Liver cancer back pain

Liver cancer

Cancer that starts in the liver (primary liver cancer) doesn’t usually cause symptoms in the early stages. When you do have symptoms, they can include:

  • weight loss
  • yellowing of the skin and whites of the eyes (jaundice)
  • itching
  • feeling sick
  • swollen tummy (abdomen)
  • loss of appetite or feeling full after eating small amounts
  • pain in your abdomen or your right shoulder
  • a lump in the right side of your abdomen

If you already have a liver condition such as cirrhosis, tell your doctor if you have any new or worsening symptoms.

See your GP if you have any of these symptoms. Remember primary liver cancer isn’t common in the UK and these symptoms can be caused by other conditions. But it’s important to get them checked by a doctor.

About these symptoms

The symptoms vary depending on where the cancer is. Some symptoms, such as itching, are caused by the jaundice.

Symptoms of liver cancer are often quite vague, such as feeling sick and loss of appetite.

Weight loss

Unexplained weight loss is a symptom of liver cancer.

Doctors define significant weight loss as losing more than 10% of your body weight. This means losing 1 stone for every 10 stone that you weigh.

See your doctor if there is no obvious reason for your weight loss.

Yellowing of the skin and whites of the eyes (jaundice)

Jaundice is the yellowing of the skin and the whites of the eyes. When you have jaundice your wee (urine) is darker than normal and your poo (stools or faeces) is lighter in colour. Most people who have jaundice also have itchy skin and may feel sick.

Jaundice is caused from a blockage in the bile duct or your liver not working properly.

You can get a high temperature (fever) when you have jaundice. It can be a sign of inflammation or an infection. When your temperature is high you may feel cold and shivery.

A swollen tummy (abdomen)

Liver cancer can cause swelling of the tummy (abdomen). This might be because:

  • the liver gets bigger from the growing cancer, and causes swelling on the right side of your abdomen
  • the cancer (or cirrhosis) increases pressure in the liver causing blood to back up in the vessels (veins). This forces fluid out of the veins into the abdomen (ascites)

The increased pressure in the veins can make them swell so they might be seen under the surface of your abdomen. Ascites can also develop when the liver isn’t making enough blood protein (albumin).

A swollen abdomen might cause discomfort or pain, and a loss of appetite or feeling full quickly.

A swollen (enlarged) liver can cause pain in your right shoulder. This is because the enlarged liver stimulates nerves that connect to nerves in the shoulder. It is called referred pain.

Controlling Liver Cancer Pain

People with liver cancer commonly experience pain, especially in their upper right abdomen.

“The sensory nerves are in the outer covering of the liver, which is like the skin around an apple. When the skin is stretched, or when the tumors eat through it, that’s what causes your pain,” explains Otis Brawley, MD, chief medical officer for the American Cancer Society.

Liver Cancer

The liver, the largest organ in the body, is situated in the right upper quadrant of the abdomen. Cancer can start in the liver itself, which is called primary liver cancer, or it can be a secondary cancer that initially arose in another part of the body, such as the colon, pancreas, lung, or breast. When this happens, it’s called metastasis. Secondary cancers of the liver are actually more common than primary liver cancer.

If the cancer starts in the liver, it usually stays in the organ, and grows within it. However, in later stages of liver cancer, it may spread to lymph nodes, bones, and the lungs.

Liver Cancer: Sources of Pain

Liver cancer pain can be caused by the tumor itself and other sources, including:

  • Referred pain. The enlarged liver could be pressing on nerves under the diaphragm. Some of these nerves connect to nerves in the right shoulder, which may result in pain in that area.
  • Treatment. You may experience discomfort from the therapies your doctors are using to treat your liver cancer. This may include postoperative pain if you have been treated with surgery, and nausea and gastrointestinal discomfort from medications.

Your doctors may need to try different ways to reduce or relieve your pain until they find what works for you.

Treating Liver Cancer Pain: Medications

Your doctor may prescribe some powerful medications for your pain. “Most rely strictly on narcotics for the control of pain for liver cancer,” Dr. Brawley says. Narcotics provide pain relief by depressing the central nervous system. Narcotic drugs, also referred to as opioids, come in many forms.

The medications can be delivered by different methods, says Russell Mark Reisner, MD, a surgical oncologist at the Cancer Treatment Centers of America in Philadelphia. “For example, system-wide pain management can be delivered by patches or lollipops absorbed under the tongue,” says Dr. Reisner.

