Liver cancer

Liver cancer treatment at GenesisCare

At GenesisCare we use state-of-the art technology and best practice, evidence-based treatment protocols to provide the latest cancer treatments.

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Chapter 01

Liver cancer

The liver is the largest internal organ of the human body, weighing around 1.5kg in the average adult. It is positioned on the upper right side of the abdomen, just below the rib cage.

The main roles of the liver include:

  • removing toxins from the body
  • processing food nutrients – breaking down fats and proteins so they can be absorbed from the small intestine
  • storing glycogen, made from sugars, to fuel the body
  • helping to regulate body

Primary liver cancer is rare. It develops when liver cells become abnormal and form malignant tumours.1

Secondary liver cancer, where cancer has spread from another place in the body such as the bowel, is far more common and happens to about 20% of people who have bowel cancer.1

Chapter 02

What is liver cancer?

Primary liver cancer is a malignant tumour that begins in the liver. There are different types:2

  • hepatocellular carcinoma (HCC) or hepatoma, is the most common type of primary liver cancer and it starts in the main cell type in the liver, the hepatocytes
  • cholangiocarcinoma, or bile duct cancer, starts in the cells lining the bile ducts (which connect the liver to the bowel and gall bladder)
  • angiosarcoma, which starts in the blood vessels. This is a rare type of liver cancer that is more likely to occur in people over

Secondary liver cancer (metastatic liver cancer) is more common than primary tumours.

Many cancers can spread to the liver. The most common cancer that spreads to the liver is bowel cancer. This is because the blood supply from the bowel is connected to the liver through the portal vein. Melanoma, breast, oesophagus, stomach, pancreas, ovary, kidney, or lung cancers can also spread to the liver.1,3

Causes of liver cancer

The biggest known risk factor for primary liver cancer is hepatitis B or C viruses which result in long term infection.2

There are also other factors that can increase the risk of developing liver cancer, including:1,2

  • non-alcoholic fatty liver disease
  • genetic disorders including haemochromatosis, or alpha 1- antitrypsin deficiency
  • type 2 diabetes
  • high alcohol consumption
  • obesity
  • smoking tobacco
  • exposure to certain chemicals.

Symptoms of liver cancer

Liver cancer symptoms are more likely to appear as the cancer grows or becomes more advanced.2

Symptoms may include:2

  • weakness and tiredness
  • pain in the abdomen
  • swelling of the abdomen due to a build-up of fluid
  • pain in the right shoulder
  • appetite loss and feeling nauseous
  • weight loss
  • yellowing of the skin and eyes (jaundice)
  • pale and frothy bowel motions
  • fever.
Chapter 03

Diagnosing your liver cancer

Your doctor will discuss your specific symptoms with you. Tests to diagnose both primary and secondary liver cancer include:

Blood tests – check how well your liver is functioning, as well as checking certain chemicals known as tumour markers, whether you have hepatitis B or C, and any genetic problems.

Ultrasound – the most commonly used method to look for primary liver cancer, it can show the size and location of abnormal tissue in your liver.

CT scan – takes three-dimensional pictures of several organs at the same time, and can help doctors plan surgery, if required. It can also see if the cancer has spread.

MRI scan – produces detailed cross-sectional pictures of the body and can show the size of a tumour and whether it is affecting the main blood vessels around the liver.

PET-CT scan – more commonly used for secondary cancers in the liver, PET– CT scans produce three-dimensional colour images that show where any cancers are in the body.

Biopsy – when a small amount of tissue is removed for examination under a microscope.

A biopsy is done by either:

  • fine needle aspiration, which involves a local anaesthetic, and a thin needle which removes the cells
  • laparoscopy (keyhole surgery), which is done under general anaesthetic and allows the doctor to look at the liver and surrounding organs, as well as take tissue samples using a laparoscope.

If you have secondary cancer in the liver, you may have further tests to find out where the primary cancer started, if this is not already known.

Chapter 04

Treatments

Treatment for liver cancer will depend on the location and extent of the cancer, whether the cancer can be removed with surgery, likely side effects of treatment and your overall health. Your doctors will discuss the treatment options with you. They may include:

Radiation therapy for liver cancer

Radiation destroys cancer cells in a targeted site in your body. Treatment is carefully planned, and with the developments in technology, very little harm is done to normal body tissue surrounding the tumour.4

Some bile duct cholangiocarcinoma patients may be offered high dose rate brachytherapy. Other patients with cancer involving the liver may be offered the latest-generation Stereotactic Body Radiation Therapy (SBRT), including systems to improve image-guided radiation therapy, and surface-guided radiation therapy technologies.

