There are a number of treatments that may be used if a neuroendocrine tumour spreads to the liver. One of these is chemo-embolisation.

Chemo-embolisation involves giving chemotherapy directly into one of the blood vessels that supplies the liver (hepatic artery) and, at the same time, blocking off the blood supply to the cancer cells in the liver.

The tissues of the liver get their blood supply from two blood vessels:

• the portal vein
• the hepatic artery

Normal liver cells get most of their blood supply from the portal vein, but secondary liver cancers get most of their blood supply from the hepatic artery. So, potentially, if the blood supply from the hepatic artery can be cut off, this damages cancer cells more than normal liver cells.

Secondary liver cancers from neuroendocrine tumours have a very rich blood supply. Because of this, it's been suggested that they might benefit from treatments blocking this supply.

Blocking the blood supply to the liver is called hepatic artery embolisation. People having this treatment usually stay in hospital for at least two days.

First, a local anaesthetic is given to numb the area around the groin. Then a small cut is made in the skin of the groin and a thin flexible tube (catheter) is placed through the skin into a large blood vessel - the femoral artery. The catheter is gradually threaded up the femoral artery until its tip reaches the hepatic artery. Once it is in place, tiny balls of starch or very small gelatin-sponge capsules, are injected. These slow down or block the blood supply to the cancer.

Chemo-embolisation means that chemotherapy is given during hepatic artery embolisation. This can be done by injecting a chemotherapy drug into the catheter or by coating the particles used to block the artery, with chemotherapy.

The chemotherapy drug that is most often used in chemo-embolisation is doxorubicin (Adriamycin).

Side-effects of chemo-embolisation may last for about 2 - 3 days after treatment. The most common side effects are:

• feeling sick (nausea)
• vomiting,
• pain
• a high temperature.

Treatments such as anti-sickness medication and painkillers can be given to help with these.

Occasionally more serious side-effects such as kidney damage or infection can occur.

Sometimes chemo-embolisation can be given more than once.

In some people, chemo-embolisation shrinks the tumours in the liver. People who have symptoms such as flushing attacks and diarrhoea, may also find that these improve after the treatment.

Chemo-embolisation is not suitable for everyone. Doctors take into account factors such as the type of neuroendocrine tumour, how much of the liver is affected by cancer, any previous treatment and a person's general fitness before deciding whether it is appropriate. Your specialist can advise you if it might be helpful in your situation.

References

• Wiedenmann, Plockinger U. Neuroendocrine gastroenteropancreatic tumours. In, Oxford Textbook of Oncology
• Gupta et al. Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumours. Cancer 2005; 104(8) 1590-602