Chemoembolization

Chemoembolization is a palliative treatment for liver cancer. This can be a cancer originating in the liver or a cancer that has spread (metastasized) to the liver from other areas of the body. During chemoembolization, three chemotherapy drugs are injected into the artery that supplies blood to the tumor in the liver. The artery is then blocked off (embolized) with a mixture of oil and tiny particles. This procedure accomplishes four things:

• The tumor becomes deprived of oxygen and nutrients once the blood supply is blocked.
• Because these drugs are injected directly at the tumor site, this dosage is 20 to 200 times greater than that achieved with standard chemotherapy injected into a vein in the arm.
• Because the artery is blocked, no blood washes through the tumor. As a result, the drugs stay in the tumor for a much longer time - as long as a month.
• There is a decrease in side effects because the drugs are trapped in the liver instead of circulating throughout the body.

The liver is unique in having two blood supplies - an artery (the hepatic artery) and a large vein (the portal vein). The normal liver gets about 20% of its blood from the hepatic artery.

When a tumor grows in the liver, it receives almost all of its blood supply from the hepatic artery. Therefore, chemotherapy drugs injected into the hepatic artery at the liver reach the tumor very directly, sparing most of the healthy liver tissue.

Then, when the artery is blocked, nearly all of the blood supply is taken away from the tumor, while the liver continues to be supplied by blood from the portal vein.

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

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.

The evening before the exam you may not eat or drink anything (NPO). You will arrive at the Hospital of the University of Pennsylvania early in the morning. Once at the hospital you will receive an intravenous (IV) line, placed in your arm, which allows large amounts of fluids to drip into your body. These fluids consist of antibiotics and other medications that are needed prior to your chemoembolization procedure.

Prior to going into the procedure suite, you will meet your Interventional Radiologist and the staff who will be assisting in the procedure. Once in the procedure suite, the Interventional Radiologist will place a small catheter (a small tube) in an artery in your groin and perform an arteriogram that will specifically look at the arteries in your liver. After these arteries are identified, the catheter is directed into the branch of the artery supplying blood to the tumor, and the chemoembolization mixture is injected.

Once this is completed, you are sent back to your room where you will lie flat in bed for six hours. More IV fluids are given to you overnight. Most patients are discharged from the hospital the following day.

Following the procedure you may have varying degrees of pain, fever and nausea. These symptoms may last a few hours to a few days, and are easily treated by various medications. You may also notice a slight hair loss, rarely perceived by anyone other than yourself.

Serious complications from chemoembolization are rare. In less than 3% of the procedures, the liver tumor killed by the procedure may become infected and abscess. There has been one fatality in 100 procedures due to liver failure.

Will chemoembolization help me?

Remember this is a treatment, not a cure. Approximately 70% of the patients will see improvement in the liver and, depending on the type of liver cancer, it may improve your survival.