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Secondary cancer in the liver

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This page tells you about cancer that has spread to the liver from another part of the body. This is called secondary liver cancer. There is information on

 

A quick guide to what’s on this page

Where a cancer starts is called the primary cancer. If some cells break away from the primary cancer and move to another part of the body they can form another tumour – a secondary cancer.

Symptoms of secondary liver cancer include feeling generally unwell and tired. You may also have pain or discomfort on your right side, feel sick and lose weight.

Tests for secondary liver cancer include a blood test to check how well your liver is working (a liver function test). You may also have an ultrasound scan or a CT scan.

The aim of treatment for secondary liver cancers may be to try and get rid of the cancer, or to control your cancer and symptoms for some time. Deciding about treatment can be difficult when you have an advanced cancer. You need to understand what treatment can do for you. You may also want to think about your quality of life while you are having treatment.

Treatment may include surgery, chemotherapy, hormone therapy, biological therapy, radiotherapy, and symptom control.

Coping with a secondary cancer can be difficult. Finding out that your cancer has spread is likely to bring up many feelings. You may be frightened, angry, shocked or numb. Support to help you cope is available at the hospital, from your GP and specialist nurses, and from support groups and online forums.

Research is going on all the time into improving treatments for secondary liver cancer and helping people to cope with symptoms. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many UK and international clinical trials.

 

Having secondary cancer

Finding out that you have secondary cancer is likely to bring up many different feelings. You may be frightened, angry, shocked or numb or all of these. Most people have already had treatment for a primary cancer and it can feel very unfair to have to cope with cancer a second time. Some people already have a secondary cancer when they are first diagnosed.

Finding out about your cancer and your treatment options can help you to feel more in control and better able to cope. Try to give yourself time. It is usually easier to deal with one issue at a time rather than trying to sort everything out at once.

You will need to get information from your own specialist to understand what the diagnosis means for you. It depends on where the cancer first started and whether it has spread anywhere else. Your specialist can also tell you about treatment and how it may help.

On this page there is information about secondary liver cancer, treatment, and coping, including where you can get help and support.

 

Secondary liver cancer

Where a cancer starts is called the primary cancer. If some cells break away from the primary cancer, they can move through the bloodstream or lymph system and spread to another part of the body, where they can form a new tumour. This is called a secondary cancer. Secondary cancers are also called metastases (pronounced met-ass-ta-sees).

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The secondary cancer is made of the same type of cells as the primary cancer. So, for example, if your cancer started in your bowel and has spread to your liver, the bowel cells have first become cancerous, then spread from the bowel tumour and formed another tumour in your liver. This is different from having a cancer that first started in the liver (a primary liver cancer). In that case, the cancer is made up of liver cells that have become cancerous. This is important because the primary cancer tells your doctor which type of treatment you need.

 

Which cancers spread to the liver

Any cancer can spread to the liver. The most common cancers to do so are

 

Symptoms

Sometimes a secondary cancer is picked up before it causes symptoms, during tests to diagnose your primary cancer. Rarely, the first symptom people have is from the secondary liver tumour rather than the primary cancer.

The liver can work well when part of it or even most of it is affected by cancer cells. The first symptoms of a secondary liver cancer are usually feeling unwell and being very tired. These symptoms are common in other conditions so remember that they could well be due to something else. They can be caused by cancer treatment or other conditions. They do not necessarily mean you have a secondary cancer. Other symptoms include

  • Discomfort or pain on the right side of your tummy (abdomen)
  • Feeling sick
  • Poor appetite and weight loss
  • A swollen abdomen

Pain happens if the tumour is pressing on the covering layer of the liver (the capsule). Or the liver may be swollen and this stretches the capsule. Not everyone has pain.

Sometimes people have yellowing of their skin and the whites of their eyes. This is called jaundice. It can also make your skin itch. The liver produces bile, which helps us digest food. If the tubes that drain bile from the liver are blocked by secondary cancer, bile builds up in the blood. This is what causes jaundice.

 

Tests

You may have blood tests called liver function tests. These show how well your liver is working. You can read more about liver function tests in our question and answer section.

You are likely to have either a CT scan or a PET scan to diagnose secondary liver cancer. Some people also have an ultrasound scan. This uses sound waves to look for changes in your liver. You can read more about these scans in our cancer tests section.

 

Treatment

Your treatment will depend on a number of factors including

  • Your type of primary cancer
  • The treatment you have already had
  • How much of your liver is affected by the cancer
  • Whether your cancer has spread to other parts of the body
  • Your general health

The aim of treatment for secondary liver cancers varies. For some people the aim is to get rid of the cancer. For others it is to control your cancer and symptoms for some time.

