Understanding the Disease

What is liver cancer?

Liver cancer means a malignant tumour growing in or on the liver. It falls into two very different groups, and telling them apart changes the entire treatment plan.

Primary liver cancer starts in the liver itself. The commonest type is hepatocellular carcinoma (HCC), which usually arises in a liver already scarred by cirrhosis, hepatitis B or C, or fatty liver disease. Less common is cholangiocarcinoma, a cancer of the bile ducts.

Secondary liver cancer (metastases) is cancer that has spread to the liver from elsewhere — most often from the colon or rectum. These are called colorectal liver metastases (CRLM). Crucially, colorectal liver metastases are not "terminal" by default: with surgery, a large share of patients can be cured.

Because the liver regenerates, a surgeon can safely remove a substantial portion provided enough healthy liver remains. This is what makes specialist liver surgery possible.

The most important message for patients

Many people are told elsewhere that liver tumours are "inoperable." A second opinion at a specialist hepatobiliary centre often changes this — with techniques such as portal vein embolisation, two-stage hepatectomy and combining surgery with chemotherapy, tumours once considered unresectable can frequently be removed. If you have been told surgery is not possible, it is worth a dedicated review.

Types We Treat

The three forms of liver cancer surgery

Each type behaves differently and is approached with a tailored surgical and oncology plan.

Hepatocellular Carcinoma (HCC)

Primary liver cancer, usually on a background of cirrhosis or hepatitis. Treated by resection or, in selected cases, transplant. Liver function (Child-Pugh) guides how much can be safely removed.

Cholangiocarcinoma

Cancer of the bile ducts — intrahepatic, perihilar (Klatskin) or distal. Often needs major hepatectomy with bile duct reconstruction, and sometimes combined with a Whipple's procedure.

Colorectal Liver Metastases (CRLM)

Spread from colon or rectal cancer. Resection of liver metastases achieves long-term survival in a large proportion of patients — and is the only curative option. Often combined with chemotherapy.

Symptoms & Diagnosis

How liver cancer is found

Early liver cancer often causes no symptoms — which is why surveillance scans in at-risk patients matter so much. When symptoms do appear, common ones include:

Symptom

Upper abdominal discomfort or a mass

A dull ache or fullness under the right ribs, sometimes with a palpable lump.

Symptom

Jaundice — yellowing of eyes and skin

More typical of bile duct cancers; may come with dark urine, pale stools and itching.

Symptom

Unexplained weight loss & loss of appetite

Along with tiredness and, sometimes, low-grade fevers.

Diagnosis

Triple-phase CT & MRI liver

Specialised contrast scans characterise the tumour and map it to the liver's segments — essential for planning resection.

Diagnosis

Tumour markers & biopsy

AFP for HCC, CA 19-9 and CEA for bile duct and colorectal spread. Biopsy is used selectively, as imaging alone can confirm HCC.

Diagnosis

PET-CT & liver function assessment

To exclude disease elsewhere and confirm the future liver remnant will be large enough to function safely.

Staging

From diagnosis to a surgical plan

Every case is reviewed at a multidisciplinary tumour board (MDT) before any treatment begins. Staging answers one question: can the tumour be removed safely and completely?

Step 1

Confirm the diagnosis & type

Imaging, markers and — where needed — biopsy distinguish HCC, cholangiocarcinoma and metastatic disease.

Step 2

Assess liver function & remnant

Child-Pugh score, volumetry and overall fitness determine how much liver can be removed safely.

Step 3

MDT decision

Surgeons, oncologists, radiologists and pathologists agree the plan — surgery first, chemotherapy first, or a combined strategy.

Step 4

Optimise, then operate

If the future liver remnant is too small, portal vein embolisation or a two-stage approach grows it before definitive surgery.

Surgical Treatment

Liver resection — done the specialist way

The aim of every liver operation is the same: remove all the cancer with a clear margin, while leaving behind enough healthy, well-functioning liver. Dr. Gore uses ICG fluorescence and parenchyma-sparing techniques to achieve both.

ADD PHOTO

ICG-guided liver resection

Add a theatre / ICG fluorescence / da Vinci image here (16:9 landscape)

Procedure

Minor & major hepatectomy

From removing a single segment to a full right or left hepatectomy — matched precisely to where the tumour sits and how the liver is supplied.

