If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
Patients who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
Side Effects Of Chemotherapy
Chemotherapy drugs may cause unpleasant side effects. These can usually be well controlled with medicines and will usually go away once treatment has finished. Not all drugs cause the same side effects and some people may have very few. You can talk to your doctor or nurse about what to expect from your treatment.
Side Effects Of Liver Cancer Chemotherapy
While chemotherapy drugs attack the rapidly dividing cancer cells, they also tend to affect other, healthy cells in the body that also divide quickly, such as those in the lining of the intestines and mouth, bone marrow and hair follicles. When these cells are affected by chemotherapy medication, side effects may occur. The side effects a patient experiences will depend on the type and dose of their chemotherapy, though common side effects include:
- Nausea and vomiting
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Why Does Chemo Cause Side Effects
Cancer cells tend to grow fast, and chemo drugs kill fast-growing cells. But because these drugs travel throughout the body, they can affect normal, healthy cells that are fast-growing, too. Damage to healthy cells causes side effects. Side effects are not always as bad as you might expect, but it’s normal to worry about this part of cancer treatment.
The normal cells most likely to be damaged by chemo are:
- Blood-forming cells in the bone marrow
- Hair follicles
- Cells in the mouth, digestive tract, and reproductive system
Some chemo drugs can damage cells in the heart, kidneys, bladder, lungs, and nervous system. Sometimes, you can take medicines with the chemo to help protect your bodys normal cells. There are also treatments to help relieve side effects.
Doctors try to give chemo at levels high enough to treat cancer, while keeping side effects at a minimum. They also try to avoid using multiple drugs that have similar side effects.
About Chemotherapy For Liver Cancer
Chemotherapy uses anti-cancer drugs to destroy cancer cells.
Chemotherapy for liver cancer is usually given directly into the blood vessel that carries blood to the liver . It is often used together with a treatment that blocks the blood supply to the tumour. This is called chemoembolisation.
This information on this page is about chemotherapy given into a vein or taken by mouth as tablets. This is not a common way of treating HCC. It can be used to try to control the tumour and reduce symptoms. It is not suitable for everyone because the liver may not be working well enough to cope with chemotherapy drugs.
Your doctor or nurse will tell you how you will have chemotherapy.
You usually have chemotherapy on one or more days, followed by a rest period of a few weeks. This is called a cycle of treatment. The rest period lets your body recover from the side effects before you start your next treatment cycle.
Your doctor or nurse will tell you how many cycles of treatment you will have.
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Side Effects Requiring Immediate Medical Attention
Along with its needed effects, capecitabine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking capecitabine:
Applies to capecitabine: oral tablet
What Is Chemotherapy For Liver Cancer
Chemotherapy is the treatment of cancer with drugs that can destroy or slow the growth of cancer cells. The goals of chemotherapy treatment are to control the cancer, keep it from spreading by slowing the cancer’s growth and improve or reduce the symptoms of the disease. Chemotherapy is more than undergoing infusions or taking pills. For patients with liver cancer who need chemotherapy, this means that a hepatologist or medical oncologist who specializes in liver cancer care is part of the team and oversees the delivery of chemotherapy.
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How Liver Cancer Is Treated
In cancer care, different types of doctors often work together to create a patients overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.
Treatment options and recommendations depend on several factors:
How much of the liver is affected by the cancer
Whether the cancer has spread
The patients preferences and overall health
The damage to the remaining cancer-free area of the liver
When a tumor is found at an early stage and the patients liver is working well, treatment is aimed at trying to eliminate the cancer. The care plan may also include treatment for symptoms and side effects, an important part of cancer care. When liver cancer is found at a later stage, or the patients liver is not working well, the patient and doctor should talk about the goals of each treatment recommendation. At this point, the goals of treatment may focus on slowing the growth of the cancer and relieving symptoms to improve quality of life.
How To Store Chemotherapy Pills
Oral chemotherapy pills may have certain requirements for storage regarding temperature. Its important to make sure to keep your medication stored at the temperature recommended.
Also, make sure to keep your medication in a dry place. Certain areas, such as the bathroom, may be damp and cause the medication to break down. Also, keep oral chemotherapy pills sealed and away from childrens reach.
