Secondary Liver Cancer Symptoms

Causes, risk factors, how to treat it

There are a lot of health risks associated with a secondary liver cancer diagnosis. Learn more about what causes this type of cancer and how it can affect your lifestyle.

The difference between primary and secondary cancer lies in its origin and spread. The site of the body where cancer occurs is the primary site. If cancer spreads to another part of the body, it develops into secondary cancer or metastases. Most liver cancers are secondary or metastatic.

How does secondary liver cancer develop?

The most common cancers that can reach the liver are bowel cancer, breast cancer, stomach cancer, lung cancer, melanomas, pancreatic cancer, and oesophagal cancer.

Cancerous cells from the primary site can sometimes travel to the liver via the bloodstream or lymphatic system through a process known as metastasis.1 When cancerous cells reach the liver, they may develop tumours.

What are the symptoms of secondary liver cancer?

You may experience a few or more of the following symptoms of secondary liver cancer:2

  • Fatigue
  • Upper Abdominal Pain
  • Shoulder Pain
  • Nausea 
  • Poor Appetite Leading To Weight Loss 
  • Jaundice (Yellowing Of Skin And Whites Of The Eyes)
  • Swollen Abdomen With Severe Pain
  • Frequent Hiccups
  • Fever

Upper abdominal pain is the most common symptom in the further stages of liver cancer metastasis. With time, cancer can cause the enlargement of the liver, causing discomfort in the upper abdomen region. The enlarged liver can stimulate nerves connected to the right shoulder, causing pain in the right shoulder, known as “referred pain.” 

How to diagnose secondary lung cancer?

One may not know that they have secondary liver cancer. A doctor or cancer specialist can detect liver metastases and diagnose primary cancer.

In some cases, secondary cancer develops years after the treatment/cure of primary cancer.

For some patients, it is difficult to determine the area of primary cancer. In such cases, liver cancer is referred to as “Cancer of Unknown Primary” (CUP).

Secondary liver cancer can be diagnosed by the following tests and scans:3

Blood tests

Blood tests on their own cannot indicate the presence of secondary liver cancer. However, they can show the presence of proteins that cause malignancy, indicating the presence of cancerous cells. These proteins include AFPs and blood clotting factors. AFP or Alpha-fetoprotein is produced in liver cancer in high amounts. Blood clotting in the liver is common in cancer.4 Therefore, high amounts of blood clotting factors in the blood may signify the presence of cancerous cells. Abnormal growth of liver cells leads to high production of iron. Consequently, a high iron level in the blood can also be a tumour marker.

CT Scan

A computerised tomography, or CT scan, uses x-rays to scan a cross-section of the liver to give a detailed image of the tumour.5 CT scans require you to either ingest or be injected with dyed glucose that colours the scanned organ under x-rays. This method helps identify a tumour’s features and the extent of the spread. 

PET Scan

A Positron Emission Tomography scan helps detect the abnormal activity of cancerous cells in your liver.6 This scan is somewhat similar to a CT scan, except you need to inject radioactive sugar rather than dye. As your blood absorbs radioactive sugar, areas that use more energy will show under the scan; in this case, the cancerous cells.


A combination of PET and CT scans allows for a more accurate diagnosis.

This scan can help determine the presence of cancer in the body. PET-CT scan requires you to get an injection of glucose combined with radioactive fluoride. This scan detects all the cancerous cells in the liver. In the case of liver CUP, a PET-CT scan can also help identify the primary source of cancer.6


Unlike PET or CT scans, an MRI uses magnetic and radio waves to view a cross-section of your liver as well as surrounding organs to find tumours.7 During an MRI scan, you get injected with a radioactive dye that is absorbed by your liver. Under the magnetic rays, your doctor or specialist can easily view the insides of your liver. Moreover, MRI shows detailed images of blood vessels of the liver. It can detect any blockage in the liver blood vessels due to cancer.


Depending on the results of the above tests, a biopsy may be performed to confirm the secondary liver cancer.8 A surgeon or doctor will remove a tissue sample by inserting a needle into your liver. The examination of tissue samples under a microscope identifies the type of tumour.

Another method for liver biopsy is laparoscopy - a small surgery where the surgeon uses tools and cameras to detect and distinguish between benign and malignant tumours.9

What treatments are there for secondary liver cancer?

Unfortunately, there are no guaranteed treatment options for secondary liver cancer.

However, surgery and other medical treatments can help you manage the symptoms and prolong your survival for years.10 

The main objective of the treatment is to control the growth of, or shrink, cancer. Though treatment varies with the location, size and number of tumours, surgical removal of cancer and chemotherapy are the most common.


