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Chemotherapy for liver cancer

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. You may have chemotherapy directly into the liver. Or into the bloodstream to circulate around the body (systemic chemotherapy).

Chemoembolisation

Chemoembolisation, also called trans arterial chemoembolisation (TACE), means having chemotherapy directly into the area of the liver that contains the cancer and blocking off the blood supply to the tumour. After giving the chemotherapy, the doctor injects tiny plastic beads or a type of gel to block the blood flow to the tumour. This helps to kill the cancer cells because it cuts off the tumour's food and oxygen supply.

Chemoembolisation can cause side effects such as sickness, pain and a raised temperature. Your nurse will give you painkillers and anti sickness medicines to help control these side effects.

Chemotherapy into the bloodstream

If you have advanced primary liver cancer, you may have chemotherapy as tablets or through a drip into a vein. You usually have this as a series of treatments every few weeks. The drugs most often used to treat liver cancer are doxorubicin (Adriamycin) and cisplatin.

Apart from children with hepatoblastoma, chemotherapy does not work as well for primary liver cancer as it does for other types of cancer. If you have chemotherapy this way, it may be as part of a clinical trial.

All chemotherapy has side effects. Some people have very few side effects and others have more. The most common side effects include sickness, diarrhoea, sore mouth or mouth ulcers, hair loss or hair thinning, and a drop in blood cells causing an increased risk of infection, bleeding or bruising, tiredness and shortness of breath.
 

CR PDF Icon You can view and print the quick guides for all the pages in the treating liver cancer section.

 

 

What chemotherapy is

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. You may have chemotherapy directly into the liver. Or as tablets or a drip into a vein, so the drugs circulate around the body (systemic chemotherapy). For more information about chemotherapy look at the main chemotherapy section.

 

Chemoembolisation

Chemoembolisation, also called trans arterial chemoembolisation (TACE), means having chemotherapy directly to the area of the liver that contains the cancer and then blocking off the blood supply to the tumour. You usually have this treatment if you cannot have surgery, or to help control the cancer while you are waiting for a liver transplant. In some cases, you may have this treatment to shrink a tumour so that it then becomes small enough to remove with surgery.

You may have chemoembolisation combined with other treatments such as surgery or radiofrequency ablation. You usually need to stay in hospital overnight or longer.

 

How you have chemoembolisation

You have this treatment in the X-ray department. You have a local anaesthetic injection and possibly a mild sedative. The doctor puts a tube called a catheter into the large artery at the top of your leg called the femoral artery. The doctor can then thread the catheter along the femoral artery until it reaches the hepatic artery that supplies blood to the liver.

The doctor will check that the catheter is in the right place in the liver. Then they inject the chemotherapy into the catheter. The drugs you are most likely to have are doxorubicin or cisplatin. The doctor also injects something to block the blood flow to the tumour. This might be tiny plastic beads or a type of gel. Blocking the flow of blood to the cancer (embolisation) helps to kill the cancer cells because it cuts off the tumour's food and oxygen supply. It also helps to keep the chemotherapy drugs in the liver for longer. Some types of beads actually release chemotherapy directly to the liver, rather than the doctor adding the chemotherapy and beads separately.

After the treatment, the catheter is taken out. You will need to stay in bed for a number of hours afterwards. This is to help prevent your wound from bleeding.

Chemoembolisation can cause side effects. You may feel or be sick. Or you may have some pain or a raised temperature after the treatment. These side effects are called post embolisation syndrome, and are common. Your doctor will give you painkillers and anti sickness drugs to control these side effects. You can also get side effects from the chemotherapy drugs themselves. As most of the chemotherapy is trapped in the liver, these side effects are generally mild compared to having chemotherapy into the bloodstream (systemic chemotherapy). Rarely, chemoembolisation can cause damage to the liver which may result in liver failure. So this treatment is not usually an option for people with moderate or severe cirrhosis.

You cannot usually have chemoembolisation if your liver or kidneys are not working well, your blood is not clotting normally or there is a blockage in your bile ducts. As chemoembolisation blocks some blood vessels to the liver, your doctor has to make sure there will still be a good enough blood supply to the liver after the treatment. If there is a blockage of the main vein supplying blood from the gut to the liver (portal vein) then your doctor is unlikely to recommend this treatment as it is generally not safe to do.

You may have chemoembolisation more than once if your doctor thinks it will help. If you have too many side effects from the chemotherapy, you may have just the embolisation part. This is called trans arterial embolisation (TAE).

 

Chemotherapy into the liver's blood supply (regional chemotherapy)

Transarterial infusion chemotherapy means giving chemotherapy directly into the main artery of the liver (hepatic artery). This gives a high dose of chemotherapy to the liver cancer. You may have the chemotherapy through a pump that is placed inside the body. Or you may have a tube that is put through the skin of the chest into the hepatic artery. In this case, the chemotherapy goes into the tube through a pump that is outside the body, and can be worn like a bag. The pump gives a steady dose of chemotherapy every day. It can shrink the tumour and generally has fewer side effects than chemotherapy into the bloodstream (systemic chemotherapy).

As you may need surgery to have the pump or tube put inside the body, this treatment isn't suitable for many people with liver cancer, as they are not well enough.

 

Chemotherapy into the bloodstream

You may have chemotherapy to treat advanced primary liver cancer as tablets or through a drip into a vein. The drugs circulate around the body through the bloodstream (systemic chemotherapy). You can only have chemotherapy if your liver is working well.

Apart from children with a rare type of liver cancer called hepatoblastoma, systemic chemotherapy does not work as well for primary liver cancer as it does for other types of cancer. If you do have this treatment, it may be as part of a clinical trial.

In hepatoblastoma, doctors may give chemotherapy before surgery to shrink a cancer and make it easier to remove. This type of treatment is called neo adjuvant chemotherapy. Some children may also have chemotherapy after surgery. This helps to stop the cancer from coming back by killing off any remaining cancer cells. The combination of surgery and chemotherapy can often cure hepatoblastoma.

 

How you have chemotherapy

If you have chemotherapy into the bloodstream you usually have it as a series of treatments every few weeks. The weeks between treatments allow your body to recover from the side effects of the drugs. A course of chemotherapy is often made up of around 6 or 8 treatments (cycles). So it can take several months to complete.

To have chemotherapy, you may need to have a central line put in. This is a thin, flexible tube that is put into a vein, usually in your chest. It runs under the skin into a large vein. Having a central line means you won't need injections or a drip each time you have treatment. The drugs can be injected straight into the tube, or the drip can be connected to it. The central line can stay in for as long as it is needed. There is more about central lines, including another type of line called a PICC line, in the main chemotherapy section.

 

The drugs used

The drugs you are most likely to have to treat liver cancer are

Chemotherapy for liver cancer is still being tested, so you may be offered a drug or combination of drugs other than these. There is information about doxorubicin and cisplatin in the cancer drugs section.

 

General side effects

All chemotherapy has side effects. The exact side effects vary from drug to drug and from person to person. Some people have very few side effects and others have more. It is not possible for your doctor to predict in advance how the treatment will affect you. The most common side effects include

 

More information on chemotherapy

For more about chemotherapy look at the main chemotherapy section. It explains the treatment in more detail including

 

Dietary or herbal supplements and chemotherapy

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Or if you are prescribed them by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having active treatment. There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking or thinking of taking these supplements talk to your doctor to find out whether they could affect your treatment.

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Updated: 24 October 2013