Colorectal cancer is among the most common cancers diagnosed in the United States. But it’s also one of the most treatable cancers—and may even be prevented—when caught early through regular checkups and screening.
But despite proven screening and preventative measures, colorectal cancer is still one of the deadliest cancers in the United States. When allowed to spread—often to the liver—colorectal cancer may be very difficult to treat, leading to poor outcomes.
While incidence and deaths from the disease have slowly declined over the past several decades, diagnoses have risen in teens and adults who do not follow screening guidelines. And because they are not screened, younger patients often are diagnosed with advanced cancer that may be more difficult to treat.
That’s why it’s important for cancer patients with advanced colorectal cancer to seek out a hospital that offers a variety of standard of care options and treatments that may not be available elsewhere, administered by experienced doctors. One such treatment that few hospitals in the country offer is hepatic artery infusion (HAI) therapy for patients with advanced colorectal cancer that has spread to the liver.
“Less than 1 percent of all hospitals across the country even have access to this treatment or have the expertise to do it,” says Ajaz Khan, MD, MBA, CPE, Chair of the Department of Medical Oncology at City of Hope® Cancer Centers in Atlanta, Chicago and Phoenix.
This article explores how HAI may help patients with liver metastasis live longer. Topics include:
- What Is hepatic artery infusion?
- Is hepatic artery infusion used with other treatments?
- Caring for a hepatic artery infusion pump
If you have been diagnosed with colorectal cancer and would like to get a second opinion on your diagnosis and treatment options, call us or chat online with a member of our team.
What Is hepatic artery infusion?
When cancer spreads it most often is found in the liver, brain, bones and/or lungs. Advanced colorectal cancer most often is found in the liver, likely after cancer cells travel in the blood supply through the hepatic artery. Once in the liver, the cancer may form multiple tumors that may grow too large to be resected—removed by surgery.
“For a patient with, say, three liver tumors and a primary colon cancer, obviously they can’t go to surgery right away,” Dr. Khan says. “We have to do something to convert these patients to resection.”
In the past, patients may have received systemic chemotherapy to treat the colon cancer and to try to shrink the liver tumors so they may more easily be removed. This treatment often produced poor outcomes for patients.
First developed in the 1960s, hepatic artery infusion delivers chemotherapy directly to the liver metastases and has a better success rate in shrinking the tumors. Today, clunky external pumps that once delivered chemo have been replaced by small hockey-puck-sized discs that are placed just under the skin.
The refillable pumps are connected to a catheter that runs into the liver and delivers the chemotherapy drug floxuridine (FUDR) directly to the tumors.
“If you deliver the drug systemically less of the chemotherapy is going to the liver,” says Dr. Khan (pictured below). “With HAI there's less systemic migration of the chemotherapy outside of the liver. It stays in the liver and works on killing or shrinking the tumor.”
Is hepatic artery infusion used with other treatments?
In patients with advanced colorectal cancer, HAI therapy is used only to treat liver metastasis. The underlying disease still needs to be treated. So, patients undergoing HAI therapy still receive systemic chemotherapy to treat their colorectal cancer.
Surgery is most often the first-line treatment for colorectal cancer. But when it is diagnosed at an advanced stage, treatment options may become more complex.
Surgery may still be an option to remove the diseased section of the colon, surrounding lymph nodes and other affected tissue. Systemic chemotherapy may be given before surgery to help shrink tumors.
Also, while colorectal cancer most often metastasizes to the liver, it may also spread elsewhere, including the lungs, brain and peritoneum (the abdominal wall). So, systemic chemotherapy may also be used to treat metastatic cancer outside of the liver.
In some cases, immune checkpoint inhibitors—a type of immunotherapy—may be an option for colorectal cancer with high microsatellite instability. And radiation therapy may be a palliative option to shrink tumors that may be pressing organs or causing pain.
Caring for a hepatic artery infusion pump
A subcutaneous HAI pump is installed during a surgical procedure that may take up to three hours with a patient under general anesthesia. Patients should expect to be admitted to the hospital for at least one night.
The HAI pump used at City of Hope Cancer Center Chicago delivers medication two ways.
In most cases, the drugs are fed through a catheter from a reservoir in the pump, which is activated by body heat. When the reservoir is empty, it is refilled with a needle that goes through the skin into a port at the center of the pump.
In some cases, a doctor may flush the reservoir and inject medication through the pump into the liver in what’s called a bolus injection.
In some cases, pumps may be installed for years, but Dr. Khan says they are usually removed after several months. The pump creates a slight bulge in the skin where it is placed and, for the most part, won’t interfere with normal activities.
The pump may cause issues if a patient needs an MRI, and it may trigger metal detectors at airports. Patients receive an ID card after the pump is installed to present to airport security or inform their radiologist.
Patients do need to take some precautions, including the following.
Avoid contact sports. Rough physical activity or a hard blow could damage the pump.
Avoid deep sea or scuba diving. The increased pressure may affect the flow rate.
Be cautious with heat sources. Saunas, hot tubs, prolonged sun exposure and heating pads over or near the pump may increase the flow rate.
Tell your doctor if you are traveling by air. The higher elevation may affect the flow rate.
Patients on HAI therapy may experience some side effects, including infection, damage to the bile duct or other issues, if the pump becomes displaced or leaks. In general, however, HAI therapy helps make advanced colorectal cancer more treatable and helps some patients with metastatic disease live longer.
“We are really proud to be able to offer it,” he says. “We have a technology that 99 percent of the people in the country may not have available to them.”
If you have been diagnosed with colorectal cancer and would like to get a second opinion on your diagnosis and treatment options, call us or chat online with a member of our team.
