Liver Cancer

Supportive Care

Managing the physical and emotional challenges of a liver cancer diagnosis and treatment can feel overwhelming, but support is available through your multidisciplinary team. Known as supportive care, this set of services can help you address the physical, emotional, practical, spiritual, financial and family-related challenges you may experience. A primary focus is to help you prevent, minimize and manage treatment-related side effects. Successfully managing the following symptoms and side effects can improve your quality of life.

Abdominal pain typically occurs in the stomach and may include cramping and dull aches. This type of pain can be more severe and debilitating than the occasional abdominal pain experienced by healthy individuals. Be sure to talk to your doctor openly about any abdominal pain you experience so it can be controlled.

Appetite loss (anorexia) is a common symptom of cancer and its treatments. To prevent weight loss, try to maintain a nutritious diet during and after treatment. If you cannot eat enough food to maintain your weight, talk to your doctor.

Ascites is a condition in which an abnormal amount of fluid collects in the peritoneal (abdominal) cavity. Ascites can be malignant, meaning it’s caused by cells distributed throughout the abdominal cavity, or non-malignant, meaning it’s caused by something other than cancer (such as cirrhosis). It can be treated with diet, diuretics, paracentesis (procedure to drain the fluid), chemotherapy or surgery. Your doctor will discuss the option that is best for you.

Bleeding problems (hemorrhages) and bruising may occur. Tell your doctor if you have a history of bleeding problems. If you experience any of these symptoms, contact your doctor immediately: blood in your stools or black stools (looks like tar); pink or brown urine; unexpected bleeding or severe bleeding that you cannot control; vomit that looks like coffee grounds; coughing up blood or blood clots; increased bruising, dizziness, weakness or confusion; changes in speech; or a headache that lasts a long time.

Cognitive dysfunction involves problems with normal thinking processes, such as thinking clearly, finding the right word or remembering names, dates and other details. Although this may result from chemotherapy, it can also result from underlying liver disease (such as cirrhosis). If you are experiencing problems with cognitive decline, talk with your doctor regarding treatments that may be employed to reduce this symptom. Some patients are given antibiotics to reduce gut bacteria, as these bacteria create toxins that the liver must try to handle. Use a planner or calendar and carry it with you. Make to-do lists, and focus on one thing at a time instead of multitasking.

Diarrhea can seriously affect your quality of life. If diarrhea causes distress or keeps you homebound, tell your doctor, who may check for a Clostridium difficile (C. diff) colon infection. Severe diarrhea can lead to dehydration and loss of essential nutrients. Ask about preventive medications and how to rest your bowels, which can reduce and ultimately eliminate symptoms.

Dysphonia (impaired voice) is a disorder that may include difficulty speaking or swallowing, hoarseness, raspy voice, soft voice, no voice or swelling in the throat. Call your doctor if you suddenly lose your voice, have severe pain in your throat or a fever of 100.5°F or higher or as directed by your doctor.

Dyspnea is the medical term for difficult or labored breathing or shortness of breath. Some patients describe it as a feeling of breathlessness. Talk to your doctor immediately if you experience any symptoms.

Fatigue related to treatment lasts longer than typical tiredness, is more severe and may not be relieved by sleep. Make sure your doctor is aware of your fatigue so that possible underlying causes, such as anemia or depression, can be addressed or ruled out. Exercise is a proven fatigue fighter.

Hair loss (alopecia) may occur on your head, face and body because certain treatments destroy rapidly growing cells. For a wig, ask your oncologist for a prescription for a “cranial prosthesis due to alopecia from cancer treatment,” as this phrasing may make it eligible to be partially or fully covered by health insurance.

Hand-foot syndrome, also known as Palmar-Plantar Erythrodysesthesia, is characterized by pain, swelling, tightness and redness on the palms of the hands or the soles of the feet. It can also cause painful blisters or calluses. Avoid hot water for bathing or washing dishes, and wear gloves or thick socks to protect hands and feet. Talk to your doctor as soon as you begin experiencing symptoms.

Hepatic encephalopathy occurs when the liver is unable to filter toxins in the blood sufficiently. The buildup of these toxins affects the brain and nervous system’s ability to function. Ask your doctor for symptoms to watch for and when to go to the emergency room.

Hypertension is abnormally high blood pressure. Over time, the elevated force of the blood on the arteries is so great that it causes small tears in the artery walls. Plaque (small particles of fat, cholesterol and other substances) then gets stuck in the tears and builds up, which slows blood flow to the heart, brain, kidneys, arms and legs.

