Liver Cancer (Secondary)
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Liver Cancer (Secondary)
Treatment for secondary liver cancer
The aim of treatment for secondary cancer in the liver is to control or shrink the cancer and improve quality of life. The types of treatment suitable for you will depend on the location of the original cancer, the size and number of tumours, and your age and general health.
The main treatment for secondary cancer in the liver is chemotherapy or a combination of surgery and chemotherapy. You may also be having treatment for the primary cancer or be offered palliative treatment.
Chemotherapy uses drugs to kill, shrink or slow the growth of cancer cells. The type of drugs you are given will depend on where in the body the cancer first started. For example, if you have cancer of the breast that has spread to the liver, you will have chemotherapy designed to treat breast cancer.
Most people receive a combination of two or three chemotherapy drugs. Depending on the aim of treatment, chemotherapy may be given as a short course over a few months or it may be given as a longer course over many months or years. Your doctor will talk to you about how long your treatment will last. The drugs may be injected into a vein (given intravenously) and/or swallowed as tablets. Chemotherapy may be used at different times:
- before surgery, to shrink the secondary cancer in the liver and make it easier to remove – this is called neoadjuvant chemotherapy
- after surgery, to get rid of any remaining cancer cells – this is known as adjuvant chemotherapy
- to slow down cancer growth and reduce symptoms such as pain – this may be called palliative treatment.
Side effects of chemotherapy – Chemotherapy drugs circulate throughout the body and can affect normal, healthy cells as well as cancer cells. This can cause a range of side effects. Depending on the type of chemotherapy drug used, side effects may include nausea; loss of appetite; tiredness; hair loss; skin changes; tingling, numbness or pain in fingers and toes (peripheral neuropathy); and mouth sores.
People react to chemotherapy differently – some people have few side effects, while others have more. Most side effects are temporary, and there are ways to prevent or manage them.
During chemotherapy, you will have a higher risk of bleeding or getting an infection. If you develop a temperature over 38°C, contact your doctor or go to the emergency department.
The aim of surgery is to remove the part of the liver that contains cancer. This is known as liver resection or partial hepatectomy. It can be an effective treatment, but it is only possible if there is enough healthy liver and the cancer hasn’t spread to other parts of the body where it can’t be removed (such as the bones). Some people need surgery for both the secondary cancer in the liver and the primary cancer. These operations may be done separately or at the same time.
A liver resection is a major operation. You will have a general anaesthetic and the surgeon will remove the tumour as well as some healthy-looking tissue around it. The operation may be done as open surgery (with one large cut) or as keyhole or laparoscopic surgery (with several smaller cuts).
Types of liver resections – Depending on the cancer’s size and position, the liver resection may be called a right or left hepatectomy (removes the right or left part of the liver), extended right or left hepatectomy (removes most of the liver), or segmentectomy (removes a small section of the liver). Sometimes the gall bladder may also be removed, along with part of the muscle that separates the chest from the abdomen (the diaphragm).
After the surgery – The liver can repair itself easily if it is not damaged already. The part of the liver that remains after resection will start to grow, even if up to three-quarters of it is removed. The liver will usually regrow to its normal size within a few months, although its shape may be slightly changed. When a very large amount of the liver needs to be removed, you may need a procedure called a portal vein embolisation (PVE) 4–8 weeks before the surgery. After surgery:
- bleeding is a risk because a lot of blood passes through the liver – your medical team will monitor you for signs of bleeding and infection
- some people experience jaundice (yellowing of the skin and whites of the eyes) – this is usually temporary and improves as the liver grows back
- most people will need a high level of care – you will spend 5–10 days in hospital after a liver resection and it is common to spend some time in the high dependency unit or intensive care unit before moving to a standard room.
People with tumours in both lobes of the liver sometimes need surgery that is carried out in two stages with a waiting period between them.
stage 1 – The tumours are removed from one lobe of the liver (partial hepatectomy). Sometimes this surgery is combined with tumour ablation or removal of the original cancer.
waiting period – After the first surgery, you will need to wait 1–2 months to allow your body to recover and the liver to regrow. You may have a portal vein embolisation during this time to improve the part of the liver that will remain after stage 2. Before you have the second operation, you will have a CT scan to check the size of your liver.
stage 2 – If enough of the liver has regrown, you will have another partial hepatectomy to remove the tumours in the second lobe of the liver.
