This section discusses symptoms, risk factors, diagnosis and treatment for secondary cancer in the liver. See information about managing symptoms.
What is secondary cancer in the liver?
Secondary cancer in the liver is a cancer that started in another part of the body, but has now spread (metastasised) to the liver. This means it is advanced cancer. Secondary cancer in the liver is much more common than primary liver cancer in Australia.
Many cancers can spread to the liver. The most likely cancer to spread to the liver is bowel cancer. This is because the blood supply from the small bowel is connected to the liver through the portal vein. Melanoma and cancer in the breast, oesophagus, stomach, pancreas, ovary, kidney or lung can also spread to the liver.
Secondary cancer in the liver may be diagnosed:
- at the same time as the original cancer (called the primary cancer)
- soon after the primary cancer is found
- months or years after the primary cancer has been treated
- before the primary cancer is found when tests can't find where the cancer started – this is known as cancer of unknown primary (CUP).
If you have secondary cancer in the liver, it may be useful to read Cancer Council's information about the primary cancer type or cancer of unknown primary.
What are the symptoms?
Secondary cancer in the liver often has no symptoms if the tumours are small. As the cancer grows, symptoms can include:
- weakness and tiredness (fatigue)
- pain in the upper right side of the abdomen or right shoulder
- severe pain in the abdomen
- appetite loss and feeling sick (nausea)
- unexplained weight loss
- yellowing of the skin and eyes (jaundice)
- dark urine and pale bowel motions
- itchy skin
- a swollen abdomen (ascites)
Which health professionals will I see?
If you have not yet been diagnosed with cancer, your general practitioner (GP) will arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a specialist. For secondary cancer in the liver, you are likely to see a doctor who specialises in the original cancer (e.g. a colorectal surgeon or medical oncologist for bowel cancer).
The specialist will arrange further tests and consider treatment options. Often the treatment options will be discussed with other health professionals at what is known as a multidisciplinary team (MDT) meeting. During and after treatment, you will see a range of health professionals who specialise in different aspects of your care.
Secondary cancer in the liver is diagnosed using several tests. These include blood tests and imaging scans.
Blood tests cannot diagnose secondary cancer in the liver on their own, but they can give doctors more information about the cancer. Samples of your blood may be tested to check how well the liver is working and to see if the liver is making proteins to help the blood clot.
You are likely to have a number of imaging scans to check the size of the cancer.
The most common imaging scan used to check the liver is an ultrasound. You will also need to have CT and/or MRI scans.
Some people may also be offered a specialised test called a PET-CT scan. This is a positron emission tomography (PET) scan combined with a CT scan. It produces a threedimensional colour image that may show where cancers are in the body. This test is available only at some major hospitals and may not be funded by Medicare. It is occasionally used for secondary cancer in the liver that has spread from the bowel or from a melanoma.
For the PET scan, you will be injected in the arm with a glucose solution containing a small amount of radioactive material. It takes 30–90 minutes for the solution to go through your body. During this time, you will be asked to sit quietly. Your whole body will then be scanned for raised levels of radioactive glucose. Cancer cells show up brighter on the scan pictures because they are more active and take up more of the glucose solution than normal cells do.
A tissue sample ( biopsy) may be used to confirm a diagnosis of secondary cancer in the liver. The sample may be removed with a needle (core biopsy) or with a small surgical procedure (laparoscopy). The biopsy is examined under a microscope in a laboratory.
Tests to find the primary cancer
If the tests listed above show you have secondary cancer in the liver, the next step is to work out where in the body the cancer started. This may be clear if you have been treated for cancer in the past; otherwise, you will need further tests.
Some people have an examination of the bowel (colonoscopy), the stomach (endoscopy) and, for women, the breasts (mammogram). You may also have a blood test to check for particular chemicals produced by cancer cells. These are known as tumour markers and they relate to the primary cancer – for example, bowel cancer sometimes produces a tumour marker called carcinoembryonic antigen (CEA). A urine test can show whether the kidneys and bladder are working properly.
