Liver Cancer (Primary)
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Liver Cancer (Primary)
Cancer in the liver can cause various symptoms, but there are ways to manage them. With advanced cancer, the palliative care team may be involved in managing symptoms.
One of the jobs of the liver is to process bilirubin, a yellow pigment formed when red blood cells in the body break down. Normally, the bilirubin passes from the liver, through the bile duct to the bowel, and then out of the body in faeces (poo).
With liver cancer, bilirubin sometimes builds up in the blood. This can be because the cancer has blocked a bile duct, the liver is not working properly (progressive liver function failure), or the liver has been replaced by widespread tumour. The build-up of bilirubin in the blood is known as jaundice. It can cause yellowish skin and whites of the eyes, itchy skin, pale faeces or dark urine.
Jaundice can sometimes be relieved by unblocking the bile duct with a small tube made of plastic or metal called a stent. Symptoms of jaundice usually go away 2–3 weeks after the stent is inserted. Stenting is not always recommended in advanced cancer.
How stents are inserted
A stent can be placed in your liver to open a blocked bile duct and relieve symptoms of jaundice. The earlier the stent is inserted, the less severe the symptoms. Stenting can be done in two ways.
Endoscopic stent placement – You may have the procedure as day surgery or you may need to stay in hospital overnight. You will have a local anaesthetic and may have a sedative to help you relax.
A gastroenterologist or surgeon will insert a long, flexible tube with a camera and light on the end (endoscope) through your mouth, stomach and small bowel into the bile duct. Pictures show up on a screen so the doctor can see where the blockage is and where to put the stent. The stent is put into the bile duct using the endoscope, which is then removed.
Recovery from an endoscopic stent placement is fairly fast. Your throat may feel sore for a short time. There is a risk that the bile duct may become infected and the pancreas may become inflamed – your doctor will talk to you about what can be done if this occurs.
Percutaneous stent placement – Sometimes a stent cannot be inserted using an endoscope so it is placed through the skin of the abdomen, using ultrasound and x-rays for guidance. This requires a small operation.
The operation may be done under general anaesthetic or heavy sedation, and you will usually stay in hospital overnight. You may have a small plastic
tube (drain) coming out through the skin for some days. This lets fluid drain from the area.
The itching caused by jaundice is often worse at night. It can be relieved to some degree by keeping your skin moisturised. Try to avoid alcohol, spicy food, hot baths and direct sunlight, which can make the itching worse. Your doctor can prescribe medicine if the itching continues and is uncomfortable.
Because the liver plays a key role in the digestive system, cirrhosis and cancer in the liver can both cause you to lose your appetite and you may lose weight. Chemotherapy, radiation therapy and other cancer treatments can also have an impact, especially if you experience side effects such as nausea and vomiting, mouth ulcers, and taste and smell changes.
During and after treatment, it’s important to make sure you are eating and drinking enough. The tips below can help you prevent or manage appetite changes and weight loss after a diagnosis of liver cancer.
How to stay well nourished
- Snack during the day – eat 5–6 small meals rather than three large ones each day.
- Ask your family and friends to cook for you and offer you food throughout the day.
- Keep a selection of snacks handy, e.g. in your bag or car.
- Try eating different foods. Your taste and tolerance for some foods may have changed and may continue to change.
- Ask your dietitian how you can increase your energy and protein intake.
- Eat when you feel hungry or crave certain foods, but be careful not to become too full by eating too quickly.
- Ensure you have room for nourishing food – avoid filling up on liquids at mealtimes, unless it’s a hearty soup.
- Prevent dehydration by drinking liquids between meals (e.g. 30–60 minutes before or after meals).
In some people, liver cancer can cause pain, particularly in the upper right area of the abdomen. This usually only happens in more advanced cases.
Pain associated with liver cancer can be managed with pain medicines. These may be mild, like paracetamol; moderate, like codeine; or strong and opioid-based, like morphine. 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).
How to cope with pain
- Keep track of your pain in a symptom diary. Try to describe what the pain feels like, how intense it is, exactly where it is, where it comes from and
travels to, how long it lasts, and if it goes away with a specific pain medicine or with any other therapy, such as a heat pack.
- Allow a few days for your body to adjust to the dose of pain medicine and for any drowsiness to improve.
- Let your doctor know if you have vivid dreams, nausea or other side effects after taking a strong pain medicine such as morphine. Adjusting the dose may help or you can try other methods of pain relief.
- Use a laxative regularly to prevent or relieve constipation from codeine or morphine.
- Take pain medicine regularly as prescribed, even when you’re not in pain. It’s better to stay on top of the pain.
Ascites is when fluid builds up in the abdomen. Chronic cirrhosis can increase pressure in the blood vessels inside the liver, forcing fluid to leak into the abdomen. Ascites can also be caused by the cancer itself blocking lymph vessels or producing extra fluid. The build-up of fluid causes swelling and pressure in the abdomen. This can be uncomfortable and may make you feel breathless.
A procedure called paracentesis or ascitic tap can provide relief. Your doctor will numb the skin on the abdomen with a local anaesthetic. Using ultrasound images as a guide, a radiologist inserts a thin needle and plastic tube into the abdomen. The tube is connected to a drainage bag outside your body. It will take a few hours for all the fluid to drain into the bag, and then the tube will be removed from your abdomen.
Water tablets (diuretics) are sometimes prescribed with paracentesis to slow down the build-up of fluid.
Chronic liver disease may cause toxic substances to build up in the blood, which can affect brain function. This is known as hepatic encephalopathy and it can lead to confusion or disorientation and, in severe cases, coma. It is important not to drive if you have any symptoms of this condition. Carers need to be aware that these symptoms can develop, so they can help identify that something is not quite right. Hepatic encephalopathy can be frightening for carers and family members, but it can be controlled with medicines. Talk to the health care team if you notice any of these symptoms.
This information is reviewed by
This information was last reviewed June 2020 by the following expert content reviewers: Dr David Yeo, Hepatobiliary/Transplant Surgeon, Royal Prince Alfred, Chris O’Brien Lifehouse Cancer Centre and St George Hospitals, NSW; Dr Lorraine Chantrill, Head of Department Medical Oncology, Illawarra Shoalhaven Local Health District, NSW; Michael Coulson, Consumer; Dr Sam Davis, Interventional Radiologist, Staff Specialist, Royal Brisbane and Women‘s Hospital, QLD; Prof Chris Karapetis, Network Clinical Director (Cancer Services), Southern Adelaide Local Health Network, Head, Department of Medical Oncology, Flinders Medical Centre and Flinders University, SA; Dr Howard Liu, Radiation Oncologist, Princess Alexandra Hospital, QLD; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Lina Sharma, Consumer; Dr Graham Starkey, Hepato-Biliary and General Surgeon, Austin Hospital, VIC; Catherine Trevaskis, Gastrointestinal Cancer Specialist Nurse, Canberra Hospital and Health Services, ACT; Dr Michael Wallace, Western Australia Liver Transplant Service, Sir Charles Gairdner Hospital,