HPB (Hepato – Pancreas – Biliary)
|Dr. Aditya J Nanavati
||MBBS, MS – General Surgery
The HPB department addresses the entire spectrum of surgical options for diseases of the liver (Hepato), Pancreas and Biliary system (gall bladder and bile duct). Common conditions that are treated at the HPB OPD include
Homeopathic medicines are effective in curing various diseases, such as the following:
- Benign (Non-cancerous) and
- Malignant (Cancer) diseases of the liver, pancreas, gall bladder and the bile duct.
Gall stones and bile duct stones (stones in the gall bladder).
Choledochal Cyst (swelling of the bile duct).
Pancreatitis - Acute and Chronic (inflammation of the pancreas).
Pseudocyst of the Pancreas (sequelae to pancreatitis).
Pancreatic lesions (Lump or swelling of the pancreas)
- Serous and mucinous Cysts
Focal Liver Lesions (Lesion seen on the ultrasound)
- Focal nodular hyperplasia(FNH)
- Hydatid cyst
- Amoebic and pyogenic liver abscess
Cancers of the liver, pancreas, gall bladder and the bile duct.
The symptoms and signs of cancer of the liver, gall bladder and pancreas
- Pain in abdomen
- Unexplained weight loss
- Abdominal distension
Why is it important to detect these cancers early?
- If you have any of the above symptoms and have one of the risk factors, it is essential to get investigated as soon as possible in order to detect it early.
- Only a small proportion of patients are deemed to have a cancer that can be cured completely by surgical re-section.
How do you detect or diagnose HPB cancers?
- Majority of the HPB cancers are detected with the help of a CT scan and certain blood cancer markers (CEA, AFP, CA 19.9).
- In addition, some of the patients may need to undergo an MRI scan.
- Patients with pancreatic cancers may need to undergo an endoscopic ultrasound in order to stage the disease and undergo a biopsy.
Primary liver cancer is the fifth most common cancer in the world and the third most common cause of cancer mortality and if left untreated, a 5 year survival rate is approximately 7%.
Cancer of the liver can be of two types-
a) Primary liver cancer/ Hepatocellular cancer (HCC)
- Can be seen on a background of cirrhotic or a normal liver.
- Risk factors for cirrhosis are alcohol, Hepatitis B, Hepatitis C, diabetes and fatty liver.
b) Secondary cancers are the ones that have spread to the liver from other organs like intestine, breast, pancreas and ovaries.
- Around 50% of patients with intestinal cancer will develop cancer spread to the liver.
- Majority of these can be offered a surgical liver re-section, with a possibility of cure.
Primary Liver Cancer
What is the treatment of liver cancer?
Once diagnosed only 30-40% of liver cancers can be re-sectioned, as this can be a silent condition and most patients present in the advanced stage.
What are the other treatment options for liver cancer (if curative re-section is not possible)?
There are a few options like
- Trans-arterial chemo-embolisation (TACE) (special technique to give directed chemotherapy).
- Radio-frequency ablation (RFA) (burning of liver tumours with special needles).
- Most patients with cirrhosis of the liver may need a liver transplant if the cancer is restricted to the liver.
The life time risk of getting pancreatic cancer is 1 in 71 (1.41%). 22 people die every day from pancreatic cancer as only 10% are diagnosed in time for potentially curative surgery.
Risk factors for pancreatic cancer
- Elderly people (age > 60 years)
- Chronic pancreatitis
- Family history of pancreatic cancer
What is the treatment of pancreatic cancer?
- Surgery is the only curative option with a 5 year survival of 30-35%. Without an operation, the 5 year survival rate is 0%.
- Only 10-15% of pancreatic lesions are amenable to curative re-section at the time of diagnosis as this can be a silent disease until symptoms appear.
What are the other treatment options in pancreatic cancer (if surgery is not possible)?
- It is common to find pancreatic cancers that are at an advanced stage and may not be able to undergo any form of surgery.
- The only other alternative options that are available are chemotherapy and radiotherapy. Both are palliative in intent and cannot cure the disease.
Gall Bladder Cancer
There is an extremely high incidence of gall bladder cancer in the Ganges river belt of northern India.
Risk factors for gall bladder cancer
- Gender - twice more common in women than men.
- Chronic cholecystitis and cholelithiasis (stones in the gall bladder).
- Chronic typhoid infection of gall bladder.
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What is the treatment of gall bladder cancer?
Surgery is the only curative option. Unfortunately, only a small proportion of patients detected with gall bladder cancer have an operable/curative tumour.
What are the other treatment options in gall bladder cancer (if surgery is not possible)?
If inoperable, some cancers can be downstaged with the help of chemotherapy and radiotherapy.