Sometimes, even after several tests, the primary cancer can't be found. This is called cancer of unknown primary (CUP).
Staging is the process of working out how far a cancer has spread in the body.
Because it has spread from another part of the body, secondary cancer in the liver is considered advanced cancer. It will be given a stage using the system for the original cancer – for example, if it started in the bowel, it will be staged using a system called TNM (tumour-nodes-metastasis). For more information, see the Cancer Council information on the primary cancer.
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease.
To work out your prognosis, your doctor will consider:
- test results
- the type of cancer
- the size of the cancer
- how fast the cancer is growing
- how well you respond to treatment
- other factors such as your age, fitness and overall health.
Doctors often use numbers (statistics) when considering someone's prognosis. Statistics reflect the typical outcome of disease in large numbers of people. While statistics give doctors a general idea about a disease, they won't necessarily reflect your situation.
Although most cases of secondary cancer in the liver can't be cured, surgery and other treatments can keep many cancers under control for months or even many years. Whatever the prognosis, palliative treatment can relieve symptoms, such as pain, to improve quality of life. It can be used at any stage of advanced cancer.
See Living with Advanced Cancer.
What to expect
To help people with liver cancer receive the best care possible, we have developed an optimal cancer care pathway. View the guide to make sure you get the best care and support at each stage.
The aim of treatment for secondary cancer in the liver is to control or shrink the cancer and improve quality of life. The types of treatment suitable for you will depend on the location of the original cancer, the size and number of tumours, and your age and general health.
The main treatments for secondary cancer in the liver are chemotherapy or a combination of surgery and chemotherapy. You may also be having treatment for the primary cancer or be offered palliative treatment.
Chemotherapy is the use of drugs to kill, shrink or slow the growth of tumours.
The type of drugs used will depend on where in the body the cancer first started. For example, if you have cancer of the breast that has spread to the liver, you will have chemotherapy designed to treat breast cancer. You will probably have a combination of two or three chemotherapy drugs.
Chemotherapy may be used at different times:
- before surgery, to shrink the secondary cancer in the liver and make it easier to remove – this is called neoadjuvant chemotherapy
- after surgery, to get rid of any remaining cancer cells – this is known as adjuvant chemotherapy
- to slow down cancer growth and reduce symptoms such as pain – this may be called palliative treatment.
Chemotherapy is usually given as a course of drugs over a few months. The drugs may be injected into a vein (given intravenously) or taken by mouth as tablets.
Side effects of chemotherapy
Chemotherapy drugs circulate in the whole body and can affect normal, healthy cells as well as cancer cells. This can cause a range of side effects. Depending on the type of chemotherapy drug used, side effects may include: nausea; loss of appetite; tiredness; hair loss; skin changes; tingling or numbness in fingers and toes (peripheral neuropathy); and mouth sores.
People react to chemotherapy differently – some people have few side effects, while others have more. Most side effects are temporary, and there are ways to prevent or manage them. See Understanding Chemotherapy.
During chemotherapy, you will have a higher risk of bleeding or getting an infection. If you develop a temperature over 38°C, contact your doctor or go to the emergency department.
The aim of surgery is to remove the part of the liver that contains cancer. This is known as liver resection or partial hepatectomy. It is the most effective treatment, but it is only possible if there is enough healthy liver and the cancer hasn't spread to other parts of the body where it can't be removed (such as the bones). Some people need surgery for both the secondary cancer in the liver and the primary cancer. These operations may be done separately or at the same time.
A liver resection is a major operation. You will have a general anaesthetic and the surgeon will remove the tumour as well as some healthy-looking tissue around it. The operation may be done as open surgery (with one large cut) or as keyhole or laparoscopic surgery (with several smaller cuts).