Treating Liver Cancer Pain: Radiation

Radiation can shrink the liver tumor and provide some relief from the pain it is causing. Spot radiation also can provide relief from bone pain, if the liver cancer has spread there. However, Brawley says, “if you have lots of areas of bone pain, you can’t use radiation, and you have to rely strictly on narcotics for control of the pain from liver cancer.”

Reisner adds that doctors are now able to deliver radiation more accurately than previously, sparing surrounding organs from damage.

Treating Liver Cancer Pain: Nerve Blocks

Doctors can sometimes inject a local anesthetic into or near nerves in the abdomen to reduce liver cancer pain. “The direct application of a local anesthetic over the source of the pain can provide some relief to the liver cancer patient,” Reisner says. “The physicians will use medications or alcohol to kill off or deaden those nerves.”

Treating Liver Cancer Pain: Alternative Treatments

Some find that alternative or complementary therapies can relieve or reduce severe liver cancer pain, especially in the late stage of the disease, Reisner says. “They can provide additional pain control on top of other treatments,” he adds.

Complementary treatment options for liver cancer pain include:

  • Acupuncture. One of the mainstays of traditional Chinese medicine, acupuncture involves inserting fine sharp needles into specific points (nerves and blood vessels) that, when manipulated, aid healing and reduce pain.
  • Acupressure. Like acupuncture, but instead of inserting needles, finger pressure is used to stimulate healing. The technique is an option for people who are afraid of needles.
  • Relaxation techniques. Some patients find that techniques that help them to relax, such as listening to soothing music or learning to breathe more slowly, can make them more comfortable. Some patients also may find that massage can provide some relief from their pain.

Because liver cancer is often not diagnosed until the later stages, patients often experience significant pain. Liver cancer patients may experience pain from their primary tumor in the liver as well as pain from other areas if their cancer has spread. Ask your treatment team about what conventional and complementary treatments are available to help alleviate your pain and get you feeling better.

Center for Liver Disease and Transplantation

Often a patient has no symptoms until the disease has reached its later stages. Many of these complaints may be caused by other illnesses, so it is important to be evaluated by a physician.

  • Unexplained weight loss or loss of appetite
  • Feeling very full after eating very little
  • Nausea or vomiting
  • An enlarged liver
  • An enlarged spleen
  • Pain in the abdomen or near the right shoulder blade
  • Swelling or fluid build-up in the abdomen
  • Itching
  • Yellowing of the skin and eyes (jaundice)
  • Fever
  • Enlarged veins on the belly that are visible through the skin
  • Abnormal bruising or bleeding

People who have chronic hepatitis or cirrhosis may feel worse than usual and produce excess hormones that cause:

  • High blood calcium levels (hypercalcemia), and symptoms of nausea, confusion, constipation, weakness, or muscle problems
  • Low blood sugar levels (hypoglycemia) and symptoms of fatigue or fainting
  • Breast enlargement (gynecomastia) and/or shrinking of the testicles in men
  • High red blood cells counts (erythrocytosis) causing redness and flushed skin
  • High cholesterol levels

Liver Cancer

Anatomy of the liver

What is liver cancer?

Cancer is a disease that happens when abnormal cells grow too quickly and leave less space for normal cells.

Liver cancer can be classified in two ways. Primary liver cancer is one that starts in the tissue of the liver. The most common type of primary liver cancer is called hepatocellular carcinoma. The number of cases of primary liver cancer in the United States has been increasing over the years.

Secondary liver cancer is cancer that started in some other place in the body and moved to the liver. This type is also called metastatic liver cancer.

What does the liver do?

The liver is one of the most important organs in the body. The liver is divided into sections, called lobes, and acts as a filter for blood. It takes harmful substances out of the blood that are later passed out of the body as waste. The liver also:

  • Makes bile, a fluid that helps digest fat.
  • Digests and stores other nutrients from food like sugar, which is used for energy.
  • Makes substances used for many body functions, including ones that make your blood clot.

What are the risk factors for liver cancer?

