Chemotherapy can be used in conjunction with surgery, radiation therapy or biological therapy. The duration of chemotherapy treatment depends upon certain factors such as the type of cancer, how far along it is goal of treatment, type of chemotherapy, and the way your body responds to treatment.

·         Targeted Therapy

 Targeted therapy affects the tissue environment that helps cancer cells to grow and survive like blood vessel cells. Targeted therapy can do several things to disrupt the cancer cells such as block or turn off signals to cease cell growth, prevent cells from living longer, and destroy cancer cells completely. To block the signals that cause cancer cells, tyrosine kinase inhibitor (TKI), a type of targeted therapy is prescribed. Some of the other targeted therapies include Sorafenib, Lenvatinib, Atezolizumab, and Bevacizumab.

·         Immunotherapy

Immunotherapy aims to strengthen the body’s defence mechanism to enhance the body’s ability to destroy cancer cells. The immunotherapy utilizes substances that are just like immune system components and use them to restore or improve the immune system for its proper functioning. Types of cancer immunotherapy includes checkpoint inhibitors, cytokines, immunomodulator, cancer vaccines, monoclonal antibodies, chimeric antigen receptor T-cell therapy, and oncolytic viruses.

According to TechSci research, “India ImmunologyDrugs Market By Drug Class (Monoclonal Antibodies (mAb), Antibody Drug Conjugates, Interferon and Cytokine therapies, Immunosuppressive medication, Others), By Indication (Arthritis, Plaque Psoriasis, Spondylitis, Inflammatory Bowel Disease, Transplant Rejection, Others), By Application (Hospitals, Clinics, Cancer Research Institute, Others), By Company, By Region, Forecast & Opportunities, FY2026”, India immunology drugs market is anticipated to grow at a significant rate during the forecast period, owing to factors such as high prevalence of immunological and autoimmune disorders. Advanced development in medical technology and rising adoption of monoclonal antibody for treatment of immunological disorders to further fuel the demand for immunology market through FY2026.