Chemotherapy for liver cancer

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. The drugs circulate in the bloodstream around the body. For more about chemotherapy look at the main chemotherapy section on CancerHelp UK.

Chemotherapy can help control the growth of a cancer when surgery is not possible. Or some people may have chemotherapy after surgery. This is called adjuvant chemotherapy. The aim of this treatment is to try to kill off any cancer cells that may have been left behind and so help to stop the cancer from coming back.

You may have chemotherapy to treat primary liver cancer as tablets or through a drip into a vein.  Another way to have chemotherapy is directly to the tumour. This is called chemoembolisation. Your specialist may suggest this type of treatment if you can't have surgery. You may have chemoembolisation combined with other treatments such as surgery, chemotherapy, or radiofrequency ablation.

Apart from children with a rare type of liver cancer called hepatoblastoma, chemotherapy is not really an effective treatment for primary liver cancer. If you do have chemotherapy, 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 neoadjuvant chemotherapy. It may also help to stop the cancer from coming back by killing off any remaining cancer cells. This combination of surgery and chemotherapy can often cure hepatoblastoma.

You usually have chemotherapy 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.

If you have chemotherapy into a vein, 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 tube 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 of CancerHelp UK.

The drugs most often used to treat liver cancer are

• Doxorubicin (Adriamycin)
• Cisplatin

Your doctor may decide to use one or more drugs in combination. 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 of CancerHelp UK.

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 are

• Sickness
• Diarrhoea
• Hair loss or thinning
• Feeling tired and run down
• Sore mouth or mouth ulcers

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

• How it works
• How chemotherapy is planned and given
• General side effects
• Living with chemotherapy

Chemoembolisation means having chemotherapy directly to the area of the liver that contains the cancer. Depending on the drugs used, you usually have to stay in hospital overnight or longer. Your doctor may recommend it if you cannot have your tumour removed by surgery. It is also sometimes used to shrink a tumour so that it is small enough to remove with surgery at a later date.  

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 tube. Doxorubicin and cisplatin are the drugs used most often for this type of treatment. 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 helps to kill the cancer cells because it cuts off the tumour's food and oxygen supply. The chemotherapy also kills cancer cells.

Chemoembolisation can cause side effects. You may feel or be sick. Or you may have some pain or a raised temperature after the treatment. Your doctor will give you painkillers or anti sickness drugs (antiemetics) to control these side effects.

You may have chemoembolisation more than once if your doctor thinks it will help. If you have too many side effects from the doxorubicin or cisplatin, you may be able to have just the embolisation part.

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 of CancerHelp UK.

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.