Treatment for secondary cancer in the liver
Doctors will consider a number of factors to decide what would be the best treatment option for you.
The choice of treatment for secondary cancer in the liver depends on:
where it has spread from (where the primary cancer was)
which parts of the liver are affected
whether other parts of the body are also affected.
Usually, treatment is aimed at controlling the cancer for as long as possible and reducing any symptoms.
Chemotherapy is the main treatment for secondary cancer in the liver. If chemotherapy worked well for the primary cancer, then it will usually work well for secondary cancer in the liver. Sometimes chemotherapy is given before liver surgery as it can make the operation more successful.
A small number of people will have surgery. It’s usually only possible for people where the cancer has spread into the liver from a cancer in the bowel. However, it may also be an option for other types of cancer. It’s most commonly used if the cancer cells affect a few areas of the liver and there is no cancer anywhere else in the body. In this situation, it’s sometimes possible to cure the cancer.
If the secondary cancer is affecting many areas of the liver, it may not be possible to remove all of the cancer cells with surgery. In this situation, other treatments may be used instead of, or in addition to, surgery.
Radiofrequency ablation (RFA) may be used as a treatment for people with liver secondaries from the bowel - and occasionally other primary sites - who’ve already had surgery or who are not fit enough to have surgery.
Radiotherapy is not usually used to treat secondary cancer in the liver. However, it may be used to relieve symptoms of pain, discomfort and sickness.
Hormonal therapies are sometimes used, usually for a cancer that started in the breast.
Targeted therapies are sometimes used to treat liver secondaries from the bowel and breast. They may be combined with other treatments, such as chemotherapy and surgery.
Supportive or palliative therapies
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Some people with secondary liver cancer may not be fit enough to have the treatments described here. Others may decide not to have treatment if it’s unlikely to shrink their cancer or has too many side effects. If this describes your situation, there are other supportive or palliative therapies that can help to control your symptoms and improve your quality of life.
You can find more information in our section about controlling symptoms.
How treatment is planned
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In most hospitals, a team of specialists will talk to you about the treatment they feel is best for your situation.
This multidisciplinary team (MDT) will include:
a surgeon who specialises in liver cancers
an oncologist (cancer specialist) who specialises in chemotherapy and radiotherapy
a radiologist who analyses scans and x-rays
a pathologist who advises on the type and extent of the cancer
a nurse specialist
The team may also include other healthcare professionals, such as a physiotherapist, an occupational therapist, a psychologist and a counsellor.
If two treatments are equally effective for the type of cancer you have, your doctors may offer you a choice. If you have to decide between treatments, make sure that you have enough information about the different options.
You might want to ask more about what is involved in each treatment, and about possible side effects, before you decide what is right for you. It often helps to make a list of the questions you want to ask and to take a relative or close friend with you. You may also find it helpful to keep notes about what has been said.
Your multidisciplinary team (MDT) uses national treatment guidelines to decide the most suitable treatment for you.
Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or your GP to refer you to another specialist for a second opinion.
Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information. If you do go for a second opinion, it may be a good idea to take a relative or friend with you, and have a list of questions ready, so that you can make sure your concerns are covered during the discussion.
Dr David Plume talks about the possible benefits or disadvantages of getting a second opinion about treatment.
Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away so they can explain again. Some cancer treatments are complex, so it’s not unusual to need repeated explanations.
It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
The benefits and disadvantages of treatment
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Many people are frightened at the idea of having cancer treatments, particularly because of the side effects that can occur. However, these can usually be controlled with medicines. Treatment can be given for different reasons and the potential benefits will vary depending upon your individual situation.
For many people with secondary cancer in the liver, the treatment will only be able to control it, leading to an improvement in symptoms and a better quality of life.
However, for some people in this situation the treatment will have no effect on the cancer, and they’ll get the side effects with little benefit.
For a few people with secondary cancer in the liver, the treatment will aim to cure the cancer. It’s important to discuss the aims of your treatment with your doctors.
If you’ve been offered treatment that aims to cure the cancer, deciding whether to accept it may not be difficult. However, if a cure is not possible and the purpose of treatment is to control the cancer for a period of time, it may be more difficult to decide whether to go ahead.
Making decisions about treatment in these circumstances is always difficult. You may need to discuss in detail with your doctor whether you wish to have treatment.
If you choose not to have it, you can still be given supportive (palliative) care, with medicines to control any symptoms.