Precision

ICG fluorescence guidance

Near-infrared dye lights up tumour boundaries and reveals small surface metastases that CT and MRI can miss — changing the operation in roughly one in five cases.

Liver-sparing

Parenchyma-sparing resection

Removing the tumour with a clear margin while preserving as much healthy liver as possible — important for cirrhotic patients and for repeat surgery later.

Minimally invasive

Robotic & laparoscopic hepatectomy

For suitable tumours, a minimally invasive approach means smaller incisions, less blood loss and faster recovery — with the same oncological clearance.

Advanced

Two-stage & portal vein embolisation

For extensive disease, the liver is grown in stages so that a tumour once judged unresectable can be safely removed.

Combined

Surgery with chemotherapy

For colorectal liver metastases, chemotherapy before and/or after surgery improves cure rates. The whole plan is sequenced at MDT.

Child-Pugh assessment Liver volumetry Pringle manoeuvre Low CVP anaesthesia Bile duct reconstruction ERAS recovery

Why Dr. Gore

Experience that changes what is possible

Experience

30+ years in GI & hepatobiliary cancer surgery

One of Pune's most senior surgical oncologists, with over 1,100 cancer operations and a 5-year surgical oncology residency at Tata Memorial Hospital, Mumbai.

Robotic

FARIS — University of Edinburgh

Fellowship in Advanced Robotic & Innovative Surgery, held by very few surgeons in India, underpinning the minimally invasive liver programme.

Technology

ICG fluorescence as standard

Routine near-infrared imaging for tumour mapping and detection of occult liver metastases in every major case.

Team

Full MDT & Centre of Excellence theatre

Every case reviewed with medical oncology, radiology and pathology; surgery performed at a Robotic Surgery Centre of Excellence.

Patient Questions

Liver cancer surgery — answered plainly

Not always. "Inoperable" at a general centre often means "not removable with one straightforward operation." At a specialist hepatobiliary centre, techniques such as portal vein embolisation, two-stage hepatectomy and combining surgery with chemotherapy can make resection possible. A dedicated second opinion with fresh imaging is genuinely worthwhile.

Yes — surgical removal of colorectal liver metastases is the only treatment that offers a cure, and a substantial proportion of patients achieve long-term survival. Many people told they were inoperable elsewhere are successfully resected at specialist centres, often after chemotherapy to shrink the disease first.

The liver regenerates, so a large portion can be removed as long as enough healthy liver remains to function. We measure this precisely with volumetry and liver-function testing. If the remnant would be too small, we grow it first using portal vein embolisation before operating.

ICG is a fluorescent dye that glows under near-infrared light. During surgery it highlights tumour edges and reveals small surface metastases that scans can miss — which can change the operation in around one in five cases, and helps achieve a complete, margin-clear resection.

For suitable tumours, yes. Minimally invasive (robotic or laparoscopic) liver resection offers the same oncological clearance with smaller incisions, less blood loss and faster recovery. Not every tumour is suited to it — the choice is made for each patient based on tumour size, position and liver condition.

Most patients are mobile within a day or two and home within about a week, depending on the extent of resection and whether surgery was minimally invasive. We use ERAS (enhanced recovery) protocols. The liver regrows over the following weeks, and follow-up scans and markers monitor for recurrence.

This page is general information, not personal medical advice. Liver cancer treatment is always individualised at a multidisciplinary tumour board. Please bring all scans and reports to your consultation.

Silver Leaf Clinic · Hadapsar, Pune

Book your liver cancer consultation

Dr. Gore sees liver and GI cancer patients at Silver Leaf Clinic, Hadapsar. Please bring all CT/MRI scans, biopsy and blood reports, and any previous operative notes to the first consultation — ideally on CD or shared via WhatsApp in advance.

Dr. Gore Direct / WhatsApp

84118 08284

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511, City Centre, Solapur Road, Opp. Vaibhav Theatre, Hadapsar, Pune 411028

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Monday – Saturday10:00 AM – 6:00 PM

SundayBy prior appointment

Surgical Hospital

Sahyadri Manipal Hospital, Pune · Robotic Cancer Surgery Centre of Excellence