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) 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.

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) 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.

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.

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.