You and a doctor must consider many factors when deciding on oral versus traditional chemotherapy. This is how they compare with each other on some key points:
|You can take it at home in a matter of seconds, so theres less disruption to your life.
|It requires a visit to a doctors office or clinic for a treatment that may take hours. Over time, this can become burdensome.
|Its less invasive and causes little to no physical discomfort when you take it.
|Getting IV medications can be uncomfortable or even painful. It can take several hours and may increase your anxiety levels.
|You have to keep track of dosing and administration, making sure to take it exactly as directed, usually several times per day.
|Your healthcare team takes care of dosing and administration.
|Your health insurance plan might list it as a pharmacy benefit instead of a medical benefit. This could increase out-of-pocket costs.
|Major medical benefits usually cover it.
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Treatment For Secondary Liver Cancer
The treatment you have depends on where your cancer started and how you are feeling. Your specialist will discuss the aims of treatment with you.
For some types of cancer that have spread to the liver, it may still be possible to cure your cancer. For other types of cancer, the aim may be to control your cancer and symptoms. This is called palliative treatment.
Cost Of Oral Chemotherapy
Getting access to oral chemotherapy drugs may be somewhat complicated, depending on your prescription drug insurance coverage.
IV chemotherapy drugs have been part of cancer treatment for a long time, and the health insurance system is set up to process and approve these prescriptions relatively quickly and easily. An established system is in place that allows pharmacies to get pre-certification from the insurance company. They then fill the prescription, knowing theyll very likely be reimbursed by the insurance company. The patient doesnt usually have to be involved in this process.
Many oral chemotherapy drugs, however, arent part of this system yet. The pharmacy may not give you the drug unless you have confirmation that the insurance company has already approved it. If not, youre required to pay the pharmacy directly when you pick up the prescription. Most people are unable to pay cash for drugs that may cost between $6,000 – $12,000 per month.
We help our patients at CTCA with this process through our CTCA/Rx oncology pharmacy. Our pharmacy communicates with your insurance provider to get the authorizations you need to receive your medication, including oral chemotherapy drugs. Our pharmacy staff will also work with patient assistance programs to try to help you find financial support for your medications if your insurance denies coverage.
Check with the nonprofits related to your specific type of cancer, too.
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Which Chemotherapy Drugs Are Used For Liver Cancer
Unfortunately, most chemo drugs do not have a great effect on liver cancer. Recent advances have shown that a combination of drugs may be more helpful than using just a single chemo drug. But even these combinations of drugs shrink only a small number of tumors, and the responses often do not last long. And most studies show systemic chemo has not helped patients live longer.
The most common chemotherapy drugs for treating liver cancer include:
Sometimes, combinations of 2 or 3 of these drugs are used. GEMOX is one option for people who are fairly healthy and may tolerate more than one drug. 5-FU based chemotherapy, for example with FOLFOX , is another option for people with bad liver disease.
How Is Chemotherapy For Colorectal Cancer Used
Your cancer team may recommend chemotherapy at different times during colorectal cancer treatment, depending on the other treatments you may need as part of your plan:
Adjuvant chemotherapy is given after cancer surgery. Its purpose is to eradicate remaining cancer cells left behind, and it may help reduce the possibility of cancer returning.
Neoadjuvant chemotherapy is given before surgery to make tumors smaller and easier for your surgeon to remove. In such cases, radiation therapy may be given in addition to chemotherapy. Rectal cancer patients are more likely to have neoadjuvant chemotherapy.
With advanced cancer that has spread to other areas of the body, chemotherapy may help reduce tumor size and help you feel better.
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Systemic Therapy For Advanced Hcc
Treatments using medication are used to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.
This type of medication is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Medications are often given through an intravenous tube placed into a vein using a needle, an injection into a muscle or under the skin, or as a pill or capsule that is swallowed . If you are given oral medications, be sure to ask your health care team about how to safely store and handle it.
The types of medications used for advanced HCC include:
The first-line treatment is the initial treatment given. First-line therapy options for advanced HCC include:
The combination of bevacizumab , with atezolizumab may be offered to some patients with advanced HCC.
