Chemotherapy for primary liver cancer
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.
Chemotherapy is sometimes used to treat primary liver cancers that can’t be removed by surgery. But in adults, chemotherapy will not usually cure the cancer. It can, however, help shrink the tumour and slow its progression, which may help control symptoms.
Chemotherapy drugs may be given as tablets, injections into a vein (intravenously) or by injection directly into the hepatic artery (the main blood vessel that takes blood to the liver). Chemotherapy can sometimes be given as part of a treatment called chemoembolisation.
There’s no standard chemotherapy drug for the treatment of HCC. The most commonly used chemotherapy drug is doxorubicin. Other chemotherapy drugs that may be used include:
A combination of chemotherapy drugs may be used.
Chemotherapy treatment is not suitable for everyone because it can only be given if your liver functions well enough.
How chemotherapy is given
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Chemotherapy is usually given as a session of treatments called cycles. Each cycle lasts a few days and is followed by a rest period of a few weeks to allow the body to recover from any side effects. The number of cycles you have will depend on the type of liver cancer you have and how well it’s responding to the drugs.
Chemotherapy is usually given in the hospital outpatient department or chemotherapy unit. Sometimes the chemotherapy is injected slowly into a vein (intravenously) or it may be given as a drip (infusion) over a few hours. You may need to stay in hospital for a few days. Occasionally, it’s given as a continuous infusion through a small pump that you take home with you. Your doctor or nurse will explain how your chemotherapy will be given and what to expect.
A number of research trials are being carried out to try to improve the results of treatment for primary liver cancer.
You may be asked to take part in a trial.
Chemotherapy can sometimes cause unpleasant side effects, but it can also make you feel better by relieving the symptoms of the cancer. Most people have some side effects, but these can often be controlled well with medicines.
Lowered resistance to infection (neutropenia)
Chemotherapy can reduce the production of white blood cells by the bone marrow, making you more likely to get an infection. The number of white blood cells will usually have returned to normal before your next cycle of chemotherapy is due. You should contact your doctor or the hospital straight away if your temperature goes above 38˚C (100.4˚F) or you suddenly feel unwell, even with a normal temperature.
Bruising or bleeding
Chemotherapy can reduce the production of platelets, which help the blood to clot and stop bleeding. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin.
Low number of red blood cells (anaemia)
You may become anaemic, which can make you feel tired and breathless.
Some chemotherapy drugs can make your mouth sore and cause small ulcers. Using mouthwashes regularly is important - your nurses will show you how to use these properly. If you don’t feel like eating during treatment, you could try replacing some meals with nutritious drinks or soft foods.
Feeling sick (nausea) and being sick (vomiting)
Some of the drugs may make you feel sick (nausea) and you may be sick (vomit). There are very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting - your doctor can prescribe these for you. Let your doctor or nurse know if your anti-sickness drugs aren’t helping, as they can change it to a different type. Some anti-emetics can cause constipation. Let your doctor or nurse know if this is a problem.
You are likely to find that you become very tired and have to take things much more slowly. Just do as much as you feel like doing and try not to overdo it.
Ask your doctor whether the drugs you are taking are likely to make your hair fall out. Not all chemotherapy drugs cause hair loss. If your hair does fall out, it will start to grow back once your treatment finishes.
Some drugs used to treat liver cancer can irritate the lining of the digestive system and cause diarrhoea for a few days. Your doctor can give you medicine to slow down your bowel and reduce diarrhoea. You may be able to help to control it yourself by eating a low-fibre diet - avoiding wholemeal bread and pasta, raw fruit, cereals and vegetables - for a few days after each treatment.
Chemotherapy can affect the skin and nails causing dryness and flaking. Some drugs make your skin more sensitive to the sun, so it’s important to cover up and use a suncream with a high sun protection factor (SPF).
Numbness or tingling in the hands or feet
Some chemotherapy drugs can affect the nerves causing numbness and tingling. This is known as peripheral neuropathy. Tell your doctor if you notice this. It usually improves slowly a few months after treatment finishes.
Effects on the kidneys
Some chemotherapy drugs can affect the way your kidneys work. Usually, this doesn’t cause symptoms and the effect is mild. Rarely, it may cause permanent damage to the kidneys unless the treatment is stopped. Before and after each treatment, your kidneys will be checked by a blood test and you’ll be given plenty of fluid through a drip to keep your kidneys working normally. It’s important to drink plenty of fluids during and after your treatment. Your urine may also be measured to check that your kidneys are working properly.
Changes in hearing
Chemotherapy can cause ringing in the ears (tinnitus) and you may be unable to hear some high-pitched sounds.
This usually improves when treatment finishes but can sometimes be permanent. Tell your doctor if you notice any loss of hearing or ringing in your ears.
Although the side effects mentioned here may be hard to bear at the time, they will gradually disappear over a few weeks once your treatment has finished.
Our section on chemotherapy has more detail on the treatment, its side effects, and individual chemotherapy drugs.