Stereotactic body radiation therapy (SBRT) is an advanced, high precision radiation therapy technique that delivers radiation doses while minimising the dose to normal tissues.4

Radiation therapy can be delivered independently or alongside chemotherapy or surgery. Your doctor will discuss your specific treatment plan with you.

Chemotherapy for liver cancer

Chemotherapy is medication that treats your cancer by disrupting the cell cycle. The drugs kill cancer cells, preventing them from dividing and spreading further.

Chapter 05

Your treatment with GenesisCare

A cancer diagnosis is life changing. Even before your initial encounter with us you will experience a wave of emotions. It’s natural to feel disbelief, anxiety, sadness, anger and loneliness. At GenesisCare we understand these emotions and strive to strengthen your confidence, settle your emotions and create care experiences for the best possible outcomes.

Our care team know your name and get to know who you are as a person. We don’t want you to feel alone when you’re at GenesisCare. Your nursing team and oncology team are here to support you before, during and after your cancer treatment. We are here to guide you to get the support you need which may include a psychologist, exercise physiologist, physiotherapy and dietitian.

Please contact your local GenesisCare centre for more details on services available. View a list of our centres here.

Chapter 06

Side effects

Radiation therapy

General side effects:5

  • Nausea and/or light headedness in the early period after the treatment
  • Tiredness and lethargy for a few weeks after you finish

Specific side effects (depending on the area being treated):

  • Digestive issues – reduced appetite, pain, discomfort or bloating
  • Change in bowel habits
  • Nausea or

Most of these side effects will ease shortly after treatment is finished. Your team will discuss any long-term considerations with you depending on the tumour type.

Chemotherapy

Side effects6

Whether you experience side effects and how severe they are, depends on the type and dose of drugs you are given and your reaction from one treatment cycle to the next.

  • Most side-effects are short-term and can be managed.
  • They tend to gradually improve once treatment stops and the normal, healthy cells recover.

You may worry about the side effects of chemotherapy. If you feel upset or anxious about how long treatment is taking or the impact of side effects, let your doctor or nurse know.

What can I do to help my treatment go smoothly?

  • Get as much rest as possible
  • Eat a wholefood, varied diet
    • Appetite changes are common, and you may experience taste changes or nausea – help manage this by eating small, frequent snacks, avoiding smells that make you feel nauseous, eating foods that interest you rather than what you think you ‘should’ eat
  • Keep up your water intake
  • Reach out to support groups and others who have had
  • Ask your team about topical treatments for skin if you are getting irritation or pain
  • Stay out of the sun as much as possible throughout your treatment
  • Record your side effects in a diary or journal
  • Take some gentle exercise, such as walking, if you feel up to it. Light to moderate exercise can reduce treatment-related fatigue and improve
    • It is important to acknowledge when you are fatigued, and rest when you need to. Plan your exercise for times in the day when you know you have more energy
  • Ask for, and accept, help from family, friends and neighbours
  • Be open with employers about your treatment and discuss flexible working options where needed.
Chapter 07

Helpful services

Other liver cancer information, resources and support services are available to assist you during your cancer journey. These include:

Cancer Council

T: 13 11 20

Cancer.org.au

Pancare Foundation

T: 1300 881 698

Pancare.org.au

Australian Cancer Research Foundation

T: 02 9223 7833

Acrf.com.au

References

  1. Ananthakrishnan A, et Semin Intervent Radiol 2006; 23(1): 47–63.
  2. Cancer Council Australia. Liver Cancer. Available at: https://www.cancer.org.au/cancer-information/types-of-cancer/liver-cancer. Accessed on: 13/05/21.
  3. Cancer Council NSW. Secondary liver cancer. Available at: https://www.cancercouncil.com.au/liver-cancer-secondary/. Accessed on: 13/05/21.
  4. Li D, et al. Cancer Biol Med 2014; 11(4):217-236.
  5. Cancer Council Australia. Radiation therapy. Available at: https://www.cancer.org.au/cancer-information/treatment/radiation-therapy. Accessed on: 13/05/21.
  6. Cancer Council Victoria. Chemotherapy side effects. Available at: https://www.cancervic.org.au/cancer-information/treatments/treatments- types/chemotherapy/side_effects_of_chemotherapy.html. Accessed on: 13/05/21.