Your doctor will be able to talk this through with you and of course, you can ask questions. You may find it helpful to talk things over with a close relative or friend. Or there may be a specialist nurse or counsellor at the hospital you can talk to.

Treatments may include

Surgery

Surgery is only suitable for some people. It depends on

  • Your type of cancer – it is most commonly a treatment for people whose cancer started in their bowel
  • Whether you only have secondary cancer in the liver – if your cancer has spread to another part of the body, surgery is not suitable
  • How many secondary tumours you have in the liver and how big they are
  • How much of the liver is affected
  • Whether your primary cancer is under control
  • Your general health

Surgery for secondary liver cancer is most common for cancer that started in the bowel. It may be possible if you have another type of cancer, but is not suitable for everyone. There is information about surgery for advanced bowel cancer in our bowel cancer treatment section.

If you have surgery you may have chemotherapy before or after the operation.

This is specialised surgery and you need to go to a specialist liver surgery centre to have the operation. Your doctor can refer you to a suitable centre if they think surgery would help.

Removing liver tumours is major surgery and can take between 3 and 7 hours. Because there is a risk of bleeding after surgery to the liver, your doctors and nurses will want to keep a close check on you. So you are likely to go to intensive care or a high dependency unit for 24 hours immediately after your operation. Most people need to be in hospital for about a week. You will have painkillers to take at home. It usually takes about 6 weeks to start to get back to normal.

Chemotherapy

Chemotherapy uses cell killing drugs to kill cancer cells. It is a common treatment for cancer spread to the liver. The type you have will depend on your type of primary cancer. You can find out more in the chemotherapy section for your type of cancer. We also have general information about chemotherapy in our main treatment section.

The aim of chemotherapy is to help control the growth of your cancer and symptoms.

You have chemotherapy into a vein in your arm or sometimes as a tablet. If the first type of chemotherapy you have (called 1st line treatment) does not control your cancer, you can usually have a different type of chemotherapy (2nd line treatment).

You can also have chemotherapy directly into the area of your liver where the cancer is. This type of chemotherapy is called hepatic artery chemotherapy. You usually have to stay in hospital overnight or longer. There is information about chemoembolisation for liver cancer in our liver cancer section.

Hormone therapy

Some cancers depend on hormones to survive and grow. So lowering hormone levels in the body can help to control some secondary liver cancers. This includes secondaries from breast and prostate cancers and some other types of cancer.

Hormone treatment may be tablets or injections. We have general information about hormone therapy. And we also have specific information about hormone therapy for your type of cancer in our cancer type sections.

Biological therapy

Biological therapies are treatments that act on processes in cells. Or they may stop cells telling each other to divide and grow. Some types encourage the immune system to attack cancer cells.

Your doctor may suggest biological therapy if it is suitable for your particular type of primary cancer. There are many different types, including monoclonal antibodies and cancer growth blockers. Cetuximab (Erbitux) is one that you may have if you have bowel cancer that has spread to your liver.

There is general information about biological therapies in our main treatment section. You can find out whether biological therapies are suitable for your type of primary cancer by going to the section about your cancer type.

Radiotherapy

Radiotherapy uses high energy rays similar to X-rays to kill cancer cells. Doctors don’t use it as a treatment very often for cancers in the liver because normal liver tissue is very sensitive to it. But you may have radiotherapy to help control pain.

Patient having linear accelerator radiotherapy

You can find out about radiotherapy in our main treatment section.

Other types of treatment

There are a number of other newer types of treatment you may have. Your doctor may suggest these treatments if you can’t have any of the above treatments. Or they may suggest them if you have already had other treatments. The newer treatments include

  • Hepatic artery chemo embolisation – blocking liver blood vessels to give a high chemotherapy dose to the cancer
  • Radiofrequency ablation – using radio waves to destroy cancer cells
  • Radiofrequency assisted surgery – using radio waves during an operation to kill the cancer cells and then remove them
  • Cryotherapy – freezing the cancer cells
  • Microwave ablation – using microwaves to destroy the cancer
  • Laser therapy –  using a laser to destroy the cancer cells
  • Alcohol injection – injecting alcohol into the cancer to destroy the cells

You can find out more about these treatments by using the links above or going to the other treatments section.

Another treatment still being researched is Selective Internal Radiation Therapy (SIRT). This is a new way of giving radiotherapy for tumours in the liver that can’t be removed with surgery. You can find out about SIRT in our question and answer section.