Types of liver resections
Depending on the cancer's size and position, the liver resection may be called a right or left hepatectomy (removes the right or left part of the liver), extended right or left hepatectomy (removes most of the liver), or segmentectomy (removes a small section of the liver). Sometimes the gall bladder may also be removed, along with part of the muscle that separates the chest from the abdomen (the diaphragm). See the pictures under treatment for primary liver cancer.
After the surgery
The liver can repair itself easily if it is not damaged already. The part of the liver that remains after resection will start to grow, even if up to three-quarters of it is removed. The liver will usually regrow to its normal size within a few months, although its shape may be slightly changed. When a very large amount of the liver needs to be removed, you may need a procedure called a portal vein embolisation ( PVE) 4–8 weeks before the surgery.
Because a lot of blood passes through the liver, bleeding after surgery is a risk. Your medical team will monitor you for signs of bleeding and infection.
Some people experience jaundice (yellowing of the skin and whites of the eyes) after a liver resection. This is usually temporary and improves as the liver grows back.
You will spend 5–10 days in hospital after a liver resection.
See Understanding Surgery for more information about recovery after surgery.
People with tumours in both lobes of the liver sometimes need surgery that is carried out in two stages with a waiting period between them.
Stage 1 – The tumours are removed from one lobe of the liver (partial hepatectomy). Sometimes this surgery is combined with tumour ablation or removal of the original cancer.
Waiting period – After the first surgery, you will need to wait two months to allow your body to recover and the liver to regrow. Before you have the second operation, the size of your liver will be checked.
Stage 2 – If enough of the liver has regrown, the tumours in the second lobe of the liver will be removed with another partial hepatectomy.
Also known as radiotherapy, radiation therapy uses targeted radiation to treat cancer. The radiation is usually in the form of x-ray beams. Conventional external beam radiation therapy is not often used for secondary cancer in the liver, but two specialised forms of radiation therapy may be offered in some cases.
The most common use of radiation therapy for secondary cancer in the liver is selective internal radiation therapy (SIRT). This precisely targets cancers in the liver with high doses of radiation placed in tiny radioactive beads. See below for an explanation of the process.
SIRT may be offered for bowel cancer and other cancers that have spread to the liver when the tumours can't be removed with surgery. It's often used if there are many small tumours throughout the liver.
SIRT is not available in all hospitals. If you don't have private health insurance that covers this treatment, you may need to pay for it yourself. Talk to your doctor about SIRT and the costs involved.
Some specialised centres offer a form of external radiation therapy called stereotactic body radiation therapy (SBRT).
For SBRT, you will lie on an examination table and a machine will deliver a few high doses of radiation very precisely to the liver.
SBRT may be offered to some people with small secondary tumours in the liver. Check costs as it may not be covered by Medicare.
Understanding the selective internal radiation therapy (SIRT) process
Also called radioembolisation, SIRT is a treatment that can deliver high doses of radiation therapy to a liver tumour while causing little damage to normal liver tissue. It uses tiny radioactive beads known by the brand name SIR-Spheres. The procedure is performed by an interventional radiologist.
Before treatment (work-up day)
- You will have a number of tests, including blood tests and a test called an angiogram, as well as a trial run (simulation) of the treatment.
- For the angiogram, you will have a local or general anaesthetic. The interventional radiologist will make a small cut in the groin area and insert a thin plastic tube (catheter) into a blood vessel. The tube will be pushed up into the artery that feeds the liver (hepatic artery). A small amount of dye will be passed through the catheter into the bloodstream. On an x-ray, the dye shows the blood vessels in the liver and helps to map where the radioactive beads need to go.
- For the simulation, some tiny spheres similar in size to the SIR-Spheres will be inserted through the catheter to check how the SIR-Spheres will behave.
- The angiogram and simulation procedure take about 45 minutes and you will be observed for 3–4 hours afterwards. You may also have CT and lung scans, which take about an hour.
- If the results of these tests are good, you will have treatment 1–2 weeks later.
