Liver Cancer (Secondary)
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Liver Cancer (Secondary)
Treatment for secondary liver cancer
The aim of treatment for secondary liver cancer depends on the type of primary cancer that has spread to the liver.
For some people, the aim may be to remove or destroy the cancer using surgery and chemotherapy. For others, the aim may be to shrink the cancer, manage symptoms and improve quality of life (called palliative treatment).
The types of treatment suitable for you will also depend on the size and number of tumours, and your age and general health.
The main treatment for secondary liver cancer is chemotherapy or a combination of surgery and chemotherapy.
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. If you have bowel cancer that has spread to the liver, for example, you will have chemotherapy designed to treat bowel cancer.
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. 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 liver cancer and make it easier to remove (called neoadjuvant chemotherapy)
- after surgery, to get rid of any remaining cancer cells (called adjuvant chemotherapy)
- to slow down cancer growth and reduce symptoms such as pain (called palliative treatment).
Side effects – Chemotherapy drugs circulate throughout the body and can affect normal, healthy cells as well as cancer cells. People react to chemotherapy differently – some people have few side effects, while others have more. 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. Most side effects last only while you are having treatment, and there are ways to manage them.
During chemotherapy, you have a higher risk of bleeding or getting an infection. If you develop a temperature over 38°C, it’s important to contact your doctor or go to the emergency department.
This is a type of drug treatment that attacks specific features of cancer cells to stop the cancer growing and spreading. Targeted therapy drugs may be used in combination with other treatments.
Side effects – These vary depending on the drugs used, but may include high blood pressure, rashes, diarrhoea, and tender hands and feet. Talk to your doctor about ways to manage side effects.
Drug treatment that uses the body’s own immune system to fight cancer is called immunotherapy. Several immunotherapy drugs are available in Australia. The type of drug used for secondary liver cancer will depend on where the cancer started in your body.
Side effects – Immunotherapy drugs can cause a range of side effects; most are mild, but some are more severe. Most immunotherapy side effects can be managed and reversed if they are reported early.
Some cancers – such as prostate cancer and certain types of breast cancer – rely on hormones to survive and grow. If one of these types of cancer has spread to the liver, hormone therapy may be an option. This treatment can lower the levels of certain hormones in the body to help to control hormone-dependent cancers. Hormone therapy is usually used in combination with other cancer treatments.
Side effects – These may be different depending on the type of drug you have.
Also known as radiotherapy, radiation therapy uses targeted radiation to treat cancer. It can be delivered internally or externally. Specialised forms of radiation therapy may be used to treat secondary liver cancer: selective internal radiation therapy (SIRT) or stereotactic body radiation therapy (SBRT).
SIRT
This is the most common type of radiation therapy used for secondary liver cancer. Also called radioembolisation, SIRT may be offered when there are many small tumours in the liver that can’t be removed with surgery. It is usually needed only once.
SIRT precisely targets cancers in the liver with high doses of internal radiation. Tiny radioactive beads (made of glass or resin) are delivered through the blood vessels to the cancer. The radiation from these beads damages the cancer cells and their blood supply, while causing little damage to normal cells.
Side effects – You may have flu-like symptoms, nausea and pain, which can be managed with medicines. Over the next week or so, you may need to take some safety precautions, such as not sharing a bed and avoiding close physical contact with children or pregnant women.
How SIRT is done
Selective internal radiation therapy (SIRT) combines embolisation (which blocks blood supply to the tumour) with internal radiation therapy.
Click on image to enlarge
SBRT
An increasing number of cancer centres now offer SBRT, which is also called stereotactic ablative body radiation therapy (SABR). SBRT is a type of external beam radiation therapy. It may be offered to some people with small secondary tumours in the liver.
You will be asked to lie very still on a treatment table. A machine will precisely target beams of radiation from many different angles onto the tumour. The highly targeted radiation means surrounding healthy tissue is protected. SBRT requires fewer treatment sessions than conventional external beam radiation therapy. People may need only 3-8 sessions over one or two weeks.
