Liver directed therapy for neuroendocrine tumours (NETs)

If neuroendocrine tumours (NETs) spread, they often spread to the liver (called liver metastases). Liver directed therapy directly targets the cancer in the liver and is often used to treat NETs that have spread to the liver. Liver directed therapy is mainly used when surgery can’t be done.

You may have liver directed therapy to:

• control symptoms caused by too many hormones released by the tumour, especially if somatostatin analogues have stopped working
• relieve or control the symptoms of advanced neuroendocrine cancer (palliative therapy)
• slow down and control the growth of cancer
• shrink one or more tumours before surgery

The following liver directed therapies may be used to treat NETs in the liver. You may have other treatments before or after liver directed therapy.

Hepatic arterial embolization blocks or slows down the flow of blood through the main blood vessel to the liver (hepatic artery). Once the blood supply is blocked or reduced, liver tumours do not receive the oxygen and nutrients they need to grow. Sometimes chemotherapy drugs are also used during this procedure. This is called chemoembolization or transarterial chemoembolization (TACE).

Hepatic arterial embolization or chemoembolization may be used to control symptoms from too many hormones or a large tumour. It may also be used to control the growth of cancer in the liver when it continues to grow and spread.

Common side effects of hepatic arterial embolization are a group of symptoms called postembolization syndrome. These side effects include pain in the abdomen, fever, nausea, abnormal liver function tests and carcinoid crisis.

Radiofrequency ablation (RFA) uses heat to destroy cancer cells or tumours. The heat is supplied by electrical currents passed through a special needle placed directly into the liver.

RFA may be used to treat NETs in the liver. Side effects will depend mainly on how much of the liver is treated.

RFA is done by surgeons with special experience. It may not be available at all treatment centres.

Find out more about radiofrequency ablation.