The aim of treatment for secondary liver cancer depends on the type of primary cancer that has spread to the liver. For some people, the aim may be to remove or destroy the cancer using surgery and chemotherapy. For others, the aim may be to shrink the cancer, manage symptoms and improve quality of life.
The types of treatment suitable for you will also depend on the size and number of tumours, and your age and general health. The main treatment for secondary liver cancer is chemotherapy or a combination of surgery and chemotherapy.
Chemotherapy uses drugs to kill, shrink or slow the growth of cancer cells. The type of drugs you are given will depend on where in the body the cancer first started.
Depending on the aim of treatment, chemotherapy may be given as a short course over a few months, or it may be given as a longer course over many months or years. The drugs may be injected into a vein and/or swallowed as tablets.
Chemotherapy may be used at different times:
- before surgery, to shrink the secondary liver cancer and make it easier to remove (neoadjuvant chemotherapy)
- after surgery, to get rid of any remaining cancer cells (adjuvant chemotherapy)
- to slow down cancer growth and reduce symptoms such as pain (palliative treatment).
People react to chemotherapy differently – some people have few side effects, while others have more. Most side effects last only while you are having treatment, and there are ways to manage them. Talk to your doctor for support.
Targeted therapy is a type of drug treatment that attacks specific features of cancer cells to stop the cancer growing and spreading. Targeted therapy drugs may be used in combination with other treatments.
Side effects vary depending on the drugs used, but may include high blood pressure, rashes, diarrhoea, and tender hands and feet. Talk to your doctor about ways to manage side effects.
Drug treatment that uses the body’s own immune system to fight cancer is called immunotherapy. Several immunotherapy drugs are available in Australia. The type of drug used for secondary liver cancer will depend on where the cancer started in your body.
Immunotherapy drugs can cause a range of side effects – most are mild, but some are more severe. Most immunotherapy side effects can be managed and reversed if they are reported early to your doctor.
Some cancers – such as prostate cancer and certain types of breast cancer – rely on hormones to survive and grow. If one of these types of cancer has spread to the liver, hormone therapy may be an option. This treatment can lower the levels of certain hormones in the body to help to control hormone-dependent cancers. Hormone therapy is usually used in combination with other cancer treatments.
Side effects will vary depending on the type of drug you have. Talk to your doctor about ways to manage side effects.
Selective internal radiation therapy (SIRT)
Selective internal radiation therapy (SIRT) is the most common type of radiation therapy used for secondary liver cancer. Also called radioembolisation, SIRT may be offered when there are many small tumours in the liver that can’t be removed with surgery. It is usually needed only once. SIRT combines embolisation (which blocks blood supply to the tumour) with internal radiation therapy.
SIRT precisely targets cancers in the liver with high doses of internal radiation. Tiny radioactive beads (made of glass or resin) are delivered through the blood vessels to the cancer. The radiation from these beads damages the cancer cells and their blood supply, while causing little damage to normal cells.
You may have flu-like symptoms, nausea and pain, which can be managed with medicines. You may need to take some safety precautions, such as not sharing a bed and avoiding close physical contact with children or pregnant women for a short time. Talk to your doctor for support.
Stereotactic body radiation therapy (SBRT)
An increasing number of cancer centres now offer stereotactic body radiation therapy (SBRT), which is also called stereotactic ablative body radiation therapy (SABR). SBRT is a type of external beam radiation therapy. It may be offered to some people with small secondary tumours in the liver.
You will be asked to lie very still on a treatment table. A machine will precisely target beams of radiation from many different angles onto the tumour. The highly targeted radiation means surrounding healthy tissue is protected. SBRT requires fewer treatment sessions than conventional external beam radiation therapy. People may need only 3-8 sessions over one or two weeks.
Side effects may include fatigue, nausea, and soreness in the treatment area. Talk to your doctor about ways to manage side effects.
A small number of people with secondary liver cancer may be able to have surgery to remove the cancer (also known as liver resection or partial hepatectomy). A liver resection is only an option for people with some types of secondary cancer and when there will be enough healthy liver for it to regrow. Surgery is also only possible when the cancer hasn’t spread to other parts of the body where it can’t be removed, such as the bones.
A liver resection is a major operation. You will have a general anaesthetic and the surgeon will remove the cancer as well as some healthy tissue around it. The operation may be done as open surgery (with one large cut in the abdomen) or as keyhole or laparoscopic surgery (with several smaller cuts).
When a large amount of the liver needs to be removed, you may have a procedure called portal vein embolisation (PVE) 4–8 weeks before the surgery. This procedure redirects the blood supply to the healthy part of the liver, helping it to grow. People with tumours in both lobes of the liver sometimes need two separate operations with a waiting period between each operation.
You will spend 5–10 days in hospital. You will be monitored for signs of infection or bleeding. Some people develop jaundice (yellowing of the skin and whites of the eyes), but this is usually temporary and improves as the liver grows back. The liver will usually regrow to its normal size within a few months.
Applying heat or alcohol (ethanol) directly to the tumour without removing it is called tumour ablation. Thermal ablation, which uses microwaves or radiofrequency to generate heat, is the most common method used. In secondary liver cancer, tumour ablation may be used in combination with chemotherapy or surgery.
