Cancer in the liver can either be a primary or secondary cancer. The two types of cancer are different.
- Primary liver cancer – cancer that starts in the liver. The most common type is hepatocellular carcinoma (HCC).
- Secondary liver cancer – cancer cells from a primary cancer can spread from another part of the body through the bloodstream or lymph vessels to the liver. It is much more common than primary liver cancer in Australia.
Secondary cancers keep the name of the original cancer. For example, secondary liver cancer that started in the lung is called metastatic lung cancer. Because the cancer has spread, it is considered advanced cancer.
Anatomy of the liver
The largest organ inside the body, the liver is about the size of a football. It is part of the digestive system, working with the gall bladder and pancreas to help break down food and turn it into energy.
The liver is found on the right side of the abdomen (belly) sitting just above the stomach and under the rib cage. The two main sections of the liver are the right and left lobes.
Blood flows into the liver from the hepatic artery and the portal vein. Blood in the hepatic artery comes from the heart and carries oxygen. Blood in the portal vein comes from the digestive organs and carries nutrients and substances (e.g. medicines) to the liver.
Unlike other internal organs, a healthy liver may be able to repair itself if it is injured or part of it is surgically removed during cancer treatment.
Function of the liver
The liver has many important jobs, including:
- storing sugars and fats, so they can be used for energy
- producing bile which helps dissolve fat so it can be easily digested
- making proteins to help blood clot and to balance fluid in the body
- breaking down harmful substances, such as drugs and alcohol.
Which cancers spread to the liver?
Bowel cancer is the most common cancer that spreads to the liver. This is because the blood supply from the bowel is connected to the liver through a major vein called the portal vein.
Other cancers that can spread to the liver include breast, oesophageal, stomach, pancreatic, ovarian, kidney, lung and melanoma. Sometimes, it’s not possible to find where the cancer started – this is called cancer of unknown primary (CUP). If you have secondary liver cancer, you may find it useful to learn more about the primary cancer type or CUP.
Types of cancer A-Z
If the tumours are small, secondary liver cancer may have no symptoms. As the cancer grows or spreads, a range of symptoms may occur, including:
- weakness and tiredness (fatigue)
- pain in the upper right side of the abdomen or right shoulder blade
- severe pain in the abdomen
- appetite loss and feeling sick (nausea)
- unexplained weight loss
- yellowing of the skin and eyes (jaundice)
- dark urine (wee) and pale faeces (poo)
- itchy skin
- a swollen abdomen (ascites)
Secondary liver cancer may be diagnosed at the same time as the primary cancer or up to several years after the primary cancer has been treated. It may also be diagnosed before the primary cancer. Secondary liver cancer is found using several tests, including blood tests and imaging scans.
Blood tests alone cannot diagnose secondary liver cancer, 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 (liver function tests) and to see if the liver is making proteins that help the blood clot.
Various imaging scans may be needed when secondary liver cancer is suspected:
- you may first have an ultrasound scan, which helps to show if there is a tumour in the liver and how large it is
- you will also have a CT (computed tomography) scan and/or an MRI (magnetic resonance imaging) scan, which can provide more detail about the size of the cancer and the number of tumours
- a PET (positron emission tomography) scan can be combined with a CT scan to provide even more detail about the cancer. This is called a PET-CT scan. Medicare does not always cover the cost of PET–CT scans for cancer diagnosis. If this test is recommended, check with your doctor if you will have to pay.
Occasionally, a tissue sample may be removed from the tumour to confirm a diagnosis of secondary liver cancer. This test is called a biopsy.
Tests to find the primary cancer
If test results show that you have secondary liver cancer, the next step is to work out where in the body the cancer started. This may be known if you have been treated for cancer in the past, otherwise, you will need further tests. Sometimes, even after several tests, the primary cancer can’t be found. This is called cancer of unknown primary (CUP).
Depending on where your doctor thinks the primary cancer started, you may have:
- an examination of the bowel (colonoscopy), stomach (endoscopy) or breasts (mammogram)
- a urine test to show whether the kidneys and bladder are working properly
- 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.
Staging is the process of working out how far a cancer has spread through the body. Because the cancer has spread from another part of the body, secondary liver cancer is considered advanced cancer (also called stage 4 cancer).
The secondary cancer will be given a stage using the system for the primary cancer. For example, if it started in the bowel, it will often be staged using a system called TNM (tumour–nodes–metastasis).
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 factors such as:
- the type of primary cancer
- the size and number of cancers in the liver
- how fast the cancer is growing
- your age
- your fitness and overall health.
Doctors often use numbers (statistics) when considering someone’s prognosis. While statistics give doctors a general idea about how a disease might progress, they won’t necessarily reflect your specific situation. Although most cases of secondary liver cancer can’t be cured, surgery and other treatments can keep many cancers and symptoms under control for months or even many years.
Questions to ask your doctors
This checklist may be helpful when thinking about questions to ask your doctor:
- What treatment do you recommend and why?
- What is the aim of the treatment?
- What are the risks and possible side effects of each treatment?
- Will the treatment affect my sex life and fertility?
- Are there any out-of-pocket expenses not covered by Medicare or my private health cover? Can the cost be reduced if I can’t afford it?
- Should I change my diet or physical activity during or after treatment?
- If I don’t have the treatment, what should I expect?
- How long do I have to make a decision?
- How will I know if the treatment is working?
- Will I have a lot of pain? What can be done about it?
- Are there any complementary therapies that might help me?
Understanding Secondary Liver Cancer
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Expert content reviewers:
Prof Desmond Yip, Clinical Director, Department of Medical Oncology, The Canberra Hospital, ACT; 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, 13 11 20 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; A/Prof Simone Strasser, Hepatologist, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital and The University of Sydney, NSW; David Thomas, Consumer.
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The information on this webpage was adapted from Understanding Secondary Liver Cancer - A guide for people affected by cancer (2022 edition). This webpage was last updated in July 2022.