Liver Cancer

There are a number of symptoms you should look out for, including:

• skin colour, and/or the whites of your eyes changing to yellow (jaundice)
• ache or pain on the right side of your belly
• hard lump on your right side, below where your ribs stop
• pain in your upper back, around the right shoulder blade
• losing weight without meaning to
• dark coloured stools or pale urine
• feeling really tired
• loss of appetite and/or nausea.

Having these symptoms may not mean you have cancer, but it’s important to check.

If you have any of these problems, or are worried about something else, yarn with your doctor, nurse or Aboriginal and/or Torres Strait Islander health worker.

You won’t know if you have liver cancer until your doctor has yarned with you, completed a physical examination and done some tests.

The tests might include:

• a physical examination
• blood tests
• imaging tests such as an ultrasound, a CT scan or MRI scan to see what your insides look like
• a laparoscopy, where a tube is put into your belly to see what’s inside
• a liver biopsy, where they take a tiny bit of your liver and look at it with a microscope.

Most people who have these tests find out they don’t have liver cancer, but it’s important to check.

The Hepatitis B immunisation offers very good protection for our mob against infection with hep B.

Hepatitis B immunisation is free on the National Immunisation Program Schedule. The National Immunisation Program Schedule is a series of immunisations given at specific times throughout your life, ranging from birth to adulthood.

Hepatitis B immunisation is recommended as part of routine immunisation to protect children. To get your and your family's hepatitis B immunisation, visit your local doctor or Aboriginal Medical Service. Other places you can get immunisations are at local council immunisation clinics, pharmacies, and community health centres, 

The immunisation is free from all Aboriginal Community Controlled Health Organisations (ACCHOs) and most medical clinics.

If you have liver cancer, you might be told it’s at a certain stage. This describes how large the tumour is, and whether the cancer has spread to other parts of your body, and how far.

Knowing the stage of the cancer helps you and your doctors to decide on the best treatment for you.
The staging of liver cancer which is only in the liver is called the Barcelona Clinic Liver Cancer (BCLC) System. This is done based on a few factors:

1. How well you are
2. How well your liver is working
3. What the tumours are like, such as their size and number

If the cancer has spread beyond the liver to other parts of the body, it is known as metastatic cancer and the treatment is planned in a different way.

With all stages of liver cancer, there is plenty of treatment and support that can help you, including traditional medicine and practices like ceremony and being on Country. 

There are many ways to treat liver cancer. The main ones are:

• surgery
• liver transplant
• radiotherapy
• thermal ablation
• embolisation
• chemotherapy
• targeted therapies.

If you have liver cancer, you might need one of these, or a combination of them.

Your doctor will yarn with you about what treatments they recommend, and what your options are best for you.

Yarn with your doctor, nurse or Aboriginal and/or Torres Strait Islander health worker about which treatment you might have and any traditional healing, bush medicines or cultural practices you want to include in your treatment plan

Surgery

Surgery is done to take out the cancer and help to stop it from spreading to other parts of your body. Surgery involves staying in hospital and having anaesthetic and an operation. Not all patients with liver cancer have surgery, as it depends on the size of the tumours in the liver and where they are. 

Some people just have the cancer and a part of their liver taken out. Some people have their liver removed and will need a liver transplant.  

Your doctor will yarn with you beforehand about what is going to happen.

Yarn with your doctor, nurse, Aboriginal and/or Torres Strait Islander health worker or social worker about your surgery and what support you and your family need before, during and after surgery. Being away from Country and family can be distressing so making sure you have the right support is important. 

Read more about surgery.

Radiotherapy

Radiotherapy, also called radiation therapy, uses X-rays to destroy cancer cells in one part of your body.

Most people who have radiotherapy have it every day (Monday to Friday) for 4-6 weeks, and each session can take 15 minutes. But it might be different for you.

You can only have radiotherapy in cities and some big towns – see this list. If your doctor thinks radiotherapy would help, and you don’t live near a radiotherapy site, assistance is available for travel and accommodation for you and your family.

Yarn with your doctor, nurse or Aboriginal and/or Torres Strait Islander health worker.

Read more about radiotherapy.

Chemotherapy

Chemotherapy, or ‘chemo’, involves you taking strong drugs to kill the cancer cells. Traditional chemotherapy is not typically used to treat liver cancer. These days oral tyrosine kinase inhibitors (TKIs) and immunotherapy are used more often.

If chemotherapy is recommended for liver cancer, the chemotherapy is mainly given directly to the tumour. This is given using a method called Trans-arterial Chemo-Embolisation (TACE). You may need to travel to a bigger town or a city where this procedure is done by a specialised doctor, an intervention radiologist. You may also need to stay in the hospital for a night to allow recovery. Assistance is available for travel and accommodation for you and your family.