During treatment (delivery day)
- On the day of treatment, you will have another angiogram.
- The interventional radiologist will make a cut in the groin area and pass a catheter through to the hepatic artery.
- The SIR-Spheres will be inserted through the catheter into the hepatic artery. These beads can then deliver radiation directly to the tumour.
- The procedure takes about an hour. You will be monitored closely for 3–4 hours before being taken to a general ward, where you will recover overnight.
- After treatment, you may experience flu-like symptoms, nausea, pain and fever.
- These side effects can be treated with medicines, and you usually can go home within 24 hours.
- The SIR-Spheres will slowly release their radiation into the tumour over the next week or so. This means you may need to take particular precautions, such as avoiding close physical contact with children or pregnant women during this time. The interventional radiologist will explain any precautions to you.
Targeted therapy drugs
New drugs known as targeted therapy attack specific particles (molecules) in cancer cells to stop their growth or reduce the size of the tumour. These drugs are sometimes used to treat secondary cancers in the liver from bowel or breast cancer. They may be used after or together with other treatments.
Side effects of targeted therapy vary depending on the drugs used, but often include high blood pressure and diarrhoea. Talk to your doctor about managing side effects.
See UnderstandingTargeted Therapy
Because secondary cancer in the liver is advanced cancer, your doctor is likely to discuss palliative treatment for symptoms caused by the cancer. Palliative treatment aims to manage the symptoms without trying to cure the disease. It can be used at any stage of advanced cancer to improve quality of life.
As well as slowing the spread of cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include chemotherapy, targeted therapy, other medicines, radiation therapy or stenting. Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, practical, emotional, spiritual and social needs. The team also provides support to families and carers.
See Understanding Palliative Care and Living with Advanced Cancer.
Key points about secondary cancer in the liver
What it is
Secondary cancer in the liver is cancer that has spread to the liver from another part of the body. Many types of cancer can spread to the liver, but bowel cancer is the most common.
The main tests are blood tests and imaging scans, such as an ultrasound, CT or MRI scan. Other tests are not always needed, but may include a specialised scan called a PET-CT, a biopsy to check a tissue sample, and tests to look for the original cancer.
Most common treatments
- Chemotherapy uses drugs to kill, shrink or slow the growth of tumours. It may be given before or after surgery, or on its own.
- Liver resection is surgery to remove the part of the liver with cancer.
- Selective internal radiation therapy (SIRT) delivers radioactive beads directly into the liver.
- A special form of external beam radiation therapy known as stereotactic body radiation therapy (SBRT) delivers targeted doses of radiation to the liver.
- Targeted therapy drugs may be available to treat some secondary cancers in the liver.
- Palliative treatment can relieve pain and other symptoms of advanced cancer.
Expert content reviewers:
em>A/Prof Nicholas O'Rourke, University of Queensland, and Head of Hepatobiliary Surgery, Royal Brisbane and Women's Hospital, QLD; Dr Lorraine Chantrill, Senior Staff Specialist Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, and Honorary Research Fellow, Garvan Institute of Medical Research, NSW; A/Prof Mark Danta, Hepatologist, St Vincent's Hospital, Sydney, and St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, NSW; Dr Samuel Davis, Diagnostic and Interventional Radiologist, Qscan Radiology Clinics and Royal Brisbane and Women's Hospital, QLD; David Fry, Consumer; Dr Nigel Mott, Diagnostic and Interventional Radiologist, Wesley Hospital and Royal Brisbane and Women's Hospital, QLD; Chris Rivett, 13 11 20 Consultant, Cancer Council SA; Meg Rogers, Nurse Coordinator, Upper Gastrointestinal Service, Peter MacCallum Cancer Centre, VIC; A/Prof Simone Strasser, Senior Staff Specialist, AW Morrow Gastroenterology and Liver Centre and Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, and Central Clinical School, Sydney Medical School, University of Sydney, NSW.