For more details on how the different surgeries are performed see ‘Treatment for Liver Cancer (Primary)‘.
Also known as radiotherapy, radiation therapy uses targeted radiation to treat cancer. The radiation is usually in the form of x-ray beams. Conventional external beam radiation therapy is not often used for secondary cancer in the liver, but two specialised forms of radiation therapy may be offered in some cases.
SIRT – The most common type of radiation therapy used for secondary cancer in the liver is selective internal radiation therapy (SIRT).
SIRT may be offered for bowel cancer and other cancers that have spread to the liver when the tumours can’t be removed with surgery. It’s often used if there are many small tumours throughout the liver.
SIRT is not available in all hospitals. If you don’t have private health insurance that covers this treatment, you may need to pay for it yourself. Talk to your doctor about SIRT and the costs involved.
How does the SIRT process work?
Also called radioembolisation, SIRT is a treatment that precisely targets cancers in the liver with high doses of radiation while causing little damage to normal liver tissue. It uses tiny radioactive beads known by the brand name SIR‑Spheres.
SIRT can be given as a single treatment to the whole liver or separate treatments to the right and left lobes.
The procedure is done by an interventional radiologist.
Before treatment (work-up day)
- You will have a number of tests, including blood tests and a test called an angiogram, as well as a trial run (simulation) of the treatment.
- For the angiogram, you will have a local or general anaesthetic. The interventional radiologist will make a small cut in the groin area and insert a
thin plastic tube (catheter) into a blood vessel. The tube will be pushed up into the artery that feeds the liver (hepatic artery). A small amount of dye will be passed through the catheter into the bloodstream. On an x-ray, the dye shows the blood vessels in the liver and helps to map where the radioactive beads need to go.
- For the simulation, some tiny spheres similar in size to the SIR-Spheres will be inserted through the catheter to check how the SIR-Spheres will behave.
- The angiogram and simulation procedure take about 45 minutes and you will be observed for 3–4 hours afterwards. You may also have CT and lung scans, which take about an hour.
- If the results of these tests are good, you will have treatment 1–2 weeks later.
During treatment (delivery day)
- On the day of treatment, you will have another angiogram.
- The interventional radiologist will make a cut in the groin area and pass a catheter through to the hepatic artery.
- The SIR-Spheres will be inserted through the catheter into the hepatic artery. These beads can then deliver radiation directly to the tumour.
- The procedure takes about an hour. You will be monitored closely for 3–4 hours before being taken to a general ward, where you will recover overnight.
- After treatment, you may experience flu-like symptoms, nausea, pain and fever.
- These side effects can be treated with medicines, and you usually can go home within 24 hours.
- The SIR-Spheres will slowly release their radiation into the tumour over the next week or so.
- The radiation from the microspheres damages the cancer cells and their blood supply. This means the cancers can’t get the nutrients they need and they shrink.
- You may need to take some safety precautions, such as avoiding close physical contact with children or pregnant women for at least a week. The interventional radiologist will explain any precautions to you.
SBRT – Some cancer centres offer a form of external radiation therapy called stereotactic body radiation therapy (SBRT). You will lie on a treatment table and a machine will deliver tightly focused beams of high-dose radiation precisely onto the tumour from many different angles. SBRT may be offered to some people with small secondary tumours in the liver. Side effects after treatment may include fatigue, nausea and abdominal discomfort. SBRT is sometimes called stereotactic ablative body radiation therapy (SABR).
This is a type of drug treatment that attacks specific features of cancer cells to stop the cancer growing and spreading. Targeted therapy drugs are sometimes used to treat secondary cancers in the liver from bowel or breast cancer. They may be used after or together with other treatments. Side effects of targeted therapy vary depending on the drugs used, but may include high blood pressure, rash, diarrhoea, and sore hands and feet. Talk to your doctor about managing side effects.
Because secondary cancer in the liver is advanced cancer, your doctor is likely to discuss palliative treatment. This aims to help maintain a person’s quality of life by managing the symptoms of cancer without trying to cure the disease. It can help at any stage of advanced cancer.
Treatment may include chemotherapy, targeted therapy, other medicines, radiation therapy or stenting. Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, cultural, spiritual and social needs. The team also provides support to families and carers.
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,