| Secondary
Liver Cancer
This section is for anyone who has been diagnosed with
secondary cancer in the liver that has spread from the breast.
It describes what secondary liver cancer
is, some of the possible symptoms and treatments that may be used.
We hope it answers some of your questions and helps you discuss
your options further with your specialist team.
Page Contents
What is secondary liver cancer?
What does the liver do?
What symptoms might I have?
What investigations will I need?
What treatments might I be offered?
Newer treatments
Living with secondary liver cancer
Help from Action Breast Cancer
What is secondary liver cancer?
Secondary liver cancer occurs when cancer cells spread from the
breast through the bloodstream and settle in the liver. You may
hear this type of spread described as metastases, recurrence
of the cancer, secondary tumours or secondaries. The cells that
have settled in the liver are breast cancer cells. It is not
the same as having cancer that starts in the liver.
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What does the liver do?
To understand some of the symptoms described in this section
it may help to know where the liver is and what it does. The liver
is a very important organ in the body. It sits on the right hand
side of your upper abdomen just under the ribs. The liver is made
up of different sections called lobes and is surrounded by a capsule.
It is close to a number of other organs including the bowel, the
diaphragm (the muscle that separates the chest and abdomen) and
the right kidney. The liver produces a substance called bile which
helps digest food. It also converts food into heat and energy and
stores substances such as glucose and vitamins. The liver breaks
down harmful substances such as alcohol and drugs. It also produces
important proteins that are needed to help the blood to clot. The
liver is a large organ and may be able to carry on working even
if part of it is affected by cancer.
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What symtoms might I have?
If you have developed
secondary liver cancer you may have a number of different symptoms
or none at all. It is important to remember that any symptoms can
also be a sign of other illnesses so you should talk to your specialist
about any new symptoms you have.
Pain
Secondary liver cancer can
cause the liver to enlarge, which then causes pressure by stretching
the capsule around the liver. For some people this may only result
in mild discomfort, while others may also feel pain under their
ribs. Sometimes pain can be felt in the right shoulder. This is
called referred pain and is caused by the enlarged liver pressing
on the nerves that lead to the shoulder. It can usually be helped
with painkillers and anti-inflammatory drugs. Liver pain also responds
well to morphine-based drugs. Sometimes steroid drugs can be very
helpful in reducing swelling around the liver and therefore reducing
pain. In some cases radiotherapy or chemotherapy may be used to
help relieve pain by shrinking the enlarged liver. For more information
call the National Cancer Freefone Helpline on 1800 200 700.
If your pain is not properly under control your GP or specialist
can refer you to a palliative care or pain team that specialises
in pain and symptom control.
Nausea
You may feel sick because of
the liver being enlarged and putting pressure on the stomach or
because of toxins building up in the body from liver damage. This
can be treated with antisickness drugs. There are many different
anti-sickness tablets. If one has been prescribed for you and does
not work, tell your doctor or nurse. Then you can try another anti-nausea
tablet. You may lose your appetite because of the nausea, which
may result in you losing weight. Nutritional supplements to meals
may help but if possible, try not to replace meals with these supplements.
Your GP or specialist may decide to give you a drug to increase
your appetite. You may like to talk to a dietician to help you
find a suitable balanced diet.
Hiccoughs
Hiccoughs may be a result of the enlarged liver pressing on the
diaphragm and causing it to spasm. You may find that it helps to
sit upright and drink small amounts frequently. There are also
drugs that may help.
Ascites
Ascites is a build up of fluid in the abdomen. It can occur if
the blood or lymphatic flow through the liver is blocked. This
results in bloating which may make you feel uncomfortable and sometimes
breathless. It can take weeks or months for this bloating to develop.
You may be given diuretics (water tablets) to help to reduce the
amount of fluid in the abdomen or it may be necessary to insert
a drain (tube) into the abdomen to drain off the extra fluid. This
is called paracentesis. It is done under local anaesthetic and
can be repeated if the fluid builds up again. This procedure is
performed by your doctor in hospital. Sometimes the drain may be
left in place for a few days, to allow time for the fluid to drain
off.
Tiredness
You may find that you tire more easily so try to get plenty of
rest. Tell your doctor how you are feeling as it may be possible
to treat the cause of the tiredness. In some cases, steroid drugs
can help to boost energy levels. You can contact the National
Cancer Freefone Helpline on 1800 200 700 for a free copy of our
booklet on Understanding Fatigue.
Anaemia
You may become anaemic (decreased number of red blood cells) for
a number of different reasons, including problems with blood
clotting. A blood test can be done to find out if you are anaemic
and in some cases iron tablets or a blood transfusion can help.
Jaundice
Jaundice can occur when the bile duct becomes blocked. If you develop
jaundice the whites of your eyes and your skin may take on a yellow
tinge. In some cases your urine may become darker and your stools
(faeces) may become pale. You may need to have a stent (tube) inserted
into the bile duct to drain the bile. Jaundice can cause itching,
which may be worse at night or when you are hot. Alcohol can make
the itching worse, as can soaps and heavily perfumed products.
