In its later stages, colorectal cancer can spread, or metastasize, to other organs in the body. One common site of metastasis is the liver, with about half of colorectal cancer patients developing liver metastases at some point in their cancer journey.

Treating a metastasis to the liver can be complicated. The ultimate goal is to remove the tumor surgically, but only about 15–20 percent of patients present with tumors that can be surgically removed when they are first discovered. This is because they are often too big or too numerous to be safely taken out at the start of treatment.

“Chemotherapy can help shrink some large liver tumors so they can be removed, but unfortunately, traditional chemotherapy doesn’t work for every patient,” said Jason A. Castellanos, MD, MS, a surgical oncologist at Fox Chase Cancer Center.

What can shrink colorectal liver metastases more effectively is something called a hepatic arterial infusion pump—a new and advanced method of delivering chemotherapy directly to these tumors.

“Hepatic arterial infusion pump chemotherapy is a way to increase chemotherapy dosage to the liver for an improved response,” Castellanos said.

The pump can help make surgery an option for more patients, which is the only treatment option that offers a chance at long-term cure.

How the Hepatic Arterial Infusion Pump Works

The hepatic artery infusion pump is about the size of a hockey puck. It is implanted surgically under the skin in the left abdomen and connected to the hepatic artery, which supplies blood to the liver.

The pump is filled with chemotherapy that is released slowly and steadily into the hepatic artery. This method delivers a higher dose of chemotherapy to the tumor without causing the same side effects as traditional chemotherapy.

Patients are treated with pump chemotherapy on and off every two weeks for up to six months.

“Treatment is given in combination with systemic chemotherapy so that we are able to target tumor cells that may be outside of the liver while also focusing on shrinking the liver tumors,” Castellanos said.

Throughout treatment, patients are closely monitored and undergo frequent lab work to make sure the liver and bile ducts remain healthy. They also receive regular scans to see if the tumors have shrunk enough to be surgically removed.

Who Is Eligible for the Hepatic Arterial Infusion Pump?

This treatment option is a good fit for individuals who have liver metastases that are confined to the liver but cannot be removed from the liver surgically at the present time.

Expertise Matters

Many patients with colorectal liver metastases do not realize they could be candidates for liver surgery. This is why it is a good idea to seek a second opinion at a specialized cancer center that offers the latest treatment options.

Fox Chase is one of the few facilities in the Philadelphia region that offers treatment with the hepatic arterial infusion pump.

Along with offering this advanced treatment option, we offer a variety of other treatments for colorectal cancer patients with liver metastases. Our multidisciplinary team understands that treatment of this disease is complex, and we take an individualized approach when caring for each of our patients.

To schedule an appointment at Fox Chase Cancer Center, please call 888-369-2427 or request an appointment online.

Updated: June 13, 2023

Radiation therapy has long been used to treat gynecologic cancers. But not every patient with gynecologic cancer is aware of brachytherapy, a targeted form of radiation therapy that has become more advanced in recent years, offering another effective option for patients.

Brachytherapy is a form of internal radiation that can provide higher doses of radiation to a more targeted area compared to external beam radiation therapy (EBRT), where high-energy X-ray beams are aimed at a tumor from outside the body.

With brachytherapy, radiation oncologists place radioactive sources directly into the site that needs treatment. As a result, the radiation is targeted away from nearby organs like the bladder or rectum. That can lower the risk for side effects and complications.

Several types of gynecologic cancer can now be treated with brachytherapy, including cervical, vaginal, and uterine (also known as endometrial) cancers. Depending on the type and stage of a patient’s cancer, brachytherapy can be used alone or as part of a larger treatment plan that includes EBRT, surgery, and/or chemotherapy.

Specialized Delivery for Gynecologic Cancers

Brachytherapy for gynecologic cancer can be administered in different ways depending on a patient’s diagnosis.

For patients who no longer have a uterus and cervix, uterine cancers near the top of the vagina can receive radiation via a targeted vaginal cylinder, similar to a vaginal ultrasound probe. This is a short, relatively pain-free procedure and doesn’t require a hospital stay. Once the cylinder is removed, patients are no longer radioactive, and there are no constraints on who they can engage with.