Targeted therapy with sorafenib or lenvatinib may be offered to people who are unable to receive atezolizumab with bevacizumab. See more under Targeted therapies below.
A second-line treatment is given if the first-line treatment does not work. Second-line therapy options for advanced HCC include:
Anti-angiogenesis therapies include:
Make An Appointment/referral Or Have Your Questions Answered
The Cancer AnswerLine is staffed by oncology nurses and is just a phone call away to answer your questions or to assist you in making an appointment.
Please call to make an appointment or for the answers to any questions you have.
NOTE: Children and young adults receive treatment in the Solid Tumor Oncology Program, part of C.S. Mott Children’s Hospital.
If you would like to refer a patient, please contact our M-Line service:
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How Much Does Oral Chemotherapy Cost
The cost of oral chemotherapy treatment varies widely depending on the duration, dosage, and type of drug. Insurance coverage also affects the price.
A 2021 review reports that adults with cancer in the United States spend $180â2,600 per month on cancer care. This amount is known as the âout-of-pocketâ cost, which is the portion of treatment that insurance companies do not cover.
The American Cancer Society notes that oral chemotherapy often involves higher out-of-pocket costs than IV chemotherapy. Some insurers may not cover certain types of drugs, and the drugs themselves may be more expensive.
A person with health insurance should call their plan provider to find out what it covers. They should speak with their cancer care team about this coverage before an oncologist issues a prescription.
How To Take And Store
When taking your chemotherapy pill or liquid, wash your hands before and after handling the medication. Oral chemotherapy should always be swallowed as directed never cut, chew, or crush it.
Chemo you swallow is as strong as other forms of chemo, and many are considered hazardous. You may be told to be careful not to let others come into contact with your medication or your body fluids while taking it and for a time after taking it. You may need to wear gloves when touching the pills or capsules.
Some drugs have to be kept in the bottle or box they came in, while some drugs and the packages they come in need to be disposed of in a certain way. Some may have to be taken back to the drug store to be thrown away safely. Some drug manufacturers will include materials for safely disposing of your medication.
Keeping your medication in a weekly pill box may help you remember to take it each day. Most chemotherapy pills and liquids can be stored at room temperature. There are some forms of oral chemotherapy that require refrigeration.
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What Can I Expect From Oral Or Topical Chemo
The side effects of any form of chemo vary from drug to drug and from person to person. Your cancer care team may not be able to tell you what side effects youll have, but they can tell you what to watch for.
Telling your team about side effects as soon as they happen can help make sure that they dont get too bad. Your doctor may have to change how much you take or give you other drugs to help you feel better. If you arent sure about a side effect and cant reach your doctor, dont take your chemo until you talk to someone on your cancer care team.
Taking chemo at home gives you more freedom without having a lot of treatment visits. You may not be seeing your doctor and nurses very often, but be sure to call them with any questions or concerns you have.
How Are Chemotherapy Drugs Administered
Chemotherapy for colorectal cancer is given in different ways, depending on a number of factors:
Systemic chemotherapy is administered to the entire body. These drugs may be given through a vein, or you might take them by mouth.
Regional chemotherapy is administered via an artery close to the area affected by cancer. This may lead to fewer side effects and help more specifically target the cancer cells in that designated area.
Chemoembolization of the hepatic artery, also called hepatic arterial infusionor sometimes referred to as a chemotherapy pumpis a treatment for colorectal cancer that has spread to the liver. Chemoembolization blocks the main blood supply to the liver so that anti-cancer drugs can be injected between that area and the liver. The drugs will then remain mainly in the liver. Sometimes this blockage is temporary, but it may also be permanent.
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What Happens If You’ve Been Told Your Cancer Cannot Be Cured
If you have advanced liver cancer it might be very hard to treat. It may not be possible to cure the cancer.
If this is the case, the aim of your treatment will be to limit the cancer and its symptoms, and help you live longer.
Finding out the cancer cannot be cured can be very hard news to take in.
You will be referred to a special team of doctors and nurses called the palliative care team or symptom control team.
They will work with you to help manage your symptoms and make you feel more comfortable.
The clinical nurse specialist or palliative care team can also help you and your loved ones get any support you need.