Chemoembolization for primary and metastatic liver cancers

How is liver cancer treated?

Malignant tumors of the liver or gastrointestinal tract which have spread to the liver may be treated by standard intravenous chemotherapy, surgery, cryotherapy (using cold probes to freeze the tumor), percutaneous ablation (using a needle to place alcohol directly into the tumor to kill it), or a combination of therapeutic techniques. A method of delivering a relatively large dose of chemotherapy directly to the liver tumor (chemoembolization) has shown some good results in patients who are not candidates for standard therapy.

Doctors may use embolization—a technique that delivers either chemotherapy or radiation therapy directly to liver tumors—to destroy cancer cells. It can also be used to treat people who have liver metastases, or cancer that has spread to the liver from other organs such as the colon. The treatment blocks blood flow to tumors, helping to kill cancer cells, and increases the effectiveness of chemotherapy or radiation therapy. A portal vein embolization can be used to help improve liver function after surgery, if necessary.

Embolization with chemotherapy is known as chemoembolization, and embolization with radiation therapy is called radioembolization.

What is chemoembolization?

Chemoembolization is performed by placing a small catheter from the blood vessel in your groin into the artery that supplies blood to the liver. This is analogous to the more familiar cardiac angiogram. The chemotherapeutic drug(s) are then delivered through the catheter along with a blood vessel occluding agent right at the site of the tumor. The result is that a very highly concentrated dose of anti-tumoral drug is delivered (without the normal dilution that occurs with a standard intravenous infusion) and the blood vessels are partially blocked with the occluding agent to starve the tumor of it’s blood supply. This “double-punch” can slow or stop tumor growth, and in some cases can even result in significant shrinkage of the tumor. If you are interested in further information on this technique or believe you might be candidate, please contact us.

What kind of tumors can be treated?

Remember, chemoembolization only treats tumors in the liver and will have little or no effect on any other cancer in the body. For example, the following liver cancers may be treated by chemoembolization:

• hepatoma (primary liver cancer)
• metastasis (spread) to the liver from:
• colon cancer
• carcinoid
• ocular melanoma
• sarcomas
• a primary tumor in another part of the body

What to Expect During Embolization

A physician starts chemoembolization or radioembolization therapy by inserting a catheter into an artery in the groin and advancing it into the artery supplying the liver. He or she then injects a contrast agent, which highlights the vessels and tumors on X-ray images of the liver.

During chemoembolization, the doctor moves the catheter directly into the artery feeding the tumor and injects doxorubicin and small beads or particles that block blood flow. For radioembolization, he or she injects radioactive particles. Afterward, the doctor withdraws the catheter from the body and applies pressure to the entry site to prevent bleeding.

Embolization is typically an outpatient procedure, although you may need to stay overnight in the hospital so your doctor can manage any pain or nausea you may experience.

How are patients evaluated?

Your physician may recommend that you have several tests, including liver function blood tests, and a CAT scan or an MRI of your liver prior to the chemoembolization procedure. Your doctor needs to check these test results to make sure you do not have:

• any blockage of the portal vein
• cirrhosis of the liver
• a blockage of the bile ducts

If you have any of these complications, your doctor may not allow you to have the Chemoembolization procedure.