A risk factor does not mean that you will develop a disease, but it does increase your chances of getting a disease. For liver cancer, risk factors include:

  • Having other liver diseases, including hepatitis B or C (viral diseases that attack the liver) or cirrhosis (a disease that causes scarring). Having a family history of liver diseases that can cause cirrhosis (liver diseases that run in families) is also a risk factor.
  • Having diabetes.
  • Being obese.
  • Being a man. Men are more likely to get liver cancer than women.
  • Drinking too much alcohol over a long period of time.
  • Being exposed to a type of poison made by moldy crops.

What are the signs and symptoms of liver cancer?

When liver cancer is in the early stages, you may have no symptoms at all. If your liver is swollen, you might notice the following symptoms: You may have:

  • A lump below the rib cage or pain on the right side of the abdomen, or pain near the right shoulder.
  • Jaundice (a disease that causes skin and eyes to yellow).
  • Unexplained weight loss, nausea, or loss of appetite.
  • Fatigue.
  • Dark-colored urine.
  • Bloating.

Remember, though, that liver cancer is only one of the reasons that a liver can be swollen.

What causes liver cancer?

You might get liver cancer from liver diseases like hepatitis. Having cirrhosis also increases your risk. However, some people who get liver cancer don’t have any other liver diseases. In many cases, the actual cause isn’t known.

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People with HCC may experience no symptoms, particularly when the tumor is detected early as part of a screening program. When symptoms or signs do occur, they include:

  • Pain, especially at the top right of the abdominal area, near the right shoulder blade, or in the back

  • Unexplained weight loss

  • A hard lump under the ribs on the right side of the body, which could be the tumor or a sign that the liver has gotten bigger

  • Weakness or fatigue

When HCC is diagnosed, some people will already know that they have cirrhosis and will be receiving care from a doctor. Some symptoms experienced by people with HCC may be caused by cirrhosis rather than the tumor. These symptoms include abdominal swelling from fluid accumulation, called ascites, and needing more water tablets, called diuretics, to control the fluid accumulation. Hepatic encephalopathy (mental confusion) and bleeding from the esophagus or stomach, or any worsening of the condition, may also indicate cancer.

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If liver cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called palliative care, or supportive care. It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Liver cancer

Deciding which treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.

Your treatment plan

Your recommended treatment plan will depend on the stage your liver cancer is at (see diagnosing liver cancer for more information about staging).

If your cancer is at stage A when diagnosed, a complete cure may be possible. The three main ways this can be achieved are:

  • removing the affected section of liver – known as a resection
  • having a liver transplant – an operation to remove the liver and replace it with a healthy one
  • using heat to kill cancerous cells – known as microwave or radiofrequency ablation (RFA)

If your cancer is at stage B or C, a cure is not usually possible. However, chemotherapy can slow the progression of the cancer, relieve symptoms, and prolong life for months or, in some cases, years. There is also a medication called sorafenib that can help prolong life.

If your cancer is at stage D when diagnosed, it is usually too late to slow down the spread of the cancer. Instead, treatment focuses on relieving any symptoms of pain and discomfort you may have.

The main treatment options for liver cancer are discussed in more detail below.

Surgical resection

If damage to your liver is minimal and the cancer is contained in a small part of your liver, it may be possible to remove the cancerous cells during surgery. This procedure is known as surgical resection.

As the liver can regenerate itself, it may be possible to remove a large section of it without seriously affecting your health. However, in the majority of people with liver cancer, their liver’s regenerative ability may be significantly impaired and resection may be unsafe.

Whether or not a resection can be performed is often determined by assessing the severity of your cirrhosis (scarring of the liver).

If a liver resection is recommended, it will be carried out under a general anaesthetic, which means you will be asleep during the procedure and won’t feel any pain as it is carried out.

Most people are well enough to leave hospital within a week or two of having surgery. However, depending on how much of your liver was removed, it may take several months for you to fully recover.

Risks

Liver resection is a complicated surgery and can have a considerable impact on your body. There is a significant risk of complications occurring during and after surgery.

Possible complications of liver resection include:

  • infection at the site of the surgery
  • bleeding after the surgery
  • blood clots that develop in your legs – the medical term for this is deep vein thrombosis (DVT)
  • bile leaking from the liver – further surgery may be required to stop the leak
  • jaundice (yellowing of the skin and whites of the eyes)
  • liver failure (where your liver is no longer able to function properly)

Liver resection can also sometimes cause fatal complications, such as a heart attack. It is estimated that around 1 in every 30 people who have liver resection surgery will die during or shortly after the operation.