Chemotherapy alone cannot cure cancer but can kill, shrink or control the growth of the tumour cells and help relieve symptoms. The selection of drugs for chemotherapy depends on the site of origin of the cancer.

For example, if cancer spreads to the liver from breast cancer, the patient will be given chemotherapy designed specially to cure breast cancer.

Chemotherapy is used at different times, such as before surgery, to shrink the tumour to make it easier for removal, and this process is called neoadjuvant therapy.

Chemotherapy used after surgery to kill the remaining tumour cells is called adjuvant chemotherapy. This is specifically used to slow down the growth of cancer, also known as palliative treatment.11 


Surgery is the best option for achieving long-term survival of secondary liver cancer patients, which involves hepatectomy (removal of all or part of the liver) and liver transplantation. The basic principle of hepatectomy is the complete removal of the tumour tissue, ensuring no residual tumour cells. It is also necessary to preserve a sufficient volume of liver tissue to compensate for the function of the liver and to reduce complications after surgery. 

The liver is capable of repairing itself after surgery. Even if three-quarters of the liver is removed, the remaining part can grow to its normal size within a few months.

If there are tumour cells in both the lobes of the liver, patients are recommended for a two-stage surgery, in which the tumour in one lobe of the liver will be removed, and surgery for the other lobe would be after one or two months.

Once the liver regrows to its original size, the second hepatectomy is performed to remove tumours in the second lobe of the liver. The need for hepatectomy among patients with secondary liver cancer has been around 4% so far.

Other treatments for secondary liver cancer may include radiation therapy, which uses a beam of X-rays as a source of radiation. The two specialised forms of radiation therapy used for secondary liver cancer are selective internal radiation therapy (SIRT) and stereotactic body radiation therapy (SBRT)1.1


Secondary liver cancer occurs when cancerous cells from the primary site travel to the liver via the bloodstream or lymphatic system through metastasis. Upper abdominal pain is the most common symptom in the further stages of liver cancer metastasis. Other symptoms include fatigue, shoulder pain, nausea, poor appetite, fever, jaundice and frequent hiccups. There are several tests that can diagnose secondary liver cancer, such as a blood test, CT scan, PET scan, MRI, or biopsy.

Once diagnosed, the main objective of the treatment is to control the growth of, or shrink, the cancer, either through chemotherapy or surgery. These treatments can help manage the symptoms of the cancer and can help prolong survival.


  1. Secondary liver cancer. Macmillan Cancer Support  [Internet]. [cited 2022 Apr 19]. Available from: 
  2. Symptoms of secondary cancer in the liver. Macmillan Cancer Support [Internet]. [cited 2022 Apr 19]. Available from: 
  3. Diagnosis of secondary cancer in the liver. Macmillan Cancer Support [Internet]. [cited 2022 Apr 19]. Available from: 
  4. Alpha Fetoprotein (AFP) Tumor Marker Test. Medline Plus  [Internet]. [cited 2022 Apr 19]. Available from: 
  5. CT scan for liver cancer. Cancer Research UK  [Internet]. [cited 2022 Apr 19]. Available from:
  6. Position Emission Tomography and Computed Tomography (PET-CT) Scans. Cancer.Net  [Internet]. [cited 2022 Apr 19]. Available from: 
  7. MRI scan for liver cancer. Cancer Research UK  [Internet]. [cited 2022 Apr 19]. Available from:
  8. Biopsy for liver cancer. Cancer Research UK  [Internet]. [cited 2022 Apr 19]. Available from:
  9. Laparoscopy. Cancer Research UK  [Internet]. [cited 2022 Apr 19]. Available from:
  10. Understanding Liver Cancer– Diagnosis and Treatment. Webmd [Internet]. [cited 2022 Apr 19]. Available from:
  11. Treatment for secondary liver cancer. Cancer Research UK  [Internet]. [cited 2022 Apr 19]. Available from:
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Pavithra Saravanan

Pharmacist, MA Pharmacy, The Tamil Nadu Dr. M.G.R. Medical University, India
Pavithra Saravanan is a pharmaceutical professional and member in TOPRA. She completed her masters in pharmacy in Pharmaceutics department from The Tamilnadu Dr.M.G.R.Medical University, India. Pavithra has 2 years experience in Drug Regulatory Affairs, is equipped with knowledge in Clinical Data Management and Drug Safety and is currently working in the United Kingdom.

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