Liver cancer – secondary

Secondary liver cancer is cancer that has spread to your liver from another part of your body, such as your lungs or colon. Where the cancer started is called the primary cancer. The secondary cancer is made up of the same type of cells as the primary cancer.

Secondary cancers develop when cancer cells break away from the primary cancer and move through your blood or lymph system to another part of your body.

Image credit: CRUK via Wikimedia Commons(external link)

Because the cancer has spread from another part of your body, secondary liver cancer is considered advanced cancer. The areas of cancer that have spread to your liver are called metastases, so secondary cancer is also known as metastatic cancer.

Secondary liver cancer is different to primary liver cancer, which is cancer that starts in your liver and is made up of liver cells that have become cancerous.

Video: What is secondary cancer?

(Cancer Research, UK, 2021)

The most common cancers that spread to the liver are:

• bowel cancer 
• lung cancer
• breast cancer 
• pancreatic cancer
• stomach cancer.

Sometimes it’s not possible to find where the cancer started – this is called cancer of unknown primary (CUP).

You may have symptoms that include:

• feeling generally unwell
• tiredness
• discomfort or pain on the right side of your tummy (abdomen) or right shoulder blade
• nausea (feeling sick)
• poor appetite and weight loss
• fever ( high temperature)
• pain in your tummy
• a swollen tummy due to a build-up of fluid (ascites)
• yellowing of the skin and eyes (jaundice)
• itchy skin
• dark urine (pee) and pale faeces (poo)
• hiccups, if your liver is pressing on a nerve in your chest.

Note: Many of these symptoms are common in other conditions so they could be due to something else and don’t necessarily mean you have secondary liver cancer.

Your healthcare provider may suspect secondary liver cancer if you’ve lost weight and have an enlarged liver, or if you have a type of cancer that’s likely to spread to the liver. Sometimes secondary liver cancer is diagnosed before the primary cancer it started from, or at the same time.

Tests that you might have to find out whether you have secondary liver cancer include:

• blood tests to check how well your liver is working
• an ultrasound scan
• a CT scan
• an MRI scan
• a PET-CT scan
• a liver biopsy – where a sample of your liver tissue is removed and examined under a microscope.

If your test results confirm you have secondary liver cancer, the next step is to find out where the cancer began in your body. This might already be known if you’ve previously had cancer treatment. If not, more tests will be needed to determine the original site.     

Treatment for secondary liver cancer will depend on where your primary cancer is (where your cancer started), how far it’s spread, how many tumours are in your liver, your general health and how you’re feeling.

Treatment may aim to remove or destroy the cancer using surgery and chemotherapy. In other cases, palliative treatment is given – this is where treatment may be given to shrink the cancer as well as to manage your symptoms and improve your quality of life.

Talk to your healthcare provider, specialist or cancer nurse about what options may be suitable for you. They can explain the treatment options, possible side effects and other aspects such as how often you’ll need to go to the hospital for treatment.

Treatments for secondary liver cancer

Chemotherapy
Chemotherapy drugs are used to kill, shrink or slow the growth of cancer cells. The type of chemotherapy you have will depend on the type of primary cancer you have. For example, if you have bowel cancer that has spread to your liver, you’ll be given chemotherapy to treat bowel cancer. Chemotherapy drugs can be given directly into the artery that goes to your liver (the hepatic artery) – this allows a high concentration of the anti-cancer drug to get to the cancer cells. Read more about chemotherapy.

Transarterial chemoembolization (TACE)
This is where chemotherapy drugs are given through the hepatic artery along with a blocking material that helps stop blood flow to the tumour. TACE is sometimes used in people with secondary liver cancer who can’t have surgery or ablation therapy (see below).     

Hormone therapy
This might be given to lower hormone levels if you have a primary cancer, such as breast or prostate cancer, that depends on hormones to survive and grow. This is usually given in combination with other cancer treatments.

