Advanced liver cancer

Advanced liver cancer means that the cancer has spread beyond the liver to other parts of the body, or has grown significantly within the liver and cannot be removed by surgery.

Some people are told they have advanced liver cancer when they are first diagnosed. Others might be diagnosed with advanced liver cancer if the cancer comes back or spreads after initial treatment.

While it can be difficult to hear that you have advanced liver cancer, there are still treatment options that can help control the cancer, relieve symptoms, and help you live as well as possible.

This section provides information about these treatment options, managing symptoms, and planning ahead. It also includes information for family members and carers.

Treating advanced liver cancer

When liver cancer has spread beyond the liver, or cannot be removed with surgery, it’s called advanced or metastatic liver cancer.

While a cure is not possible at this stage, treatment can help control the cancer, relieve symptoms, and improve quality of life.

Treatment plans are individual and depend on your general health, how far the cancer has spread, and the specific features of your tumour.

Treatment options

Treatment options for advanced liver cancer include:

• Radiation therapy can sometimes be helpful when cancer has spread to other parts of the body. It can be used to shrink tumours, relieve pain, or manage other symptoms.
• Chemotherapy. For liver cancer that has spread, chemotherapy may be used to slow the growth of cancer cells. The most common type of chemotherapy for liver cancer is TACE (transarterial chemoembolisation), which delivers high doses of chemotherapy straight into the tumour.
• Supportive (palliative) care is appropriate at any time during the cancer journey and focuses on maintaining quality of life and managing symptoms.
• Clinical trials. There are ongoing clinical trials in Australia testing new drugs and combinations for advanced cancer, including next-generation immunotherapies and targeted agents. Ask your oncologist if a trial might be suitable for you.

Choosing not to have treatment

Some people decide not to have treatment for advanced liver cancer, or to have only certain treatments to help manage symptoms.

This is a personal choice, and your healthcare team will support you whatever you decide.

You may want to talk through your decision with your:

• specialist or GP
• family or close friends
• counsellor or cancer support service.

Questions for your treatment team

Here are some questions you might want to ask your healthcare team when you are deciding about treatment for advanced liver cancer.

• What can you do to reduce my symptoms?
• What extra support can I get if my family and friends care for me at home?
• Can you help me to talk to my family about what is happening?
• What support is available for my family or carer?
• Can I be referred to a community support service?

Supportive (palliative) care

When a cure for liver cancer is not possible, the focus of your treatment will shift to controlling your symptoms and keeping you living as well as possible. This is also known as supportive or palliative care.

When you hear the term ‘palliative’, you might think about ‘end of life’. But palliative care is focused on comfort, quality of life and your whole wellbeing.

It is important to understand that palliative care is appropriate at any time during the cancer journey. People who access palliative care early tend to have an improved quality of life and reduced distress due to symptoms.

Recent studies have shown that people who have early palliative care may live longer, with fewer symptoms and with a better quality of life than patients who did not have palliative care.

Who provides supportive (palliative) care?

You may receive palliative care from a wide range of people including your:

• GP
• nurses
• oncologists
• palliative care specialists
• other medical specialists
• hospice organisations.

It can be provided alongside other treatments, or it can become the focus of care.

Palliative care guides families and carers through decision-making to allow them to work toward their healthcare goals. These goals may include the hope to prolong life and to encourage peace and dignity throughout the illness and at the end of life.

What services are offered under palliative care?

Palliative care identifies and treats symptoms which may be physical, emotional, spiritual, or social and can be delivered anywhere, including at home, in a hospital or nursing home, through outpatient care or in any other setting. Because palliative care is based on individual needs, the services offered will differ, but may include:

• relief of pain and other symptoms, e.g. vomiting, shortness of breath
• resources such as equipment needed to aid care at home
• assistance for families to come together to talk about sensitive issues
• links to other services such as home help and financial support
• support for people to meet cultural obligations
• support for emotional, social and spiritual concerns
• counselling and grief support
• referrals to respite care services.

As much as palliative care is a person-centred, it is also a family-centred model of care, meaning that family and carers can receive practical and emotional support.

Planning for the future

Your GP or healthcare team may talk with you, your family, and carers about your wishes for your future medical and healthcare treatment. These conversations are a chance for you to think about what’s important to you and to share your preferences, in case there’s ever a time when you can’t make or communicate decisions yourself.

Advance care planning is voluntary, and it's up to you whether you choose to do this or not.

Advance Care Directive

An Advance Care Directive is a legal document that records your wishes about the type of treatment and care you would or wouldn’t want if you became too unwell to make those decisions yourself. It helps your family and healthcare team understand and respect your choices.

You can also choose someone you trust to make medical decisions on your behalf if you’re unable to. This person is called a substitute decision maker.

With help from your family, carer, or healthcare team, you may wish to think about appointing this person and completing an Advance Care Directive to make sure your wishes are clearly known and followed.