Chemotherapy for the Liver

Your medical oncologist is usually the quarterback of your treatment team.  He/she will treat your cancer systemically with the appropriate chemotherapy for your specific cancer.  If cancer spreads to the liver, you will likely continue with a systemic chemotherapy regimen.

What is chemotherapy? What are Biologics?

Chemotherapy, often called chemo, is the use of strong drugs to treat a wide variety of cancers. It was first used to treat cancer in the 1950s. It has been beneficial in allowing those of us with cancer to live full lives. 

Chemo is used in about half of all cases of cancer, and it is often used in combination with other therapies. It works by killing cancer cells throughout the body as they are in the process of duplicating. Different drugs target specific aspects of the replication process. Hundreds of chemotherapy drugs exist, and generally a combination of several drugs will be used in an individual’s treatment. 

Biologics include a wide range of drugs that are developed for their ability to specifically target cancer cells, stimulate the immune response, and/or aid in your recovery from cancer treatment. Biologics are often used in combination with other therapies, including chemotherapy.

There are three main categories of biologics: Substances that are nearly identical to the body’s own key signaling proteins. These signals can either act to activate your immune system to fight the cancer or act to stimulate blood production. Monoclonal antibodies designed to target a specific cell type. These specialized antibodies are similar to the antibodies the human immune system uses to fight off bacteria and viruses, but their targeting mechanism is custom-designed to fight cancer cells. Agents that interfere with chemical processes in cancer cells, including those regulating their growth, survival, and blood supply. 

The chemo and/or biologics you receive will depend on your specific type of cancer. They can be used for different reasons such as keeping cancer from spreading or slowing it’s growth, to shrink or destroy cancer cells that have spread to other parts of the body, to relieve or diminish cancer symptoms, and to cure cancer. Sometimes, chemotherapy and biologics are the only cancer treatments a patient needs. Usually, though they are used along with other treatments that can include surgery, radiation therapy, and targeted therapies.

Most chemo and biologic drugs are given in one of these ways: 

  • Pill or liquid that can be taken carefully at home.
  • As a shot. The shots may be given in your doctor’s office, a hospital, a clinic, or at home.
  • Most of the time chemo and biologics are given through an IV. The medications are put into your vein through a needle or tiny plastic tube called a catheter.
  • Other types of chemo can be put right into the spine, chest, or belly (abdomen), or rubbed on the skin. 


Questions to Ask

  • After chemo and/or biologics, will I be cured?
  • Are there other ways besides chemo and/or biologics to treat my cancer?
  • Can I use other treatment besides chemo and/or biologics or along with chemo and/or biologics to treat my cancer?
  • Does my insurance cover chemo and/or biologics ? If not, how will I pay for it?
  • How long will it take for me to receive treatment?
  • How often will I get chemo and/or biologics ?
  • How will I get chemo and/or biologics , how often, and for how long?
  • How will I get chemo and/or biologics ?
  • How will we know if the chemo and/or biologics is working?
  • How will we know if the chemo and/or biologics is working?
  • If chemo and/or biologics do not work, are there other treatments for me?
  • Is there anything I should do to get ready for treatment?
  • What can I do to make the side effects more manageable?
  • What is the goal of chemo and/or biologics for my cancer?
  • What is the goal of chemo and/or biologics for my cancer?
  • What side effects should I watch for?
  • What side effects will I have?
  • Will chemo and/or biologics cure me?
  • Will I have surgery or radiation? If so, when and why?
  • Will I have to undergo surgery or radiation? If so, when and why?
  • Will I still be able to work during treatment?


Hepatic Artery Infusion (HAI)

What is hepatic artery infusion chemotherapy?

HAI chemotherapy is designed to improve chemotherapy benefits for liver cancer or cancer that has spread to the liver by increasing the amount of chemotherapy delivered to the site of the tumor. Chemotherapy is dispensed from a specialized infusion system in which a catheter is placed into the hepatic artery to directly deliver the chemotherapy to the liver. A fully implanted system is used so that the pump that connects to the catheter in the hepatic artery is implanted under the skin. This allows for long-term administration of chemotherapy medication directly into the liver. The pump is periodically filled with chemotherapy by your oncologist. 

Direct infusion of chemotherapy into the liver minimizes the side-effects of the chemotherapy and allow high doses to be administered. Infusion of chemotherapy directly into the hepatic artery (HAI) to minimize the side effects of the chemotherapy is an option in selected patients with liver cancer or metastatic spread of cancer to the liver. 

This treatment has been of special interest in patients with colorectal cancer with liver metastasis. Because liver metastases from colorectal cancer derive more than 80% of their blood supply from the hepatic artery, hepatic arterial infusion is well suited as an alternative or together with systemic chemotherapy for the treatment of liver tumors. Hepatic artery infusion of chemotherapy has also been used in patients after liver resection (removal) for colorectal cancer spread to the liver. 

Benefits of HAI

  • HAI chemotherapy often leads to a better response of the liver disease compared to regular chemotherapy and delays further growth of the tumor
  • HAI therapy shows a trend toward increased survival rates
  • HAI therapy shows reduced systemic side effects that are associated with regular chemotherapy
  • HAI therapy enhances quality of life


The demonstrated reduction in side effects with regional chemotherapy vs. systemic chemotherapy can increase the patient’s quality of life. Even with progressive increase in hepatic tissue replacement, physical symptoms tended to occur late in the course of the disease. The development of fully implanted pumps allows the patient to be mobile and reduces the need for frequent clinic visits for drug infusion. Further, these pumps have an advantage over port access systems because they usually require little or no home care, such as maintenance of the port. Patients often can participate in activities of daily life as their illness permits with little hindrance from side effects or administration of chemotherapy. 

How is hepatic artery infusion chemotherapy (HAI) administered

Your doctor will place the pump just under the skin of your abdomen, just above or below your belt line. The pump is placed on the right side of your abdomen under the skin through a 6 inch long abdominal incision. 

To insert the catheter into the hepatic artery your surgeon has to open the abdomen. On opening the abdomen a branch of the hepatic artery is identified for insertion of the catheter. More than likely, your doctor will remove your gallbladder when implanting the pump. The gallbladder is connected to the liver by blood vessels. As a result, if the gallbladder is not removed, some of the chemotherapy that is delivered to the liver could travel to the gallbladder and may cause inflammation of the gallbladder. 

Once the catheter and pump are in place, your doctor will attach the catheter to the pump. The pump is filled after the surgery with chemotherapy that is then pumped directly into the liver through the catheter in the hepatic artery. 

Laparoscopic techniques to insert the hepatic artery infusion device

Insertion of HAI device require opening the abdomen to place the catheter into the hepatic artery. Laparoscopic insertion avoids the large incision associated with open laparotomy that is usually performed to place the catheter into the hepatic artery. Furthermore the postoperative recovery is much shorter and patients can be treated soon after the placement of the pump.