Targeted cancer drugs
These are drugs that target specific features of the cancer cells to stop the cancer growing and spreading. 

Immunotherapy
This is a drug treatment that uses your body’s own immune system to fight cancer. The type of drug used will depend on where the cancer started in your body. 

Radiotherapy
This uses radiation to treat cancer. It can be given internally or externally.  Livers are very sensitive to radiotherapy so it’s not a common treatment for liver cancer, but it may be used to help control pain. Selective internal radiation therapy (SIRT) might be used if you have lots of small tumours in your liver that can’t be removed with surgery.

Tumour ablation
This procedure destroys cancer cells using heat, cold or alcohol (ethanol). It may be used in combination with chemotherapy or surgery. 

Surgery to remove part of your liver
This is a major operation and is only considered if your cancer hasn’t spread to other parts of your body. It might be considered if you have liver cancer that’s spread from your bowel and if only one part of your liver is affected. You might have chemotherapy or a targeted cancer drug before or after your operation.

Treatment to control symptoms
The treatments above can help control your symptoms by shrinking or removing the tumours in your liver. However, if you continue having symptoms, there are other ways to control them. These include draining fluid that builds up in your tummy if you have ascites, anti-nausea treatment, pain medicines, inserting a stent if you have blockage of your bile duct causing jaundice, treatments for jaundice itch, or medicine for hiccups.

Palliative treatment
This aims to improve your quality of life by managing the symptoms and spread of cancer without trying to cure it. It might include some of the treatments mentioned above and it’s one part of palliative care. Palliative care focuses on your physical, emotional, cultural, social and spiritual needs when you have an advanced illness. Read more about palliative care. 

Liver transplants are rarely done for secondary liver cancer.

Here are some things you can do to help take care of yourself if you have secondary liver cancer.

• Extreme tiredness is common with advanced cancer so do things at a pace that suits you and ask for help from friends and whānau.
• If your appetite is affected try eating small meals or snacks often, rather than 3 main meals. Eat what you feel like having rather than worrying about what you should eat. Try high energy supplement drinks if you don’t feel like eating. 
• Tell your healthcare team if your pain medicines aren’t working. They can adjust the dose or prescribe different ones for you to try. Check before taking any over-the counter pain medicines because some aren’t suitable for people with liver cancer.
• Reach out to family, whānau, friends, your healthcare team and the Cancer Society(external link) for support.
• Look after your mental health. You might like to try some mindfulness techniques, or you may find that your own spiritual or religious practices or professional counselling help – especially with managing feelings of fear, anxiety, grief or loss.
• Focus on things that bring you joy, such as listening to your favourite music, and have goals to look forward to.
• Learn about managing chemotherapy side effects.
• Keep active when you can.
• Don’t smoke.
• Limit your alcohol intake.
• Try complementary therapies (such as meditation or acupuncture), or traditional treatments (such as rongoā Māori), to help relieve symptoms and side effects of treatment and cope with fear and anxiety. Tell your healthcare team if you’re using any of these therapies in case they could affect your cancer treatment.

You may also want to think about making some practical decisions. This might include making an advance care plan which can guide your care providers and your family/whānau in making decisions if you’re unable to make them yourself.

Apps reviewed by Healthify

You may find it useful to look at some meditation and mindfulness apps.

If you have secondary liver cancer, your outlook will depend on things such as:

• the type of primary cancer you have
• the size and number of cancers in your liver
• whether the cancer has spread to other parts of your body
• how quickly it’s growing
• how well it responds to treatment
• your general health. 

You can talk to your healthcare team about your individual 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 years, and there is support available to help you live well with advanced cancer.

The Cancer Society(external link) provides support and information for people with cancer, including secondary liver cancer. You can phone 0800 CANCER (226 237) to speak to a cancer information nurse or find a cancer society office(external link) near you. The booklet Living well with advanced cancer(external link) has lots of information and advice for people with advanced cancer and their families.

Hospice New Zealand(external link) provides palliative care information and support.