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Chemotherapy and targeted therapy use drugs to kill cancer cells or stop them from growing. Chemotherapy kills any cells that divide quickly. That means they kill cancer cells as well as some fast growing normal cells, such as those in the hair. Its goals are to shrink a tumor and keep it from spreading. How chemotherapy drugs affect normal cells depends on the amount and types of drugs used. It also depends on the person taking the drugs. Liver cancers are not very sensitive to chemotherapy. Targeted therapies are medications that target specific molecular defects found in the cancer cells. They preferentially kill cancer cells, or stop the cells from growing, relatively sparing normal cells. Thus they may be more effective than chemotherapy with fewer side effects. Sorafenib (Nexavar) is a targeted therapy used in liver cancer and the first drug that has been shown to improve survival in liver cancer patients.
These are the three main ways to get chemotherapy or targeted therapy for liver cancer:
Systemically, meaning drugs go through the whole body
By local injection, straight into your liver into the cancer cells
By chemoembolization or bead embolization
Chemotherapy for liver cancer can be given through a vein for delivery to the whole body. Sorafenib is taken by mouth and absorbed into the blood stream for delivery. This is called a systemic treatment. Sorafenib is the most common systemic therapy for liver cancer. The most common chemotherapy used to treat liver cancer is Adriamycin (doxorubicin), which is now rarely used.
Chemotherapy may also be put into an artery that goes right to your liver. This may be done with oil and chemotherapy or using beads coated with chemotherapeutic agents. This is called local injection, or more specifically, hepatic artery infusion. It is used less often than systemic chemotherapy. Your doctor must first test you to make sure you do not have tumors in other parts of your body. Much of the chemotherapy is broken down as it enters the liver, so it doesn't reach other parts of the body. This may allow doctors to use higher doses of chemotherapy. One limitation of this treatment is that it may require surgery to insert a small tube called a catheter into the hepatic artery, which many people with liver cancer may not be healthy enough for.
Chemoembolization is another way to deliver chemotherapy into the hepatic artery. You may have this treatment if you can’t have surgery and you have poor liver function with advanced liver cancer. This procedure is usually used to reduce the tumor for better pain control. It may also be used to shrink the tumor before you have surgery. For this procedure, the doctor uses X-rays to guide a small tube called a catheter into an artery in your groin and to the artery that supplies blood to the tumor. Then, the doctor injects chemotherapy drugs into the tube mixed with particles that are coated with chemotherapeutic agents or oil mixed with chemotherapeutic agents. Then, the particles block the blood flow (known as embolizing) to the tumor. The rest of the body is exposed to the chemotherapy drugs at a lower dose.
The side effects of chemotherapy depend on the type of drugs you take and the length of your treatment. Since chemotherapy attacks cells that divide quickly, it can also affect healthy blood cells. Report any symptoms of infection during chemotherapy, especially fever, to your doctor or nurse as soon as possible.
These are some of the possible side effects from chemotherapy for liver cancer:
Bruising and bleeding (from low platelet counts)
Infection (from low white blood cell counts)
Loss of appetite
Tiredness and fatigue (from low red blood cell counts)
Bone marrow suppression
Some drugs can reduce side effects and help you recover from chemotherapy more quickly. Most side effects go away when treatment is complete.
Sorafenib does not usually cause as many side effects as chemotherapy drugs, but it may cause fatigue, high blood pressure, skin rashes, decreased appetite, diarrhea, and skin redness or blistering on the hands or feet.
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