Antihistamine tablets or cream may help.
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What investigations will I need?
Physical examination
Your specialist will ask you to describe your
symptoms. S/he will examine you and if your liver is enlarged s/he
may be able to feel it.
Blood tests
When liver cells are damaged certain substances are released that
can be detected in the blood. Blood tests can measure these substances
and may also help to show how effective any treatment has been.
Liver biopsy
In most cases your specialist will be able to tell if the cancer
cells in the liver are from the breast. If there is any doubt about
your diagnosis a liver biopsy can be done. This involves removing
a small piece of tissue from the liver under local anaesthetic.
Close monitoring is required afterwards by nursing staff.
Ultrasound scan
An ultrasound scan uses sound waves to build up pictures of the
liver to show up any abnormalities. It is painless and only takes
a few minutes.
CT scan (computerised tomography)
A CT scan is a type of x-ray that creates a three dimensional picture
of the liver. To help show up any abnormalities more clearly a
coloured dye may be injected into the vein. The scan is completely
painless but you will have to lie still for up to an hour.
MRI scan (magnetic resonance imaging)
This scan uses magnetic waves instead of x-rays. It is usually
used if the CT scan pictures are not clear. It is not painful but
you will have to lie still for up to an hour.
ERCP (endoscopic retrograde cholangiopancreatography)
This is used to find out if the bile duct is blocked. A narrow
flexible tube with a light at the end is passed through the mouth
and the stomach into the bile duct. A dye is put through the tube
and a series of x-rays are taken to look at the movement of the
dye through the duct. (If you need a stent to help reduce jaundice
it can be put in place at the same time.) You will be not be able
to eat or drink anything for several hours before this test and
you will be given medication to make you feel relaxed beforehand.
This may make you feel drowsy.
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What treatments might I be offered?
Secondary liver cancer can be treated although it cannot be cured
in the long term. The aim is to relieve your symptoms and improve
your quality of life by slowing down the growth of the cancer.
You may be offered treatments such as chemotherapy, hormone therapy,
radiotherapy or surgery, either alone or in combination.
Chemotherapy
If you had chemotherapy when your breast cancer was first diagnosed
you may be given a similar combination of drugs, or you may be
offered different ones.
For more information call the National Cancer freefone Helpline
on
1800 200 700.
Hormone therapies
Hormone therapies are usually used to treat cancers that are sensitive
to oestrogen (oestrogen receptor positive). If you were already
taking a hormone drug such as tamoxifen when you developed secondary
liver cancer, you may be given a different hormone drug.
Surgery
In rare cases, if only a small part of the liver is affected then
surgery might be an option. However, in most cases several areas
of the liver are affected and surgery is not possible. Liver transplants
are not possible for people who have secondary liver cancer.
Monoclonal antibodies
Monoclonal antibodies are a new group of drugs used to treat secondary
breast cancer. An example of a drug used is called Herceptin (trastuzumab).
In 25-30% of breast cancers, cells become overloaded with a protein
called HER2 and grow and divide uncontrollably. Monoclonal antibodies
aim to stop the cells growing and dividing. For more information
see the section on Herceptin.
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Newer treatments
Thermal ablation
This treatment is still in its early stages of clinical use and
its possible role in the treatment of breast cancer is still uncertain.
Thermal ablation involves using heat to destroy cancerous cells.
Using scanning to guide their position, needles are inserted into
the tumour and heated to approximately 80 degrees centigrade. This
causes damage to the cells that can’t be repaired.
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Living with secondary liver cancer
Knowing that your cancer has spread to your liver may leave you
feeling a variety of emotions similar to when you were first diagnosed,
only this time they may be stronger. There may be times when you
feel overcome by fear, anxiety, sadness, depression or anger. The
uncertainty of living with secondary liver cancer can sometimes
contribute to you feeling emotionally up and down. You may be able
to cope with these feelings on your own or with the support of
those closest to you such as your family and friends. If you find
you need extra support, you can talk to your oncology nurse or
home care specialist nurse. S/he will have a greater understanding
of the special needs and difficulties that go along with secondary
cancers and will be familiar with the different ways of coping
and adapting to the diagnosis. A counsellor or psychotherapist
may be more appropriate if you need more long-term professional
help. The Irish Cancer Society funds a counselling service. A councillor
will provide emotional support by allowing you to express your
feelings and fears. Counselling may help you to see things differently,
and help you through a difficult patch. You may be able to express
worries or concerns to a counsellor that you do not wish to discuss
with others. For further information contact the National
Cancer Freefone Helpline on 1800 200 700.
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Help from Action Breast Cancer
Action Breast Cancer is a national project established by the Irish Cancer Society
to provide breast cancer information and support and to fund breast cancer
research. Its services are free, confidential and accessible. For more information
call
the National Cancer Helpline on Freefone 1800 200 700 or visit www.cancer.ie
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ABC would like to thank Breast Cancer Care in the UK for their permission
to adapt the text in this factsheet from their series of factsheets.
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