Controlling Liver Cancer Pain

People with a liver cancer diagnosis 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, a professor of oncology at John Hopkins University School of Medicine.

Liver Cancer

The body’s largest internal organ, the liver, 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 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. Metastatic liver cancer is 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.

Sources of Pain

A common side effect, 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 other 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 for your liver cancer treatment. 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 [skin] patches or lollipops [containing narcotics] absorbed under the tongue,” says Dr. Reisner.

Treating Liver Cancer Pain: Radiation

Radiation therapy 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 abdominal area 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 [injections] 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 liver tumor, 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.