Managing symptoms

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.

How to stay well nourished

During and after treatment, it’s important to eat and drink enough to keep your energy levels up. Maintaining your weight can help your recovery.

Eat foods you enjoy – Eat foods that you like, but also try different foods; your taste and tolerance to some foods may change. Chew foods well and  slowly. Keep a selection of snacks handy (e.g. in your bag or in the car).

Drink liquids – Prevent dehydration by drinking liquids between meals (e.g. 30–60 minutes before or after meals). Avoid filling up on liquids at mealtimes – unless it’s a hearty soup.

Ask for advice and help – Talk to a dietitian about how you can add more energy and protein to your meals. Ask your friends and family to cook for you and offer you food throughout the day. Try having small, frequent meals or snacks rather than three large meals each day.

Download our booklet ‘Nutrition for People Living with Cancer’

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).

Download our booklet ‘Understanding Cancer Pain’

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.

Download our fact sheet ‘Fatigue and Cancer’

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.