Secondary cancer in the liver may not cause any symptoms for a long time and it may only be discovered by routine tests.

The symptoms that might occur include loss of appetite, weight loss, feeling sick (nausea) and tiredness (lethargy). Some people may also have a high temperature and feel shivery.

People sometimes notice a vague discomfort in the upper abdomen, which may become painful. This is due to enlargement of the liver. Pain can sometimes also be felt in the right shoulder. This is known as referred pain and is due to an enlarged liver stimulating nerves beneath the diaphragm (the sheet of muscle under the lungs) that are connected to nerves in the right shoulder.

If the bile duct becomes blocked, bile produced by the liver will flow back into the bloodstream causing jaundice. This will make the skin and whites of the eyes go yellow and may make the skin very itchy. Other signs of jaundice are dark-coloured urine and pale stools (bowel motions).

Sometimes, fluid builds up in the abdomen and causes swelling known as ascites. There may be several possible reasons for this:

• If cancer cells have spread to the lining of the abdomen, they can irritate it and make fluid build up.
• If the liver itself is affected by cancer cells, this causes an increase in pressure in the veins which lead to the liver. Fluid from the abdomen then cannot pass quickly enough through the liver, so it starts to collect in the abdomen.
• If the liver is damaged, it may produce less blood protein. This can upset the body's fluid balance, which makes fluid build up in the body tissues, including the abdomen.
• Cancer cells may block the lymphatic system. The lymphatic system is a network of fine channels throughout the body. One of its functions is to drain off excess fluid, which is eventually passed out of the body in the urine. If some of these channels are blocked, the system cannot drain efficiently and fluid may build up.

If ascites develops, a tube can be put into the abdomen to drain the fluid away.

Whatever the cause, jaundice or ascites will always indicate a condition that needs medical attention and so should not be ignored. Always have these symptoms checked by your doctor.