Download UG17 Secondary liver cancer (treatment options)

Secondary liver cancer
(treatment options)
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!! You have been told that you have secondary liver
cancer (liver metastases). We know that you will
be distressed by this news and may not have
been able to take in everything that your doctor
has told you.
This document will give you information about
secondary liver cancer and will reinforce what
your doctor has told you. If there is anything you
do not understand, please ask your doctor or the
healthcare team.
You are now being looked after by a team of
specialists dedicated to providing care for people
with secondary liver cancer. Their aim is to make
sure you receive the best treatment to meet your
needs. The healthcare team will take account of
your views on the treatment you want to have,
and will fully involve you in making decisions
about your treatment. The healthcare team will
not treat you without your consent.
What is secondary liver cancer?
Your liver carries out many important functions,
including producing bile to help you to digest food
and cleaning your blood of medicines and
chemicals. It is the largest organ in your body
(see figure 1).
Liver
Figure 1
Your doctor can mark where the cancer is
The liver has the ability to regenerate (grow
back), and it can work normally even if up to
two-thirds have been removed.
Secondary liver cancer means that cancer from
another part of your body (the primary cancer)
has spread through your bloodstream to your
liver.
The cancer in your liver is made up of the same
abnormal cells as the primary cancer. About one
in three people with cancer develops secondary
liver cancer.
An ultrasound scan, or special X-ray such as a
CT or MRI scan, will usually show if you have
secondary liver cancer.
In the early stages, you may not have any
symptoms or have only the following mild
symptoms.
• Pain and tenderness in the upper abdomen
caused by the fibrous capsule (covering) of your
liver being stretched as the cancer gets larger.
• Weight loss and malnutrition caused by food
not being digested properly.
• You may also have tiredness, feeling sick and
a high temperature.
In the later stages of the disease, you may have
the following symptoms.
• Jaundice (your eyes and skin turning yellow)
caused by bile staying in your liver.
• Fluid collecting in your abdominal cavity
(ascites), causing discomfort.
How can secondary liver cancer be treated?
There are several different options for treating
secondary liver cancer.
• Surgery involves removing the cancer and
the part of your liver affected by the cancer. The
operation is called a liver resection (or
hepatectomy). Some secondary liver cancers,
especially those that have spread from a cancer
in your bowel, can be removed by surgery. The
amount surgery will help depends on the number
of secondary cancers, how large they are and
where they are in your liver. Surgery will not help
if you have secondary cancer in other areas of
your body such as your lungs or abdominal
cavity.
• Chemotherapy involves injecting special
medicine directly into a vein or taking tablets to try
to shrink the cancer and kill off cancer cells.
Chemotherapy will not cure you but may control
the cancer and even reduce its size. This can
help to control any symptoms you may have and
may also help you to live longer. Sometimes
chemotherapy may be given before surgery to
improve the results or to shrink large cancers so
they can be removed by surgery.
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• Hormone treatments can be used to help
slow down the growth of cancer cells and to
improve symptoms. However, hormone
treatments are helpful only where the primary
cancer is of a certain type such as breast or
prostate cancer.
• Chemoembolisation involves injecting a
special medicine, usually under a local
anaesthetic, directly into the blood vessel that
supplies the cancer. The medicine helps to kill
the cancer cells and shrink the cancer. The
medicine is mixed with an oily substance which
blocks the blood supply to the cancer, destroying
the cancer cells.
• Ablation treatments can be used to destroy
cancer cells. Radio-frequency ablation (RFA) or
microwave ablation destroys cancer cells by
heating them up, while cryotherapy works by
freezing them. These treatments involve
inserting a probe into the cancer, either directly
through your skin or by open surgery. These
treatments are usually used for cancers that are
in parts of your liver that are difficult to remove by
surgery or if you are not strong enough to have
major liver surgery. Sometimes they are used in
combination with surgery.
Your doctor will help you to decide which
treatment, or combination of treatments, is best
for you.
How do I know what is the best treatment for
me?
Removing the cancer by surgery gives the best
chance of you being free of secondary liver
cancer. However, the choice of treatment will
depend on where in your body the primary
cancer is, the number, size and location of the
secondary liver cancers and if the cancer has
spread to other areas of your body.
If the cancer has spread so far that it is no longer
possible for you to be cured, treatments may
control the cancer for a long time and improve
your quality of life.
Some people who have other medical problems
may not be strong enough to have major surgery
and so non-surgical treatments would be better.
To decide on the best treatment for you and if
surgery is likely to help you, you may need to
have a number of tests. If you have recently had
some of these tests, they will not need to be
repeated.
• CT scan – This shows if the primary cancer
has spread to other areas of your body.
• Ultrasound scan – This uses sound waves to
give pictures of your internal structures.
• MRI scan – A powerful magnetic field and
radio waves give pictures of your abdomen.
• Staging laparoscopy – This minor operation,
performed under a general anaesthetic, involves
inserting a small telescope into your abdomen.
The examination will show if the cancer has
spread to areas that are not usually seen on a CT
scan, and will help your doctor to decide if
surgery is likely to help you.
• Heart and lung function tests – These tests
show if you are fit enough for surgery. They may
include cardio pulmonary exercise tests.
• Blood tests - These can show how well your
liver is working.
Once all the information is available, your doctor
will discuss the results at a team meeting with the
other specialists involved in your care.
• Liver cancer surgeons – Surgeons who
specialise in diseases of the liver.
• Oncologists – Doctors who specialise in
treating cancer with medicine (chemotherapy)
and radiotherapy.
• Radiologists – Doctors who specialise in
X-rays and scans.
• Histopathologists – Doctors who examine
tissue to confirm the diagnosis.
The team will recommend the best treatment for
you. Your doctor will discuss the
recommendation with you and give you further
written information to help you to decide what to
do.
Keep this information leaflet. Use it to help
you if you need to talk to the healthcare team.
Acknowledgements
Author: Mr Ian Beckingham DM FRCS
Illustrations: Medical Illustration Copyright ©
Medical-Artist.com
This document is intended for information
purposes only and should not replace advice
that your relevant healthcare professional would
give you.
You can access references online at
www.aboutmyhealth.org. Use reference UG17.
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