Liver transplant

A liver transplant involves removing a cancerous liver and replacing it with a healthy one from a donor.

This is a major operation and there is a risk of potentially life-threatening complications. It’s estimated around 1 in every 30 people will die during the procedure and up to 1 in 10 people will die at some point in the year after surgery.

A liver transplant may be suitable for you if:

  • you only have a single tumour less than 5cm (50mm) in diameter
  • you have three or fewer small tumours, each less than 3cm (30mm)
  • you have responded exceptionally well to other treatments, with no evidence of tumour growth for six months

If you have multiple tumours or a tumour larger than 5cm, the risk of the cancer returning is usually so high that a liver transplant will be of no benefit.

If you are suitable for a liver transplant, you will normally need to be placed on a waiting list until a donor liver becomes available. The average waiting time for a liver transplant is 142 days for adults.

In some cases, a small part of the liver of a living relative can be used. This is known as a living donor liver transplant.

The advantage of using a living donor liver transplant is that the person receiving the transplant can plan the procedure with their medical team and relative, and will not usually have to wait very long.

Read more about liver transplants.

Microwave or radiofrequency ablation

Microwave or radiofrequency ablation (RFA) may be recommended as an alternative to surgery to treat liver cancer at an early stage, ideally when the tumour or tumours are smaller than 5cm (50mm) in diameter.

They can also be used to treat tumours larger than this, but the treatment may need to be repeated in such cases.

These treatments involve heating the tumours with microwaves or radio waves produced by small, needle-like electrodes. This heat kills the cancer cells and causes the tumours to shrink.

Similar procedures using lasers or freezing can also achieve the same result.

There are three main ways microwave ablation or RFA can be carried out:

  • where the needles are passed through the skin (percutaneously)
  • where the needles are inserted through small incisions in your abdomen – “keyhole” surgery (laparoscopy)
  • where the needles are inserted through a single large incision made in your abdomen – “open” surgery

Continuous ultrasound or computerised tomography (CT) scans are used to make sure the needles are guided into the correct position.

Microwave ablation or RFA can be carried out under general anaesthetic or local anaesthetic (where you are awake but the area being treated is numbed), depending on the technique used and the size of the area being treated.

How long it takes to carry out the treatment depends on the size and number of tumours being treated, but it usually takes between one and three hours in total. Most people need to stay overnight in hospital.

You may experience some minor discomfort and flu-like symptoms, such as chills and muscle pains, for a few days after the procedure.

The risk of complications occurring with microwave ablation or RFA is low, but possible problems can include bleeding, infection, minor burns and damage to nearby organs.

Chemotherapy

Chemotherapy uses powerful cancer-killing medications to slow the spread of liver cancer.

A type of chemotherapy called transcatheter arterial chemoembolisation (TACE) is usually recommended to treat cases of stage B and C liver cancer. In these cases, the treatment can prolong life, but cannot cure the cancer.

TACE may also be used to help prevent cancer spreading out of the liver in people waiting for a liver transplant.

It is not recommended for stage D liver cancer because it can make the symptoms of liver disease worse.

TACE procedure

During TACE a fine tube called a catheter is inserted into the main blood vessel in your groin (femoral artery) and passed along the artery to the main blood vessel that carries blood to the liver (hepatic artery).

Chemotherapy medication is injected directly into the liver through the catheter and either a gel or small plastic beads are injected into the blood vessels supplying the tumours to help slow down the speed they grow.

TACE usually takes one to two hours to complete. After the procedure, you will stay in hospital overnight before returning home.

This procedure can be completed several times if necessary.

Side effects

Injecting chemotherapy medications directly into the liver, rather than into the blood, has the advantage of avoiding the wide range of side effects associated with conventional chemotherapy, such as hair loss and tiredness.

However, the procedure is not free of side effects and complications. The most common side effect is post-chemoembolisation syndrome, which can cause abdominal (tummy) pain and a high temperature (fever), as well as making you vomit or feel sick.

These symptoms may last for a few weeks after a TACE session.

Read more about chemotherapy.

Alcohol injections

If you only have a few small tumours, alcohol (ethanol) injections may be used as a treatment. A needle passes through the skin to inject alcohol into the cancerous cells. This dehydrates the cells and stops their blood supply.

In most cases, this is carried out under a local anaesthetic, meaning you will be awake, but the affected area is numbed so you won’t feel any pain.

