"Colon and rectal cancer are the second leading cause of cancer-related deaths in the United States," said Vikas Dudeja MD, FACS, James P. Hayes Endowed Professor and Director of the Division of Surgical Oncology at UAB. "As these tumors metastasize, the most common site they target is the liver. Unfortunately, by the time we see these patients here at UAB, in many cases, the tumors in the liver are too advanced to remove them all."
With this in mind, UAB Medicine, O'Neal Comprehensive Cancer Center and the UAB Heersink School of Medicine have launched a new Hepatic Artery Infusion Pump Program to offer more treatment options to patients with colon or rectal cancer that has spread to the liver.
In this procedure, physicians implant an infusion pump under the patient's skin, which is connected by a small catheter to the hepatic artery. Oncologists are able to deliver high-dose chemotherapy through the pump directly to the liver. As a result, in 40 percent of these patients, the cancer in their liver has shrunk enough that it can be surgically removed. In the other 60 percent, response varies by case, but most patients are living longer and able to spend more time with their loved ones.
"Since most chemotherapy goes throughout the body, side effects tend to limit the dosage," Dudeja said. "Because the hepatic artery infusion pump delivers the chemotherapy directly to the liver, nausea isn't usually a problem, and we can use stronger doses of FUDR and Mitomycin C.
"We monitor patient labs closely to avoid damage to bile ducts in the liver. Our nurses work closely with patients during the five days or so they are in the hospital, and then in recovery and follow up. It's a team approach."
Three surgeons from UAB's oncology surgery department perform the implant procedure, with a multidisciplinary team contributing their support to patient care.
"After patients are released from the hospital, we generally recommend the usual six weeks of taking it easy post-surgery. Then patients can continue with their usual activities. However, we do tell them no skydiving or scuba diving with the implant to avoid sudden changes in pressure," Dudeja said.
After chemotherapy has had time to work, patients are evaluated to see if the cancer in their liver has shrunk enough to be surgically removed.
"We typically recommend leaving the pump in for up to five years, even after surgery, Dudeja said. "That way, if there is a recurrence, we could immediately start treatment."
The hepatic artery implant pump was developed a generation ago, but ended up back on the shelf due to a combination of the specialized skills needed to use it and advances in treatment that replaced it in its original role.
"A few major medical centers recently began investigating how it might be used to deliver stronger chemotherapy to the liver and possibly make a difference in outcomes for patients with colon and rectal cancer that had spread to the liver. Memorial Sloan Kettering in New York has done a great deal of work in this area," Dudeja said.
There are still very few hospitals offering the procedure compared to the many patients who could benefit from it. Dudeja introduced the implant through UAB's surgical oncology program. It is the only place the procedure is available in Alabama and one of very few in the South.
UAB Surgical Oncology is also introducing another state-of-the-art approach. "We have recently initiated a program using Heated Intraperitoneal Chemotherapy (HIPEC) to treat patients whose cancer has spread to the lining of the abdominal cavity," Dudeja said. "We performed the first procedure in January and hope to soon report back on how our patients are responding."
"In a patient with cancer too widely spread throughout the body, an implant to treat the liver may not be enough to make a difference. But if we can detect the cancer sooner and get more patients evaluated, so we can be ready to quickly fight any spread to the liver, we can save more lives and give others more time with the people they love. In that regard, if there is one thing I can communicate to physicians treating patients whose colon or rectal cancer has spread to the liver, it's this: every patient should be evaluated for surgical options as soon as possible. Even a diagnosis of stage four with liver involvement doesn't necessarily have to be a death sentence."