Managing symptoms of liver cancer

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.

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. This can be because the cancer has blocked a bile duct, the liver is not working properly, or the liver has been replaced by widespread tumour. The build-up of bilirubin in the blood is known as jaundice. It can cause yellowing of the skin and whites of the eyes, pale faeces, dark urine and itchy skin.

This itching is 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.

Pain

In some people, liver cancer can cause pain 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.

Poor appetite and weight loss

Because the liver plays a key role in the digestive system, cirrhosis and cancer in the liver can affect how much you eat, and you may lose weight. Radiation therapy and other cancer treatments can also have an impact on appetite and weight, especially if you have side effects such as nausea and vomiting, mouth ulcers, and taste or smell changes.

Maintaining your weight can help your recovery, so it's important to eat and drink enough during and after treatment. Gentle physical activity, like a short walk around the block, can help to stimulate your appetite, and eating a variety of foods may boost how much you are able to eat.

Your doctor may suggest that you avoid salty foods as these can increase the risk of ascites.

How to stay well nourished

Eat foods you enjoy

Eat foods that you like, but also try eating different foods. Your taste and tolerance for some foods may have changed and may continue to change. Chew foods well and slowly to avoid becoming too full.  

Drink fluids

Prevent dehydration by drinking fluids, such as water, between meals (e.g. 30–60 minutes before or after meals). Avoid filling up on fluids at mealtimes – unless it’s a hearty soup – to ensure you have room for nourishing food.

Talk to a dietitian

Ask your dietitian what foods you can eat to increase your energy and protein intake.

Get help

Ask your family and friends to cook for you and offer you food throughout the day.

Snack during the day

Try eating 5–6 small meals rather than three large ones each day. Keep a selection of snacks handy (e.g. in your bag or car).

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.

Learn more about Fatigue and listen to Cancer Council's podcast episode Managing Cancer Fatigue.

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

John

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.

Confusion

In people with cirrhosis, toxic substances can sometimes build up in the blood and affect how your brain functions. Called hepatic encephalopathy, this 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.