Read more about chemotherapy and side effects.

Thermal ablation and embolisation

For small tumours, you may be offered to have a treatment given to the tumour directly to destroy it.

Ablative therapy (ablation) can be given in the form of heat (thermal) using high-energy radio waves.

Your doctor may also use other types of ablative therapies, such as alcohol or cryotherapy (freezing the cancer cells).

Embolisation means injecting a substance into a blood vessel to block the flow of blood to tumours in the liver.

Targeted therapies

Targeted therapies are newer drugs that try to stop the cancer growing. Targeted therapies attack cancer cells without harming healthy cells. If your doctor thinks they might help, here are some questions to ask. 

Read more about targeted therapy.

Immunotherapy

Immunotherapy is treatment with drugs that help your immune system attack the cancer cells. Immunotherapy is given in your arm through a vein.  It is usually given in cycles of once every few weeks. You will need to go to a hospital or clinic to have this treatment.

Yarn with your doctor, nurse or Aboriginal and/or Torres Strait Islander health worker, and with other mob who have had the treatment.

Read more about immunotherapy.

It is important for you to understand why you are getting the treatment your doctor chooses and how it is supposed to help you. Different treatments try to do different things. It depends on what cancer you have, and whether it has spread, and where you live, and what you want. Ask your doctor or specialist if the treatment they suggest:

• is meant to cure you, by getting rid of the cancer and stopping it spreading, or
• won’t cure you, but is meant to prolong your life, or make you feel better.

Your doctors will yarn with you and explain this. You can yarn with them and tell them what you think, and what you want. Some people will want to try everything possible to stay alive. Others want simpler treatments, or don’t want to leave Country for treatment, or don’t want any treatment. It’s your choice. You can also talk to another doctor to help you decide.

It can take time to decide about treatment. There are usually some options to hear about and choices to make.

It can be helpful to write things down, have someone else come to appointments to help remember information.

Other mob who have had cancer say that yarning with trusted family, friends or Elders also helps. You may want to combine medical treatment with traditional healing, bush medicines and/or cultural practices.

Yarn with your doctor, specialist, nurse or Aboriginal and/or Torres Strait Islander health worker.

Always ask about the cost of treatment. Many treatments are free through public hospitals. Yarn with your doctor, nurse or Aboriginal and/or Torres Strait Islander health worker.

Learn more about financial support.

It all depends on the type of treatment you’re having. People will have treatment for different durations of time. After treatment is over, your doctor might keep in touch with you to check how you’re going and monitor your health.

During your cancer journey you will have the opportunity to build trust and safe relationships with your doctors, nurses and Aboriginal and/or Torres Strait Islander health workers that may last beyond your treatment.

It is not possible to say what causes liver cancer in a single person. We do know there are some features that are more common in people who develop liver cancer. These features are called ”risk factors”. 

But it is usually hard to be sure whether a risk factor contributed to the development of the cancer. And having one or more risk factors for liver cancer does not mean that someone will develop this cancer. In fact, many people with liver cancer have no obvious risk factors.

Some factors can even lower your risk of developing liver cancer.

Risk factors for liver cancer you can change:

• being overweight
• drinking alcohol
• tobacco smoking
• chronic hepatitis B (hep B) infection

These lifestyle factors can lead to cirrhosis of the liver, which happens when the liver is damaged or scarred by liver diseases and conditions, such as hepatitis and chronic alcoholism. Cirrhosis of the liver is a risk factor for liver cancer.

Risk factors for liver cancer you can’t change:

• chronic hepatitis C (hep C) infection
• family history of liver cancer
• haemochromatosis. 

Hepatitis B is caused by the hepatitis B virus, which is spread between people by body fluids. Hepatitis B can lead to liver damage and liver cancer. If you're not sure if you've been tested or immunised for hepatitis B before, ask your doctor for a free test. The test is simple and can tell you if you have contracted hepatitis B, or if you need immunisation to protect you.

Hepatitis C is a disease caused by the hepatitis C virus. Like hepatitis B, it can infect and damage the liver. If hepatitis C is not treated, it can lead to liver failure or liver cancer. There is no immunisation for hepatitis C. 

Haemochromatosis is a condition passed on through bloodlines. It causes the body to absorb and store too much iron. In some cases of haemochromatosis, the extra iron can lead to organ damage.

Clinical trials might be an option for you. Yarn with your doctor to help you decide if taking part is a good option. Read more about clinical trials

Read more detail on liver cancer here.