For patients who still have a uterus, brachytherapy for cervical cancer usually involves inserting a high-dose radiation device, called a tandem, directly into the cervical os, and an ovoid applicator nearby. The device is left in the cervix for several minutes while it delivers radiation and is then removed. To minimize discomfort, general anesthesia is use during cervical brachytherapy.  

Compared to EBRT, basic brachytherapy for gynecologic cancers has a lower chance for side effects. But it’s not entirely without risk. Women can experience cramping, spotting, or soreness after the procedure, and other, less common side effects to regional organs may occur. Patients should weigh their individual benefits and risks with their care team.

Experience and Expertise Matter

As with other advanced treatments, brachytherapy is best performed by a multidisciplinary care team at a major cancer center, such as the Fox Chase Cancer Center, which has one of the largest brachytherapy programs in the Eastern United States.  At a center for excellence like Fox Chase, patients benefit from decades of experience, specialized staff, and the state-of-the-art equipment for delivering brachytherapy. That maximizes outcomes and minimizes inconvenience.

It’s also worth it to seek out a second opinion on brachytherapy, even if your oncologist has recommended EBRT. Expert advice can help you understand your treatment options and make the best choice for your needs. 

Your choice of treatment can make a big difference. Brachytherapy takes less time than other options, and patients feel better, so they don’t necessarily have to rearrange their life or take a leave of absence from work to get treatment.

Learn more about brachytherapy treatment at Fox Chase.

Pancreatic cancer has long been treated with surgery followed by chemotherapy or radiation. However, reversing the order of those treatments—a process known as total neoadjuvant therapy—could lead to better outcomes for patients.

Total neoadjuvant therapy is a newer approach to treating pancreatic cancer in which a patient receives radiation therapy or chemotherapy to shrink their tumor before undergoing surgery to remove it. Many experts believe that sequencing of treatments in this order can lead to better outcomes.

“There’s more and more science showing that this is the right way to treat pancreatic cancer,” explained Sanjay S. Reddy, MD, FACS, a surgical oncologist at Fox Chase Cancer Center.

The benefits of total neoadjuvant therapy

Surgery to remove the tumor is typically considered the main treatment for pancreatic cancer, if the cancer has not spread beyond the pancreas. This procedure is not a small operation, and it’s not always possible to remove every bit of cancer.

Some pancreatic tumors are attached to or wrapped around blood vessels, making them harder to remove. However, even when a tumor isn’t touching a blood vessel, many patients have microscopic pancreatic cancer cells in other areas that can’t be detected.

Giving chemotherapy or radiation before surgery can help shrink large tumors that are on or near blood vessels so they’re easier to operate on. It can also help kill those undetectable cancer cells in other parts of the body.

“I think of these tumors as a large plant, and surrounding this are weeds which we can’t see,” Reddy explained. “Surgery can address the plant, but chemotherapy is the best way to address the weeds.”

Is total neoadjuvant therapy right for everyone?

Total neoadjuvant therapy is often recommended for pancreatic cancer patients whose tumors are too big to be removed by surgery at the time of their diagnosis, or if the tumor involves major blood vessels. “However, if the tumor is completely away from any blood vessels, surgery is still considered standard. Although there is growing support in sequencing these patients with systemic chemotherapy first,” Reddy said.

Still, experts like Reddy are convinced that total neoadjuvant therapy could play a valuable role in treating many pancreatic cancer cases.

“The microscopic cancer cells that we can’t see, the so-called weeds and seeds, can’t be addressed through surgery. We hope that chemotherapy can control those cells,” Reddy said. “So, the combo of the two, I feel, holds the most promise.”

That’s why even for patients with small, early-stage pancreatic tumors, seeing a medical oncologist to discuss systemic treatments before definitive resection could prove beneficial.

“This disease is one that involves a true team approach,” Reddy said. “Meeting with a surgical, medical, and radiation oncologist helps the patient understand all the available options, including clinical trials, so that they can make a better informed decision regarding their care.”

Learn more about pancreatic cancer treatment at Fox Chase Cancer Center.