The treatment you have depends on where your cancer started and how you are feeling. Your specialist will discuss the aims of treatment with you.
For some types of cancer that have spread to the liver, it may still be possible to cure your cancer. For other types of cancer, the aim may be to control your cancer and symptoms. This is called palliative treatment.
Deciding about treatment
Deciding about treatment can be difficult. You need to understand:
- what treatment can do for you
- any side effects of the treatment
- how many visits to hospital the treatment involves
You can stop whenever you want to if you are finding it too much to cope with.
Talk through your options with your doctor or specialist nurse. You may find it helpful to talk things over with a close relative or friend, or a counsellor if one is available.
Your treatment will depend on a number of factors including:
- your type of primary cancer
- the treatment you have already had
- how many tumours are in the liver
- whether your cancer has spread to other parts of the body
- your general health
- your symptoms
Types of treatment
Surgery is not suitable for everyone and depends on:
- where your cancer started, it is a common treatment for bowel cancer that has spread
- whether you only have secondary cancer in the liver – if your cancer has spread to another part of the body, surgery is not usually suitable
- how many secondary tumours you have in the liver and how big they are
- whether your primary cancer is under control
Removing part of the liver (liver resection) is major surgery and can take several hours. You have the surgery at a specialist centre. After your operation, you usually stay in intensive care or a high dependency unit. This is for at least 24 hours after. Most people need to be in hospital for about a week. It usually takes about 6 weeks to start to feel back to normal.
You might have chemotherapy or a targeted cancer drug before or after your operation.
Before surgery, it is sometimes possible to encourage the healthy part of the liver to grow. This helps to make sure there is enough liver left afterwards and can reduce the risk of liver failure. They do this by blocking a branch of the main vein leading to the liver (the portal vein). Also called portal vein embolisation (PVE). This usually happens several weeks before the liver resection.
Sometimes the liver is removed in two stages. First, you have an operation to remove part of the liver, then a week or so later you have another part removed. This is called a staged liver resection.
Chemotherapy uses anti cancer drugs to kill cancer cells. The type of chemotherapy you'll have depends on your type of primary cancer.
If the first type of chemotherapy you have (1st line treatment) doesn't control your cancer, you might be able to have a different type of chemotherapy (2nd line treatment).
Hepatic artery infusion (HAI)
This treatment gives chemotherapy directly into the artery going into the liver (hepatic artery). It's known as hepatic artery infusion (HAI). You have a small tube (catheter) put into the main artery leading to the liver.
HAI allows a high concentration of the chemotherapy drug to get to the tumour. You usually have to stay in hospital overnight or longer for this treatment.
This treatment is not suitable for everyone with secondary liver cancer.
Transarterial chemoembolisation (TACE)
Chemoembolisation involves giving a chemotherapy drug into an artery along with an oily liquid or an absorbable gelatin sponge. The doctor puts a thin tube called a catheter into a large artery in the leg or arm.
They thread the catheter into the main artery that carries blood to the liver. They then inject the mixture of chemotherapy and oily liquid or foam through the catheter. The oil or foam cuts off most of the blood flow to the liver, which cuts off the supply of oxygen and nutrients to the cancer. This damages the cancer cells.
The chemotherapy mixture also stays in the area of the cancer for some time, so the cancer cells get a high dose of the treatment. You may need to stay in hospital overnight or longer for this treatment.
Some cancers including breast and prostate cancer depend on hormones to survive and grow. So lowering hormone levels in the body can help to control them. You might have the hormone treatment as a tablet or injection.
Targeted cancer drugs
Targeted cancer drugs are treatments that target the differences that help a cancer cell to survive and grow.
Your doctor may suggest a targeted cancer treatment if it is suitable for your primary cancer. There are different types of targeted cancer drugs including:
- monoclonal antibodies (MABs)
- cancer growth blockers
- PARP inhibitors
- drugs that block blood vessel growth (anti angiogenics)
Radiotherapy treatment uses high energy waves usually x-rays to kill cancer cells. Radiotherapy can help to control cancer growth and symptoms. You usually have this as external radiotherapy.
Livers are very sensitive to radiotherapy so it is not a common treatment for liver cancer. But you may have radiotherapy to help control pain.
Selective Internal Radiation Therapy (SIRT)
This is a type of internal radiotherapy (brachytherapy), it is also called radioembolisation.
You have a thin tube called a catheter inserted into the hepatic artery that supplies blood to the liver. The doctor sends tiny beads called microspheres down the catheter. These get stuck in the small blood vessels around the cancer.
The microspheres contain a radioactive substance that gives a dose of radiation to the cancer. Yttrium-90 and Holmium-166 are two radioactive substances in the microspheres. SIR-spheres or TheraSphere are beads that contain Yttrium-90. QuiremSphere bead contains Holmium-166.
The radiation from the microspheres damages the tumours’ blood supply. This means that the cancer can’t get the nutrient it needs. The radiation also damages the cancer cells.
The range of radiation from the beads is very small. So it causes very little damage to the surrounding healthy tissue. Most of the radiation from the microspheres is gone within 2 weeks. The microspheres stay in the liver permanently but are harmless.
Other types of treatment
Your doctor may suggest another treatment if you can’t or have already had the standard treatments. These treatments include:
- 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
Secondary liver cancer can cause symptoms. All the treatments above can help to control these 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 be mild.
This is a common symptom of secondary liver cancer. It can make everyday life difficult. Try to give yourself extra time to do things and let other people help.
There are many different treatments for sickness. It might be best to take something to prevent you from being sick or a certain amount of time before you eat a meal. Tell your doctor or nurse if treatment isn’t controlling it.
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. Have high energy supplement drinks if you don’t feel like eating.
Cancer can sometimes cause swelling of the tummy (abdomen) due to a build up of fluid called ascites.
Fluid can build up when:
- cancer has spread to the liver and raises the pressure in nearby blood vessels, which forces fluid out
- the liver can’t make enough blood proteins so fluid leaks out of veins into the abdominal cavity
Your doctor can drain the fluid from the abdomen by putting a needle in and draining the fluid through a tube. 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.
There are many different pain killers and other treatments that help to control pain.
Tell your doctor or nurse if yours don’t work. Sometimes you have to try different painkillers before you find one that works for you.
Your skin and the whites of your eyes may become yellow, your bowel movements may be pale or white and your skin might be itchy.
When large areas of the liver are damaged or there is a blockage in a bile duct it can cause jaundice.
You might be able to have a small tube (stent) put into your bile duct to relieve the blockage.
Tell your doctor or nurse if you are itchy, there are treatments such as creams that can help to reduce it.
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.
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. It also supports many UK and international clinical trials.
Current research is looking at bowel cancer that has spread to the liver. The research includes:
- taking a fish oil supplement before surgery to prevent the cancer from coming back
- having a vaccine directly into the artery going into the liver (hepatic artery infusion), as well as taking a drug called flucytosine
Researchers are also looking at a new targeted cancer drug called MIV-818. This drug is taken up by liver cells so it lowers the amount of drug getting into the rest of the body. This is early research so doctors are looking at the side effects and how much MIV-818 people can safely have.