Sorafenib

Sorafenib is a medication given in tablet form that can disrupt the blood supply to liver tumours and slow down their growth.

It is sometimes used as a treatment for advanced cases of liver cancer, although it is not routinely available on the NHS because the National Institute for Health and Care Excellence (NICE) has said the cost of the medication is high for the limited benefit it offers.

Whether or not you are eligible for sorafenib will be decided by your medical team, and will depend on the likelihood of whether you will significantly benefit from the medication.

For more information, see the NICE guidelines on sorafenib for the treatment of advanced hepatocellular carcinoma.

Advanced liver cancer

Treatment for advanced liver cancer focuses on relieving symptoms such as pain and discomfort, rather than attempting to slow down the progression of the cancer.

Some people with advanced liver cancer require strong painkillers, such as codeine or possibly morphine. Nausea and constipation are common side effects of these types of painkillers, so you may also be given an anti-sickness tablet and a laxative.

Read more about end of life care.

Hepatocellular carcinoma: ESMO-ESDO clinical practice guidelines for diagnosis, treatment and follow up
C Verslype and others
Annals of Oncology, 2012. Volume 23, Pages 41-48

Survival for all stages of liver cancer

For adults diagnosed with liver cancer in England:

  • around 36 out of 100 people (36%) will survive their cancer for 1 year or more after diagnosis
  • more than 12 in 100 people (more than 12%) will survive their cancer for 5 years or more after they are diagnosed

Remember – these figures relate to primary liver cancer in adults. Primary liver cancer in children is very rare in the UK.

Office for National Statistics
Cancer survival in England : Adult patients diagnosed between 2011 and 2015 and followed up to 2016
Accessed

Survival for liver cancer by age

5 year survival for liver cancer is generally higher in younger people compared to older people.

In people aged 15 to 39, around 35 out of 100 people in England diagnosed with liver cancer (around 35%) survive their cancer for 5 years or more.

In people aged 75 and over, around 5 in 100 people diagnosed with liver cancer (around 5%) survive their cancer for 5 years or more.

Office for National Statistics
Cancer survival in England: Adult patients diagnosed between 2011 and 2015 and followed up to 2016
Accessed

What affects survival?

Your outlook is affected by the treatment you have.

Treatment decisions depend on the size of the cancer and whether it has spread. It also depends on the health of your liver tissue that is not affected by the cancer, for example if you have liver cirrhosis.

Your general health and fitness also affects survival.

More statistics

For more in-depth information about survival and liver cancer, go to our Cancer Statistics section.

What Is Liver Cancer?

The liver continuously filters blood that circulates through the body, converting nutrients and drugs absorbed from the digestive tract into ready-to-use chemicals. The liver performs many other important functions, such as removing toxins and other chemical waste products from the blood and readying them for excretion. Because all the blood in the body must pass through it, the liver is unusually accessible to cancer cells traveling in the bloodstream.

The liver can be affected by primary liver cancer, which arises in the liver, or by cancer which forms in other parts of the body and then spreads to the liver. Most liver cancer is secondary or metastatic, meaning it started elsewhere in the body. Primary liver cancer, which starts in the liver, accounts for about 2% of cancers in the U.S., but up to half of all cancers in some undeveloped countries. This is mainly due to the prevalence of hepatitis, caused by contagious viruses, that predisposes a person to liver cancer. In the U.S., primary liver cancer strikes twice as many men as women, at an average age of 67.

Because the liver is made up of several different types of cells, several types of tumors can form there. Some of these are benign (noncancerous), and some are cancerous and can spread to other parts of the body (metastasize). These tumors have different causes and are treated differently. The outlook for health or recovery depends on what type of tumor you have.

The more common benign tumors of the liver include:

  • Hemangioma
  • Hepatic adenoma
  • Focal nodular hyperplasia
  • Cysts
  • Lipoma
  • Fibroma
  • Leiomyoma

None of these tumors are treated like liver cancer. They may need to be removed surgically if they cause pain or bleeding.

Liver cancers include:

  • Hepatocellular carcinoma (HCC)
  • Cholangiocarcinoma (These are really cancers of the bile duct. They will not be discussed in this article.)

This article discusses hepatocellular carcinoma. It’s important to know what type of liver tumor you have. Be sure to get that information from your healthcare provider.

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