Liver-directed therapy for neuroendocrine cancer

If neuroendocrine cancer spreads, it often spreads to the liver. This is called neuroendocrine cancer with liver metastases. Liver-directed therapy directly targets cancer in the liver. It’s often used to treat neuroendocrine cancer that has spread to the liver when surgery can’t be done.

You may have liver-directed therapy to:

• control symptoms when a tumour makes and releases too many hormones, especially if somatostatin analogues have stopped working
• relieve or control the symptoms of advanced neuroendocrine cancer (palliative therapy)
• slow down and control the growth of cancer
• shrink one or more tumours before surgery
• treat tumours that are close to major blood vessels in the liver

The following types of liver-directed therapy are most commonly used to treat neuroendocrine cancer.

Hepatic arterial embolization reduces the flow of blood through the main blood vessel to the liver (hepatic artery). There are different types of hepatic arterial embolization.

Bland embolization, also known as transarterial embolization (TAE), is the most common type used to treat neuroendocrine cancer. During bland embolization, the doctor places a catheter in the hepatic artery and injects a special substance (called an embolic agent) that blocks the blood supply to the tumour through the catheter. Without enough blood supply, liver tumours cannot receive the oxygen and nutrients they need to grow.

Sometimes chemotherapy drugs are also used during this procedure. If chemotherapy drugs are used, the procedure is called chemoembolization or transarterial chemoembolization (TACE). The chemotherapy is delivered directly to the liver tumour through the catheter. Because embolization reduces the blood flow, the tumour is exposed to chemotherapy longer.

Bland embolization or chemoembolization may be used to:

• control symptoms from too many hormones or a large tumour
• shrink tumours in the liver
• control the growth of cancer in the liver

The chemotherapy drugs that may be used alone or together in this procedure are:

• doxorubicin
• cisplatin

Find out more about transarterial chemoembolization (TACE) for liver cancer.

Radiofrequency ablation (RFA) uses heat to kill cancer cells. High-frequency electrical currents are passed through a special needle or probe called a needle electrode. When treating neuroendocrine cancer that has spread to the liver, the needle electrode is placed directly into the liver. The electrical current from the probe heats a small area containing cancer cells to high temperatures, killing the cancer cells.

RFA may be used to treat neuroendocrine cancer when there are several tumours in the liver. It’s also used when the tumour is close to a major blood vessel that makes surgery difficult.

Find out more about radiofrequency ablation.

Side effects of liver-directed therapy will depend mainly on the type of therapy and your overall health. Tell your healthcare team if you have side effects that you think are from liver-directed therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Liver-directed therapy may cause these side effects:

• pain in the abdomen
• fever
• nausea and vomiting
• fatigue
• loss of appetite
• infection

Talk to your doctor or pharmacist about which side effects to expect.