Transarterial chemoembolisation (TACE)
Transarterial chemoembolisation (TACE) is sometimes used in people with secondary liver cancer who can’t have surgery or ablation.
In TACE, chemotherapy drugs are delivered directly to the tumour through the hepatic artery. The chemotherapy will either be mixed with an oily substance or loaded onto tiny plastic beads. The blood vessel feeding the tumour may also be blocked (embolisation).
It is common to have a fever the day after the procedure, but this usually passes quickly. You may have nausea and vomiting, or feel some pain, which can be controlled with medicines. Some people may feel tired or have flu-like symptoms for up to a week after the procedure.
New treatments are constantly becoming available. Clinical trials test new treatments to see if they’re better than current methods. Getting access to new treatments may be helpful in your care. Talk with your doctor about the latest clinical trials and whether you’re a suitable candidate.
Palliative treatment and care
Secondary liver cancer is advanced cancer, so your doctor is likely to discuss palliative treatment. This helps to improve people’s quality of life by managing the symptoms and spread of cancer without trying to cure the disease.
Many people think that palliative treatment is for people at the end of their life, but it may help at any stage of secondary liver cancer. It is about living for as long as possible in the most satisfying way you can.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, cultural, spiritual and social needs. The team also provides support to families and carers.
Secondary liver cancer can cause various symptoms, but there are ways to manage them. As this is an advanced cancer, the palliative care team may be involved in managing symptoms.
Complementary therapies can be used alongside conventional medical treatments to help manage symptoms. Therapies such as massage, relaxation and acupuncture can increase your sense of control, decrease stress and anxiety, and improve your mood. Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based.
Bilirubin is a yellow pigment formed when red blood cells in the body break down. In secondary liver cancer, bilirubin sometimes builds up in the blood. This can be because the cancer has blocked a bile duct or affected how the liver is working. The build-up of bilirubin in the blood is known as jaundice. It can cause yellowing of the skin and whites of the eyes. People with jaundice may feel very tired and lose their appetite.
Jaundice can also cause pale faeces, dark urine and itchy skin, which is often worse at night. Try to avoid alcohol, spicy food, hot baths and direct sunlight, which can make the itching worse. Keeping your skin moisturised can provide some relief, or your doctor can prescribe medicine that may help.
Jaundice can sometimes be relieved by inserting a small tube made of plastic or metal (a stent) into the bile duct. Symptoms of jaundice usually go away 2–3 weeks after the stent is placed into the bile duct. However, stenting is not always recommended or possible in advanced cancer.
Poor appetite and weight loss
Because the liver plays a key role in the digestive system, secondary liver cancer can affect your appetite and you may lose weight. Chemotherapy, 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 and smell changes.
In some people, secondary liver cancer can cause pain, particularly in the upper right area of the abdomen (belly). Your doctor may prescribe pain medicine, but check before taking any over-the-counter medicines because some are not suitable for people with liver cancer.
Radiation therapy, chemotherapy or surgery 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).
Many people with secondary liver cancer experience fatigue. This is different to feeling tired 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.
Ascites is when fluid builds up in the abdomen (belly). It can be caused by the cancer producing extra fluid or blocking lymph vessels from draining fluid. This fluid build-up causes swelling in the abdomen, which can be uncomfortable and may make you feel breathless. Draining the fluid with a procedure called paracentesis or ascitic tap can help. Diuretics (water tablets) may also be prescribed to reduce the build-up of fluid.
Secondary liver cancer may cause toxic substances to build up in the blood, which can affect brain function. Called hepatic encephalopathy, this can lead to confusion or disorientation and, in severe cases, coma. Hepatic encephalopathy can be controlled with medicines.
How to stay well nourished
During and after treatment, it’s important to eat and drink enough to keep your energy levels up. Maintaining your weight can help your recovery.
- Eat foods you enjoy – eat foods that you like, but also try different foods, as your taste and tolerance to some foods may change. Chew foods well and slowly. Keep a selection of snacks handy (e.g. in your bag or in the car).
- Drink liquids – prevent dehydration by drinking liquids between meals (e.g. 30–60 minutes before or after meals). Avoid filling up on liquids at mealtimes – unless it’s a hearty soup.
- Ask for advice and help – talk to a dietitian about how you can add more energy and protein to your meals. Ask your friends and family to cook for you and offer you food throughout the day. Try having small, frequent meals or snacks rather than three large meals each day.
More about cancer and nutrition
Living with secondary liver cancer
Some people diagnosed with secondary liver cancer can feel well and have periods of time without symptoms. But the uncertainty of living with cancer that cannot be cured can leave you feeling emotionally up and down. At times, you may feel overcome by fear, anxiety, sadness or anger.
Your doctor, nurses, a social worker or counsellor can help you and your family find ways to cope with how you are feeling. You can also call our compassionate and trusted cancer nurses on 13 11 20 for support.
Understanding Secondary Liver Cancer
Download our Understanding Secondary Liver Cancer fact sheet to learn more and find supportDownload now
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.