Primary liver cancer can cause various symptoms, but there are ways to manage them. With advanced cancer, the palliative care team may be involved in managing symptoms.

Common symptoms

Jaundice

One of the liver’s jobs is to process bilirubin, a yellow pigment formed when red blood cells in the body break down. Normally, the bilirubin passes from the liver, through the bile duct to the bowel, and then out of the body in faeces (poo).

With liver cancer, bilirubin sometimes builds up in the blood (jaundice). This can be because:

• the cancer has blocked a bile duct
• the liver is not working properly
• or the liver has been replaced by widespread tumour.

Jaundice can cause yellowing of the skin and whites of the eyes, pale faeces, dark urine and itchy skin (often worse at night). It can be relieved to some degree by keeping your skin moisturised, and avoiding alcohol, spicy food, hot baths and direct sunlight.

If the itching continues, your doctor may prescribe medicine, which can sometimes help. When jaundice is caused by a blocked bile duct, it may be relieved by unblocking the duct with a small tube made of plastic or metal (a stent).

Symptoms of jaundice usually go away 2–3 weeks after the stent is put in place. The earlier the stent is inserted, the less severe the symptoms. Stenting is not always recommended or possible in advanced cancer.

“After treatment, a psychologist explained that it’s common to feel like you have had the rug pulled out from underneath you.” John

Pain

In some people, liver cancer can cause pain, particularly in the upper right area of the abdomen (belly) and, sometimes, in the right shoulder. If the cancer has spread outside the liver, pain may also occur in the ribs, back or pelvis.

Pain can be managed with different types of pain medicines. These may be mild, like paracetamol, or strong and opioid-based, like morphine, hydromorphone or fentanyl.

Some pain medicines, such as ibuprofen and aspirin, may not be suitable for pain caused by liver cancer. Speak to your doctor about this.

Pain can also be managed with radiation therapy (to reduce the size of a liver tumour) or a nerve block (when an anaesthetic is injected into the nerve). You may also be referred to see a pain or palliative care specialist.

How to cope with pain

Fluid build-up

Ascites is when fluid builds up in the abdomen. In people with cirrhosis, pressure can build up in the blood vessels inside the liver, which may force fluid to leak into the abdomen.

Ascites can also be caused by the cancer itself blocking lymph or blood vessels or producing extra fluid. The fluid build-up causes swelling and pressure in the abdomen. This can be uncomfortable and may make you feel breathless.

Initial treatment may include reducing salt intake in your diet and the use of diuretics (sometimes called water or fluid tablets) to reduce fluid in the body. If needed, a procedure called paracentesis or ascitic tap can also provide relief.

Your doctor will numb the skin on the abdomen with a local anaesthetic. A thin needle and plastic tube are then placed into the abdomen, and the tube is connected to a drainage bag outside your body.

Sometimes, an ultrasound scan is used to guide this procedure. It will take a few hours for all the fluid to drain into the bag, and then the tube will be removed from your abdomen.

Diuretics may be prescribed with paracentesis to slow down the build-up of fluid.

“I’d like people with advanced cancer to know that there are a myriad of services. You only have to ask; you are not alone.” Pat

Fatigue

Many people with primary liver cancer experience fatigue. This is different to normal tiredness as it doesn’t always go away with rest or sleep.

The fatigue may be a side effect of treatment or caused by the cancer itself. Managing fatigue is an important part of cancer care.

Confusion

Chronic liver disease may cause toxic substances to build up in the blood, which can affect how your brain functions. Called hepatic encephalopathy, it can lead to confusion or disorientation and, in severe cases, coma.

Carers need to look out for these symptoms as this condition can develop quickly. Hepatic encephalopathy can be controlled with medicines.

Follow-up appointments

After treatment ends, you will have regular appointments to monitor your health, manage any long-term side effects and check that the cancer hasn’t come back or spread.

During these check-ups, you will usually have a physical examination and you may have blood tests, x-rays or scans.

People who still have hepatitis B or hepatitis C may be given medicines (antiviral therapy) to help manage these diseases and reduce the chance of the cancer coming back.

Your doctor will also talk to you about the importance of not drinking alcohol, not smoking, eating healthy foods and exercising.

Check-ups will become less frequent if you have no further problems. Between follow-up appointments, let your doctor know immediately of any symptoms or health problems.

What if the cancer returns?

When cancer won't go away