Primary liver cancer can cause various symptoms, but there are ways to manage them. With advanced cancer, the palliative care team may be involved in managing symptoms.
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for liver cancer can help you make sense of what should happen. It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
Read the guide
One of the liver’s jobs is to process bilirubin, a yellow pigment formed when red blood cells in the body break down. Normally, the bilirubin passes from the liver, through the bile duct to the bowel, and then out of the body in faeces (poo).
With liver cancer, bilirubin sometimes builds up in the blood (jaundice). This can be because:
- the cancer has blocked a bile duct
- the liver is not working properly
- or the liver has been replaced by widespread tumour.
Jaundice can cause yellowing of the skin and whites of the eyes, pale faeces, dark urine and itchy skin. This itching is often worse at night. It can be relieved to some degree by keeping your skin moisturised, and avoiding alcohol, spicy food, hot baths and direct sunlight. If the itching continues, your doctor may prescribe medicine, which can sometimes help.
When jaundice is caused by a blocked bile duct, it may be relieved by unblocking the duct with a small tube made of plastic or metal (a stent). Symptoms of jaundice usually go away 2–3 weeks after the stent is put in place. The earlier the stent is inserted, the less severe the symptoms. Stenting is not always recommended or possible in advanced cancer.
In some people, the liver cancer itself can cause pain, particularly in the upper right area of the abdomen (belly) and, sometimes, in the right shoulder. In advanced cancer, the liver may press on nerves that connect to the shoulder (referred pain).
Pain associated with liver cancer can be managed with different types of pain medicines. Some medicines, such as ibuprofen and aspirin, may not be suitable for pain caused by liver cancer, especially in people with a history of gastric ulcers or gastritis. Speak to your doctor about the best type of medicines to use to manage pain.
Radiation therapy may also provide relief by reducing the size of a liver tumour that is causing pain. Some people may have an injection of local anaesthetic to numb the nerve sending the pain signals (nerve block). People may also be referred to a palliative care or pain specialist, as this can be very helpful in managing pain caused by cancer.
Poor appetite and weight loss
Because the liver plays a key role in the digestive system, cirrhosis and cancer in the liver can affect how much you eat, and you may lose weight. Radiation therapy and other cancer treatments can also have an impact on appetite and weight, especially if you have side effects such as nausea and vomiting, mouth ulcers, and taste or smell changes.
Maintaining your weight can help your recovery, so it’s important to eat and drink enough during and after treatment. Gentle physical activity, like a short walk around the block, can stimulate appetite, and eating a variety of foods may boost how much you eat. Your doctor may suggest that you avoid salty foods as these can increase the risk of ascites.
More about cancer and nutrition
Ascites is when fluid builds up in the abdomen. In people with cirrhosis, pressure can build up in the blood vessels inside the liver, which may force fluid to leak into the abdomen. Ascites can also be caused by the cancer itself blocking lymph or blood vessels or producing extra fluid.
The fluid build-up causes swelling and pressure in the abdomen. This can be uncomfortable and may make you feel breathless. A procedure called paracentesis or ascitic tap can provide relief. Diuretics (sometimes called water tablets) may be prescribed with paracentesis to slow down the build-up of fluid.
Chronic liver disease may cause toxic substances to build up in the blood, which can affect how your brain functions. Called hepatic encephalopathy, it can lead to confusion or disorientation and, in severe cases, coma. Carers need to look out for these symptoms as this condition can develop quickly. Hepatic encephalopathy can be controlled with medicines.
Many people with primary liver cancer experience fatigue. This is different to normal tiredness as it doesn’t always go away with rest or sleep. The fatigue may be a side effect of treatment or caused by the cancer itself. Managing fatigue is an important part of cancer care.
After treatment ends, you will have regular appointments to monitor your health, manage any long-term side effects and check that the cancer hasn’t come back or spread. During these check-ups, you will usually have a physical examination and you may have blood tests, x-rays or scans.
People who still have hepatitis B or hepatitis C may be given medicines (antiviral therapy) to help manage these diseases and reduce the chance of the cancer coming back. Your doctor will also talk to you about the importance of not drinking alcohol, not smoking, eating healthy foods and exercising.
Check-ups will become less frequent if you have no further problems. Between follow-up appointments, let your doctor know immediately of any symptoms or health problems.
What if the cancer returns?
For some people, liver cancer does come back after treatment, which is known as a recurrence. The cancer may come back in the liver, in nearby organs or in other parts of the body. This is why it’s important to have regular check-ups.
You may be offered more treatment, which will depend on the type of cancer you have, where it has spread, your general health and the types of treatment you have had before.
When cancer won't go away
For many people with primary liver cancer, the cancer cannot be cured. Talking to your health care team can help you understand your situation and plan for your future care. Palliative treatments may help control the growth of the cancer and allow you to continue doing the things you enjoy for months or even several years.
Facing the fact that the cancer cannot be cured can be very distressing. You can call us on 13 11 20 for support and information or talk to the social worker or spiritual care practitioner (such as a chaplain) at your hospital or treatment centre.
Understanding Liver Cancer
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Expert content reviewers:
A/Prof Simone Strasser, Hepatologist, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital and The University of Sydney, NSW; A/Prof Siddhartha Baxi, Radiation Oncologist and Medical Director, GenesisCare, Gold Coast, QLD; Prof Katherine Clark, Clinical Director of Palliative Care, NSLHD Supportive and Palliative Care Network, Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW; Anne Dowling, Hepatoma Clinical Nurse Consultant and Liver Transplant Coordinator, Austin Health, VIC; A/Prof Koroush Haghighi, Liver, Pancreas and Upper Gastrointestinal Surgeon, Prince of Wales and St Vincent’s Hospitals, NSW; Karen Hall, 131120 Consultant, Cancer Council SA; Dr Brett Knowles, Hepato-Pancreato-Biliary and General Surgeon, Royal Melbourne Hospital, Peter MacCallum Cancer Centre and St Vincent’s Hospital, VIC; Lina Sharma, Consumer; David Thomas, Consumer; Clinical A/Prof Michael Wallace, Department of Hepatology and Western Australian Liver Transplant Service, Sir Charles Gairdner Hospital Medical School, The University of Western Australia, WA; Prof Desmond Yip, Clinical Director, Department of Medical Oncology, The Canberra Hospital, ACT
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The information on this webpage was adapted from Understanding Liver Cancer - A guide for people with cancer, their families and friends (2022 edition). This webpage was last updated in July 2022.