Treatment for symptoms and advanced cancer

Even if your cancer is advanced when it is diagnosed, there is still treatment that your doctor can offer you.

Treatment to shrink the cancer

Even if your cancer can’t be cured, your doctor may be able to control it for a while. Just about any treatment in this section can be used in some circumstances. The links will take you to the page on that type of treatment. You may have

• a targeted (biological) therapy
• ablation, using heat to destroy all or part of a tumour
• radiotherapy
• chemotherapy

Which type of treatment is suitable for you will depend on:

• the exact type of liver cancer you have
• your overall health and the health of your liver

Controlling symptoms

Advanced cancers can cause a number of symptoms, but there is treatment available to control them and help you to feel better. There are a number of different symptoms you may get with a liver cancer:

• Sickness
• Swelling
• Itching
• Losing weight or losing your appetite
• Pain

if you’re having trouble with symptoms, your doctor or nurse may refer you to a symptom control team. These are specialist nurses who can visit you at home. They are very experienced at helping people manage symptoms of advanced diseases, including cancer. They can also give advice and support to you and your family.

Sickness

You may feel sick at times, either because of your cancer or treatment. Treating sickness depends on what exactly is causing it. If you are feeling sick because an enlarged liver or a swollen tummy (abdomen) is squashing your stomach, then relieving the pressure may help.

If you are feeling or being sick, tell your doctor. They can give you anti-sickness medicine. As with painkillers, there are many different ones. So if the first doesn’t help, tell your doctor.

If necessary, anti-sickness medicines can be given through a pump with a painkiller.

Swelling

Problems with your liver can lead to swelling. The liver makes proteins that hold water in the bloodstream and lymph system. If your levels of these proteins are low, fluid can leak out. You may have puffy hands and feet.

In liver disease, it’s quite common fluid to collect around the organs in the tummy (abdominal cavity). Doctors call this ascites (say: ass-sight-ease). Although it will build up again, you can have this drained to relieve any discomfort.

The doctor will give you some local anaesthetic. Then put a needle through the skin into your abdomen. The needle will be attached to a drainage bag. The fluid has to drain slowly. If it’s too fast, it can make your blood pressure drop suddenly. Depending on how much fluid there is, it may take a few hours.

Itching

The main cause of itching in liver cancers is jaundice. So the best way to help with it is to relieve the jaundice. There is more about this above, on this page.

Your doctor may prescribe tablets to help absorb bile salts and relieve itching that way. Antihistamines are sometimes used for itching, but these don’t tend to help so much for jaundice caused by a blocked bile duct.

Showering may help to relieve the itch. Try not to use soaps or skin washes that dry your skin. Aqueous cream may be better as it’s moisturising.

Complementary therapies may also help to relax you and distract you from the itching.

Losing weight or losing your appetite

It can sometimes be hard to keep your weight up when you have cancer. Difficulty eating may be caused by the liver cancer. For example a swollen liver or fluid collecting in your tummy (abdomen) can squash your stomach and make you feel full. Or it may be caused by treatments, such as chemotherapy.

You may not feel much like eating for a variety of reasons. Sometimes it just feels like too much effort. Don’t force yourself. Sip a nourishing drink instead. Or have a snack every couple of hours instead of trying to manage a large meal.

Ask to speak to a dietician if you’re having trouble with your weight. There are build-up drinks your doctor can prescribe. The dietician can also suggest ways of adding calories to your regular diet. There are diet tips  in our information on living with liver cancer that may help.

Pain

Most people think cancer always causes pain. But this isn’t the case. So don’t think it’s inevitable. The liver only has nerves that transmit pain in its fibrous covering, the capsule. If you have an enlarged liver, it can stretch the capsule and that’s what causes the pain. You may feel it on your right side, just under your ribs. Liver pain may also spread up to your shoulder.

If your liver cancer has spread to your bones, that may also cause pain. Your doctor may suggest a short course of radiotherapy which can help a lot.

There are many different painkillers available. If the painkiller your doctor prescribes isn’t helping, let them know. You may need a stronger one or a different one that works better for you.  Or, you may just need advice on how to take them, which makes a big difference.

You should always take painkillers for cancer pain regularly. Many people try and leave it as long as possible before they take the next dose. That really doesn’t help. Your pain builds up and then it’s harder for the painkillers to get on top of it. You may even end up taking more or a higher dose. So do take them according to the schedule your doctor prescribes.

If you have any pain between doses, tell your doctor or nurse. You may need a higher dose.  They may suggest a breakthrough dose or a different painkiller you can take between times.

When possible, doctors will always use painkillers that you take by mouth. But if someone is not able to manage this, there are other options. For very advanced cancers, doctors and nurses often use a clockwork or battery pump to give a continuous dose of a painkiller through a needle placed just under the skin (subcutaneously).

Complementary therapies

Many people use complementary therapies when they have cancer. They can be relaxing and help to take the edge off symptoms you’re having to cope with. You may find that relaxation, massage or visualisation are comforting and can help you to manage pain, sickness and other symptoms. There is more about relaxation and mindfulness  in our page on mental wellbeing.

There is information about complementary and alternative therapies in the section on living with liver cancer.

Thinking ahead

It’s important for patients with advanced liver cancer to have the opportunity to talk about the impact of their condition, and to think about their wishes for the future.

Information in our Thinking ahead booklet will help you talk to your hepatology team, GP, relatives and carers about how you would like your future care to progress, and encourage you to start those conversations early, so you can make your preferred care options clear.

Download it here.