Treatment for bowel cancer that has spread to the liver

There are different types of treatment for bowel cancer that has spread to the liver (secondary liver cancer). You might have one of these treatments if you can’t have surgery to remove the secondary cancer.

Treatments include specialised ways of giving chemotherapy and radiotherapy directly into the secondary cancer. 

How your doctor decides about treatment

Your doctor will consider different factors when deciding if a treatment is suitable for you. Some factors are:

• your general health 
• how quickly your cancer came back after other treatments 
• whether you have secondary cancer anywhere else that cannot be removed 

Your doctor will talk to you about the possible benefits and risks of these treatments. If your bowel cancer has spread anywhere else in your body, your doctor is not very likely to suggest these treatments. They might suggest chemotherapy instead. Chemotherapy circulates throughout the body and so treats all areas of the cancer.

Transarterial chemoembolisation (TACE)

Chemoembolisation involves giving a chemotherapy drug into an artery along with an oily liquid or an absorbable gelatin sponge. The doctor puts a thin tube called a catheter into a large artery in the leg or arm.

They thread the catheter into the main artery that carries blood to the liver. They then inject the mixture of chemotherapy and oily liquid or foam through the catheter. The oil or foam cuts off most of the blood flow to the liver, which cuts off the supply of oxygen and nutrients to the cancer. This damages the cancer cells.

The chemotherapy mixture also stays in the area of the cancer for some time, so the cancer cells get a high dose of the treatment. You may need to stay in hospital overnight or longer for this treatment.

Selective Internal Radiation Therapy (SIRT)

This is a type of internal radiotherapy (brachytherapy). It is also called radioembolisation.  

You have a thin tube called a catheter put into the hepatic artery that supplies blood to the liver. The doctor sends tiny beads called microspheres down the catheter. These get stuck in the small blood vessels around the cancer.

The microspheres contain a radioactive substance that gives a dose of radiation to the cancer. The radiation from the microspheres damages the tumour's blood supply. This means that the cancer can’t get the nutrients it needs. The radiation also damages the cancer cells. 

The range of radiation from the beads is very small. So it causes very little damage to the surrounding healthy tissue. Most of the radiation from the microspheres is gone within 2 weeks. The microspheres stay in the liver permanently but are harmless.

Radiofrequency ablation

Radiofrequency ablation uses radio waves to destroy cancer cells in the liver by heating them to high temperatures.

You usually have a sedative to make you drowsy but some people have a general anaesthetic. If you have the sedative, your doctor injects a local anaesthetic into the skin of your tummy (abdomen) to numb it. They then push a thin needle through the skin and into the centre of each tumour. They use a CT scan or ultrasound scan to make sure the needles are in the right place. Then they pass radio waves through the needle to heat the tumours and destroy them.

RFA can treat tumours up to 5cm (2 inches) in size. It takes about 10 to 15 minutes. Usually, you can go home a few hours afterwards.

You might need to have the treatment repeated. The main side effects are pain and a high temperature for a few days. Your doctor or nurse will give you painkillers to take at home. They will also give you instructions on what to do if you get a high temperature.

Cryotherapy

Cryotherapy is also called cryosurgery. It destroys the cancer by freezing it. It is only suitable for small tumours, usually up to 4 cm. It takes about 30 to 60 minutes. You might have it as part of open surgery under general anaesthetic or using keyhole techniques under local or general anaesthetic.

The surgeon puts one or more cryotherapy probes (called cryoprobes) through a small cut in the skin and into the cancer. The surgeon uses a CT scan or ultrasound scan to make sure each probe is in the right place. The tip of the cryoprobe is then cooled to below freezing.

The probe creates an ice ball within the surrounding tissue that aims to destroy the cancer cells. Sometimes the area is thawed for 10 to 15 minutes and then frozen again.

You will have some pain afterwards and possibly a high temperature, but you will have painkillers to help. You usually have a short stay in an intensive care unit followed by around 2 days in the specialist liver treatment ward.

Microwave ablation

Microwave ablation uses microwave energy to produce heat and kill cancer cells. You can have this treatment for more than one secondary liver tumour. You might have a local anaesthetic or general anaesthetic.

Your doctor puts a thin needle into each tumour. They use a CT scan or ultrasound scan to make sure the needles are in the right place. Then they connect the needles to a microwave generator. The microwaves are released through the needles to destroy the cancer cells.

The most common side effects include pain and a high temperature.

Laser therapy

Laser therapy is also called laser ablation. The surgeon uses a very high powered beam of light to destroy cancer cells in the liver, by heating them to high temperatures. You usually have a sedative to make you drowsy but you might have a general anaesthetic.

If you have the sedative, your doctor injects a local anaesthetic into the skin of your abdomen to numb it. They then push a flexible tube that carries the laser light through the skin over the liver and into the centre of each tumour.

The doctor uses a CT scan or ultrasound scan to make sure the tip of the tube is in the right place. Then the laser heats the tumours and destroys them.

Laser therapy can treat tumours up to 5cm (2 inches) in size.  It takes about 10 to 15 minutes.

Usually, you can go home a few hours afterwards. You might need to have the treatment repeated. The main side effects are pain and a high temperature for a few days afterwards.

Alcohol treatment

This treatment uses sterile alcohol to destroy cancer cells. It involves injecting alcohol (ethanol) through the skin, directly into the cancer in the liver. Ethanol destroys the cancer cells by killing the proteins in the tumour and dehydrating it.  

It is only suitable for liver tumours smaller than 4 to 5cm.

You might have medicine to make you drowsy. The surgeon then injects local anaesthetic into the skin over the liver. They push a thin needle through the skin and into the tumours. A CT scan or ultrasound scan makes sure the needle is in the right place. Then they inject the alcohol directly into the tumour. 

You can have this treatment for more than one tumour in the liver.

It can be painful, so you take painkillers for a while afterwards. Some people feel drunk for about 10 to 15 minutes after the injection.

You usually stay in hospital for a few hours after your treatment, in case you have any bleeding or pain. You can have the treatment again some time later if the tumours grow back.