Chemotherapy

Chemotherapy uses drugs to treat the cancer. These drugs work by interfering with the growth of cancer cells and lends to cell death. Chemotherapy can be administered in a variety of ways. Treatment of the entire body is called systemic chemotherapy, while treatment of localized areas is called regional chemotherapy. If more than one anti-cancer drug is administered at once, the treatment is called combination chemotherapy. Oftentimes, chemotherapy will be used in conjunction with other treatments like radiation and surgery and is termed adjuvant chemotherapy.

Chemotherapy is administered in a variety of ways: orally, intravenously or intra-arterially. Most oral drugs can be administered at home or in the doctor's office. Intravenous drugs are usually administered at a clinic or in the doctor's office. In some cases, drugs will be administered intra-arterially with the use of a sophisticated pump. The actual treatment will depend on the type of cancer, the level of cancer invasion, and the extent of the disease. A drug may be taken every day, every week, or every month. A drug may be taken in cycles alternated with a rest period when no drug is taken.

Effectiveness of treatment is evaluated regularly with physical exams, blood tests and x-rays. A drug is considered effective if it causes the cancer cells to shrink, to stop growing, or to die.

Because anti-cancer drugs attempt to kill cancer cells, many of them will also attack and kill healthy cells. Side effects are a direct result of the killing of healthy cells. Certain cells are more susceptible to damage than others, including bone marrow cells, cells in the digestive tract, reproductive system and hair follicles. Although many patients never experience symptoms, possible side effects include nausea and vomiting, hair loss, fatigue, increased chance of bleeding and/or getting an infection, and anemia. Most of these side effects will disappear in a few days or weeks after chemotherapy ends.

Metastatic colon cancer to the liver can be treated with chemotherapy in a variety of ways. One of the most common regimens is the systemic or intravenous administration of 5 - Fluorouracil (5 FU) and Leucovorin. This drug combination is given in the vein as an outpatient and is effective in killing metastatic cancer in 20 - 30% of patients and can potentially prolong life for approximately twelve months. Other systemic drug regimens include continuous infusion of 5 FU, Tomudex, Mitomycin C, CPT-1 1 and other experimental drugs. In addition, active research protocols are investigating the effectiveness of administering chemotherapy by mouth with the goal of making the treatment easier for the patient.

Chemotherapy can also be administered directly into the liver artery and is called intra-arterial chemotherapy. Liver tumors derive their blood supply from the hepatic artery, and intra-arterial administration will expose the tumor to very high doses of chemotherapy (100 - 400 times higher values than systemic infusion).This increased drug exposure achieves tumor shrinkage in 50 - 70% of patients. The two most commonly used drugs are 5 FU and FUDR. Administering combinations of drugs can improve the chance of tumor shrinkage.

In the majority of cases, intra-arterial chemotherapy is given through an implanted pump that will deliver drugs at a rate of 2 -3 cc/day and does not require a battery. A picture of the pump is shown.

Drugs are loaded into the pump with a needle placed in the middle of the device. A picture of a patient with a device is shown and the arrows depicts the location of the pump.

The last photograph shows the pump being loaded with chemotherapy drugs. Intra-arterial chemotherapy is given as an outpatient and once the chemotherapy has been placed into the pump (which takes 15 minutes), the patient returns to their normal activity.

The first two CT images are from a patient with liver metastases from colon cancer wprior to beginning intra-arterial chemotherapy. Tumors are indicated by the arrows.

The next two images are from the same patient after two months of intra-arterial chemotherapy. They demonstrate a significant shrinkage in the size of the liver metastases.

I believe that intra-arterial chemotherapy is valuable and is used frequently in the treatment of my patients. I use it after performing a liver resection and/or cryosurgical ablation with the goal of eliminating microscopic disease that may remain in the liver. In addition, intra-arterial chemotherapy is effective in treating unresectable liver tumors. In patients who achieve significant tumor shrinkage following intra-arterial therapy, I have been able to successfully perform a liver resection at a later time. In patients who do not become resection candidates, intra-arterial chemotherapy can prolong survival. However, only two prospective randomized trials have demonstrated a statistically significant improvement in survival. Research is currently ongoing in an attempt to identify the most effective drugs.

Before consenting to chemotherapy, be sure to find out what drugs will be used and how they will be administered. Ask for a frank discussion of possible side effects and pay particular attention to these that may persist or cause permanent damage. Ask for alternatives and discuss what may happen if you choose not to undergo chemotherapy. Chemotherapy, like all cancer treatments, is a matter of choice and is something you should consider carefully. You should feel confident that chemotherapy is the best treatment option at the given time and that your doctor is doing everything possible to keep you informed and comfortable.

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