Side effects – These may include fatigue, nausea, and soreness in the treatment area.
Transarterial chemoembolisation (TACE) is sometimes used in people with secondary liver cancer who can’t have surgery or ablation. In TACE, chemotherapy drugs are delivered directly to the tumour through the hepatic artery. The chemotherapy will either be mixed with an oily substance or loaded onto tiny plastic beads. The blood vessel feeding the tumour may also be blocked (embolisation).
Side effects – It is common to have a fever the day after the procedure, but this usually passes quickly. You may have nausea and vomiting, or feel some pain, which can be controlled with medicines. Some people may feel tired or have flu-like symptoms for up to a week after the procedure.
Applying heat or alcohol (ethanol) directly to the tumour without removing it is called tumour ablation. Thermal ablation, which uses microwaves or radiofrequency to generate heat, is the most common method used. In secondary liver cancer, tumour ablation may be used in combination with
chemotherapy or surgery.
A small number of people with secondary liver cancer may be able to have surgery to remove the cancer (also known as liver resection or partial hepatectomy). A liver resection is only an option for people with some types of secondary cancer and when there will be enough healthy liver for it to regrow. Surgery is also only possible when the cancer hasn’t spread to other parts of the body where it can’t be removed, such as the bones.
A liver resection is a major operation. You will have a general anaesthetic and the surgeon will remove the cancer as well as some healthy tissue around it. The operation may be done as open surgery (with one large cut in the abdomen) or as keyhole or laparoscopic surgery (with several smaller cuts).
When a large amount of the liver needs to be removed, you may have a procedure called portal vein embolisation (PVE) 4–8 weeks before the surgery. This procedure redirects the blood supply to the healthy part of the liver, helping it to grow.
People with tumours in both lobes of the liver sometimes need two separate operations with a waiting period between each operation.
After the surgery – You will spend 5–10 days in hospital. You will be monitored for signs of infection or bleeding. Some people develop jaundice (yellowing of the skin and whites of the eyes) but this is usually temporary and improves as the liver grows back. The liver will usually regrow to its normal size within a few months.
Secondary liver cancer is advanced cancer so your doctor is likely to discuss palliative treatment. This helps to improve people’s quality of life by managing the symptoms and spread of cancer without trying to cure the disease. Many people think that palliative treatment is for people at the end of their life, but it may help at any stage of secondary liver cancer. It is about living for as long as possible in the most satisfying way you can.
Palliative treatment may include chemotherapy, targeted therapy, immunotherapy, other medicines, radiation therapy or stenting. Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, cultural, spiritual and social needs. The team also provides support to families and carers.
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This information is reviewed by
This information was last reviewed June 2022 by the following expert content reviewers: Prof Desmond Yip, Clinical Director, Department of Medical Oncology, The Canberra Hospital, ACT; A/Prof Siddhartha Baxi, Radiation Oncologist and Medical Director, GenesisCare, Gold Coast, QLD; Prof Katherine Clark, Clinical Director of Palliative Care, NSLHD Supportive and Palliative Care Network, Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW; Anne Dowling, Hepatoma Clinical Nurse Consultant and Liver Transplant Coordinator, Austin Health, VIC; A/Prof Koroush Haghighi, Liver, Pancreas and Upper Gastrointestinal Surgeon, Prince of Wales and St Vincent’s Hospitals, NSW; Karen Hall, 13 11 20 Consultant, Cancer Council SA; Dr Brett Knowles, Hepato-Pancreato-Biliary and General Surgeon, Royal Melbourne Hospital, Peter MacCallum Cancer Centre and St Vincent’s Hospital, VIC; Lina Sharma, Consumer; A/Prof Simone Strasser, Hepatologist, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital and The University of Sydney, NSW; David Thomas, Consumer.