Secondary liver cancer
Find out 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.
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.
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.
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.
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.
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 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 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.
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.
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 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.
What investigations will I need?
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.
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.
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.
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.
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.
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 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.
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 are a new group of drugs used to treat secondary breast cancer. An example of a drug used is called Trastuzumab (Herceptin®).
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 Trastuzumab (Herceptin®).
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.
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.
Call our National Cancer Helpline
Freephone 1800 200 700 to talk to a specialist cancer nurse
It's open Monday-Thursday from 9am to 7pm and Friday from 9am to 5pm