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Sunday, May 4, 2008

Chemotherapy for secondary liver cancer

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.

Treating secondary liver cancer with chemotherapy

Chemotherapy is the main type of treatment for secondary cancer in the liver and the drugs used will depend on where in the body the primary cancer started. For example, if you have cancer of the breast that has spread to the liver, you will receive chemotherapy designed to treat secondary breast cancer.

Unfortunately, it is not possible to cure a secondary liver cancer completely with chemotherapy. However it may slow or stop the growth of the cancer and may shrink the cancer to reduce any symptoms that it may be causing. Chemotherapy may also sometimes be used to shrink a liver tumour so that it can be removed by surgery.

How it is given

Chemotherapy drugs are sometimes given as tablets or, more usually, by injection into a vein (intravenously).

Intravenous chemotherapy is often given as a cycle of treatment. Each cycle may involve having the chemotherapy drugs for a few days, followed by a rest period of a few weeks to allow your body to recover from any side effects of the treatment. The number of cycles you have will depend on the type of liver cancer you have and how well it is responding to the drugs.

Chemotherapy is usually given in the outpatient department, but you may need to spend a few days in hospital.

Sometimes, chemotherapy drugs are given through a tube channelled through the skin of the chest into a vein near the heart (a central line or skin-tunnelled catheter). A pump (similar in size to a Walkman stereo) is attached to the tube and gives a continuous dose of the chemotherapy drugs. This way of giving the chemotherapy is known as continuous infusion and allows the person to stay at home and carry out most normal activities. The drugs in the pump are changed every week or couple of weeks by staff at the hospital.

Central lines

Some people having more intensive chemotherapy or a continuous infusion may find it easier to have a central line or a PICC line. These tubes (lines) make it easier for the doctor or nurse to give chemotherapy and collect blood samples, and saves you having repeated injections.

A central line is a narrow, flexible, plastic tube, which is inserted into a main vein and then comes out through the skin of the chest. Central lines can be put in under local or general anaesthetic.

Chemotherapy and other drugs can be given through the tube and blood samples can be drawn out with a syringe. The central line stays in place throughout your treatment. Once your treatment is finished, the line is taken out. Usually this is easily done, using local anaesthetic if necessary.

A PICC line (peripherally inserted central catheter) is like a central line, but it enters your body through a vein in the crook of your arm, instead of through the chest.

You can have a PICC line put in as an outpatient, using local anaesthetic. The line can stay in place throughout your treatment. Once your treatment has finished, the PICC line is easily removed.

Implantable ports (Portocaths)

An implantable port is a thin, soft, plastic tube (catheter) that is put into a vein and has an opening (port) just under the skin on your chest or arm. This allows medicines to be given into the vein through the port, or blood to be taken.

The catheter is usually inserted (tunnelled) under the skin of your chest. The tip of the catheter lies in a large vein just above your heart and the other end connects with the port which sits under the skin on your upper chest. The port is a disc about 2.5–4 cm in diameter and will show as a small bump underneath your skin. It can be felt, but nothing is visible on the outside of your body.

Side effects

Chemotherapy can sometimes cause unpleasant side effects, but it can also make you feel better by relieving the symptoms of the cancer. Any side effects that occur can often be well controlled with medicine. The main side effects are described here, along with some ways they can be avoided or reduced.

Tiredness

The chemotherapy can cause tiredness, which can affect your daily life.

Lowered resistance to infection

Some drugs can reduce the production of white blood cells by the bone marrow, making you more prone to infection.

Contact your doctor or the hospital straightaway if:

  • Your temperature goes above 38°C (100.5°F), or
  • You suddenly feel unwell (even with a normal temperature).

You will have regular blood tests during your chemotherapy treatment. Occasionally it may be necessary to delay your treatment if your blood count is low.

Bruising or bleeding

Some drugs can reduce the production of platelets, which help the blood to clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells)

While having treatment with chemotherapy, you may become anaemic. This may make you feel tired and breathless.

Feeling sick

Some of the drugs used to treat primary liver cancer may make you feel sick (nauseated) and possibly vomit. There are now very effective anti-sickness drugs (anti-emetics) to prevent or greatly reduce nausea and vomiting. Your doctor will prescribe these for you.

Taste changes

Some people find that the taste of food and drinks changes.

Sore mouth

Some chemotherapy drugs can make your mouth sore and cause small ulcers. Regular mouthwashes are important and your nurses will show you how to do these properly. If you don't feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet.

Hair loss

Unfortunately, hair loss is another common side effect of some - but not all - of these drugs. Your doctor can tell you if the drugs you are taking are likely to cause hair loss. You can often cover up by wearing wigs, hats or scarves. You may be entitled to a free wig from the NHS. Your doctor or nurse will be able to arrange for a wig specialist to visit you. If your hair falls out, it will grow back over a period of 3–6 months once the treatment has ended.

Although they may be hard to bear at the time, these side effects will begin to disappear once your treatment is over.

It is important to remember that chemotherapy affects different people in different ways. Some people find they are able to lead a fairly normal life during their treatment, but others find they become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it.

Contraception

It is not advisable to become pregnant or father a child while taking chemotherapy drugs, as they may harm the developing foetus. It is important to use effective contraception during your treatment and for a year afterwards. You can discuss this with your doctor or specialist nurse.

Condoms should be used during sex within the first 48 hours after chemotherapy. This is to protect your partner from any of the drug that may be present in semen or vaginal fluid.

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