 

Controlling symptoms

All the treatments above can help to control symptoms by shrinking or removing the liver tumours. But if the symptoms are still troublesome, there are other ways of controlling them. The symptoms below are the most common ones that people have with secondary liver cancer. Not everyone has them and they may only be mild. They include

Tiredness

Feeling tired or exhausted is common with secondary liver cancer. It can make everyday life difficult. Many people find it hard to make changes in how they live but try to give yourself extra time to do things and let other people help when necessary.

There is information about tiredness in our coping physically section.

Feeling and being sick

There are many different treatments for sickness. If one treatment doesn’t work for you, you can try others. The best treatment will depend on what is causing the sickness. There is information about controlling sickness in our coping physically section.

Loss of appetite

Many people lose their appetite when they have secondary cancer.  It can help to eat small frequent meals rather than a big meal. Don’t worry about what you eat. If you feel like eating something in particular, have it. If you really don’t feel like eating you can have high energy supplement drinks instead.

There is information about diet changes in our coping physically section. 

Swollen abdomen (ascites)

This swelling is due to fluid building up in the abdomen. There are 2 main reasons for it. 

If cancer blocks the normal blood flow through the liver, it causes a back pressure of fluid. 

The liver also makes proteins that circulate in the blood. The proteins help to keep fluid in the blood and stop it from leaking out into the tissues. If the liver is damaged, it may not make enough of these proteins. Then fluid can leak out and collect in the abdomen or in other parts of the body, such as the feet and ankles.

Your doctor can drain the fluid from the abdomen by putting a needle in and draining the fluid through a tube. But unless they can stop the fluid from collecting, it will build up again. Doctors can sometimes put an internal tube under the skin of the abdomen to permanently drain the fluid away.

Pain

There are many very good pain killers that help to control pain. If yours don’t work, let your doctor or nurse know. There are different types of painkiller and sometimes you have to try different ones before you find one that works for you.

There are other ways of treating pain depending on what is causing it. You can find out more in our section about pain control

Yellowing of your skin (jaundice) 

Yellowing of your skin (jaundice) can happen if the cancer is affecting a large area of your liver. More rarely it can happen if one of the bile ducts becomes blocked. A blockage in the bile duct causes bile to build up in the blood.

When you have yellowing of the skin, the whites of your eyes usually also turn yellow. And your bowel movements may be pale or white.

When you are jaundiced it can also make your skin itchy. There are a number of things that can help to reduce itching. You can read about them in our section on dealing with itching.

If you have a blockage in your bile duct you may be able to have a small tube (stent) put in to your bile duct to relieve it.

Other symptoms

Other symptoms you may have include hiccups and feeling hot or cold. Hiccups happen if the liver is pressing on a nerve in the chest. Your doctor can give you a drug to help control them.

The liver helps to control body temperature. So extremes of temperature may affect you more than usual and you may feel very hot or very cold. Tell your doctor or nurse if you have this symptom.

 

Coping with secondary cancer

There is no set way of dealing with cancer that has spread. Support is available at the hospital and from cancer support groups. Getting the support you need can help you to cope. Your hospital or cancer organisations can offer emotional support or practical help, such as dealing with money matters.

It is important that you feel as well as you possibly can. Ask your specialist, GP or hospital nurse about referral to a symptom control nurse (sometimes called palliative care nurses or home care nurses). These specialist nurses can work with you and your doctor to help control your cancer symptoms and improve your physical well being.

Most people are worried about their outlook (prognosis) when they have a secondary cancer. It is very difficult to say what will happen. Only your own doctors can guide you, as they have all the information about your cancer. Even then, they can only give you a general idea. Your individual outlook depends on many factors including whether the cancer has spread to more than one part of your body, how quickly it is growing, and how it responds to treatment.

Your doctor may have told you that treatment is no longer working or is not possible. This can be a shock. It is likely that you will have all sorts of questions that are difficult to ask and also difficult to answer.

Common questions include

  • How long do I have to live?
  • How will I die?
  • Will I have pain?
  • What will happen to me?

It may help to write your questions down before you talk to your doctor or nurse. Or you can contact the Cancer Research UK information nurses to talk your questions and worries through with them. The number is freephone 0808 800 4040 and the lines are open from 9am to 5pm, Monday to Friday.

It is common in any family for some people to want to ask difficult questions and some not. Try to respect this and give each other space to ask as much as you want to. This may mean that you need to give your doctor permission to talk to your next of kin or other family members alone. Or if you are a relative you may need to give the person with cancer the space to talk to the doctor on their own.

Our section about dying with cancer has information about coping with the news. It also discusses the help and support that is available to you and your family.

 

Research into secondary liver cancer

Research is going on all the time into improving treatments for secondary liver cancer and helping people to cope with symptoms. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many UK and international clinical trials.

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Updated: 12 August 2013