Immune-related adverse events (irAEs) are serious side effects of some immunotherapy treatments, including checkpoint inhibitors. An irAE can cause inflammation in different organs and systems, and initial signs may include redness or swelling and/or a fever. Symptoms can develop rapidly and in some cases become severe, even life-threatening, without emergency medical attention. Report symptoms immediately to your doctor for up to two years following immunotherapy.

Infection can occur as a result of low white blood cell count (neutropenia). Contact your doctor immediately – do not wait until the next day – if you have any of these symptoms: oral temperature over 100.5°F, chills or sweating; body aches, chills and fatigue with or without fever; coughing, shortness of breath or painful breathing; abdominal pain; sore throat; mouth sores; painful, swollen or reddened skin; pus or drainage from an open cut or sore; pain or burning during urination; pain or sores around the anus; or vaginal discharge or itching.

Joint pain (arthralgia), muscle pain (myalgia) and pain in general may be related to treatment, the cancer itself or the underlying liver condition. Many pain management strategies are available, so contact your doctor or nurse right away if you are in pain.

Mouth sores (oral mucositis) may affect the gums, tongue, roof of mouth and/or lips. Pain may range from mild to severe, making it difficult to talk, eat or swallow. Ask your doctor about medications to prevent or minimize this condition.

Nausea and vomiting may be prevented with antiemetics (anti-nausea drugs) before treatment begins. Contact your doctor about any of these serious symptoms: more than three episodes of vomiting an hour for at least three hours; blood in vomit; vomit resembling coffee grounds; inability to drink more than eight cups of fluid or ice chips in 24 hours; inability to eat solid food for more than two days; weakness or dizziness; or inablility to keep medications down.

Skin reactions can include redness and irritation (similar to sunburn), rash, itching or dry, flaky skin. Most symptoms are mild to moderate, but some can be severe or even life-threatening without early treatment. If you have neutropenia (low white blood cell count) when reactions occur, seek immediate medical attention.


Understanding Why Pallitive Care is so Important

Liver cancer is often accompanied by serious complications, especially as the disease progresses. It is crucial to talk with your doctor soon after diagnosis so you can have a plan in place to help manage these complications. The foundation of this plan is known as palliative care.

Also referred to as supportive care, this valuable set of resources is available to assist you and your caregiver. Palliative care spans a wide range of services and employs many different specialists from your multidisciplinary team. It may include educating you about your illness and prognosis, managing symptoms and quality-of-life issues, offering psychosocial support, coordinating care among the health professionals, helping with advance care planning and assisting caregivers. It is recommended you seek assistance soon after diagnosis because the course of liver disease is difficult to predict. Advance care planning is also recommended as early as possible after diagnosis so you can make decisions before the disease progresses and interferes with normal thinking and decision making.

As the disease progresses, you may need the services of an oncology nurse navigator, who will be key in accessing palliative care services. This person is your liaison with the health care team who can coordinate your care with other specialists, find psychosocial support services, provide survivorship or end-of-life services or care transitions, find community resources and be your advocate. The navigator can also identify a need for home-based care, screen for other unrelated health conditions and assist with hospice referral.

Some physical side effects can become much more serious as liver cancer advances. As liver function decreases, toxins that are normally filtered by the liver can build up, which can cause cognitive decline and other conditions that may make it difficult to think clearly. This is known as hepatic encephalopathy. You may need assistance to understand the prognosis and make decisions about treatment and quality of life or advance care planning, and palliative care specialists can help.

Another serious side effect of advanced liver cancer as well as cirrhosis is an accumulation of fluid in the abdominal cavity known as ascites. The fluid buildup causes abdominal pain and may make it difficult to breathe. To relieve the discomfort, your doctor may perform a large volume paracentesis, which is a procedure to remove the fluid. If intermittent paracentesis is needed for symptom relief that will be ongoing, the doctor will place a catheter through the abdomen and into the peritoneal cavity so that the fluid can be drained at home. Your nurse will show you how to clean and change the catheter and dispose of the fluids.

Your emotional well-being may be at risk. It is common for people with liver cancer to experience feelings of anxiety, depression, sadness, anger, isolation and hopelessness, among many other emotions, which may require ongoing monitoring. You and your caregiver must notify your health care team if your distress becomes excessive and any of the following symptoms occur:

  • Inability to follow treatment due to extreme emotional distress
  • Constant thoughts of death or feelings of hopelessness
  • Becoming unusually angry, irritable or moody
  • Withdrawing and isolating yourself from family and friends
  • Feeling worthless or thinking of suicide

You don’t need to face these emotional challenges alone. Psychosocial services are available to assist you and your caregiver through this challenging time and may include referrals to mental health specialists, religious or faith-based resources or support groups. Your doctor may consider medications or alternatives, such as cognitive-behavioral therapy, relaxation practices, guided imagery, meditation, yoga and tai chi.



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