Radioembolization is very similar to chemoembolization but using radioactive microspheres instead of chemotherapy drugs. This therapy is used to treat both primary and metastatic liver tumors.
This treatment involves injection of plastic or glass microspheres incorporating the radioactive isotope Yttrium-90 directly into the tumor. Each sphere is about the size of five red blood cells in width and looks like a speck of dust. The microspheres are injected through a catheter introduced from the groin and threaded into the liver artery supplying the tumor. The microspheres become lodged in the tumor blood vessels, where they emit their local radiation that causes tumor cells to die. This technique allows for a high local dose of radiation to be delivered, without subjecting healthy tissue in the body to the radiation. The Yttrium-90 radiates from within and can be viewed as "internal" radiation or "brachytherapy."
Radioembolization is a palliative, not a curative, treatment. Patients may benefit by extending their lives and improving their quality of life. Some patients who initially have too much tumor to undergo surgery or transplantation may respond well enough to undergo surgery later. Radioembolization is performed as an outpatient treatment. There are fewer side effects from this treatment compared to standard cancer treatments, with the main one being fatigue lasting a few weeks.
Chemoembolization is a minimally invasive treatment for liver cancer that can be used when the tumor is not amenable to treatment by surgery or by radiofrequency ablation (RFA).
Chemoembolization delivers and traps a high dose of cancer-killing drug (chemotherapy) directly in the tumor while depriving the tumor of its blood supply by blocking, or "embolizing," the arteries feeding the tumor. Using real time X-ray imaging for guidance, the interventional radiologist threads a tiny catheter up the femoral artery in the groin into the blood vessels supplying the liver tumor. Using the catheter ensures treatment of the tumors while sparing other areas of the liver and the rest of the body. The embolic agents trap the chemotherapy drug in the tumor. This allows for a high dose of chemotherapy drug to be used, because less of the drug is able to spill into the tumors' surroundings. Chemoembolization usually involves a hospital stay of less than a day. Patients typically have lower than normal energy levels for a few weeks afterwards.
Chemoembolization is a palliative, not a curative, treatment. It can be very effective in treating primary liver cancers (hepatocellular carcioma or hepatoma), and in some cases, can result in reduction of tumors sufficiently to qualify a patient for transplantation. Chemoembolization has also shown promising results with some types of metastatic tumors. The individual materials used in this treatment are FDA approved and this technique has been performed for decades, but the treatment itself is not specifically approved by the FDA.
For inoperable tumors in the liver and elsewhere, radiofrequency ablation (RFA) offers a nonsurgical, localized treatment that kills the tumor cells with heat while sparing the surrounding healthy tissue. This treatment is easier on the patient than systemic therapy or surgery. Radiofrequency ablation can be performed without affecting the patient's overall health and most people can resume their usual activities within a few days.
In this procedure, the interventional radiologist guides a needle through the skin of the sleeping patient into the tumor, using CT scan or ultrasound imaging for guidance. From the tip of the needle, radiofrequency energy (similar to microwaves) is transmitted to the surrounding tumor, where it produces enough heat to cook the tissue. The dead tumor tissue shrinks slowly and forms a scar after weeks or months. The FDA has approved RFA for the treatment of liver and other tumors.
RFA is palliative and can extend patients' lives. RFA is particularly effective for smaller tumors that can be completely and permanently eradicated. Because it is a local treatment with minimal harm to surrounding healthy tissue, the treatment can be repeated if new tumors appear. Even if a tumor can not be completely eradicated by RFA, decreasing the size of a large tumor using RFA may improve a patient's quality of life by decreasing pain and disability. It is a very safe procedure, and has been available since the 1990s.
There are a number of tests that can help in the diagnosis of cancer, including blood tests, physical examination and a variety of imaging techniques including X-rays (e.g., chest X-rays and mammograms); computed tomography (CT); magnetic resonance imaging (MRI) and ultrasound. Usually, however, the final diagnosis is made based on a biopsy. In a biopsy, a sample of tissue from the tumor or other abnormality is obtained and examined by a pathologist using a microscope. By examining and performing tests on the biopsy sample, pathologists and other experts can determine what kind of cancer is present, whether it is likely to be fast or slow growing, and what genetic abnormalities it may have. This information is important in deciding the best type of treatment. Open surgery is sometimes performed to obtain a biopsy, but in most cases, tissue samples can be obtained without open surgery using interventional radiology techniques.
Needle biopsy, also called image-guided biopsy, is usually performed using computed tomography (CT), real-time X-ray (fluoroscopy), ultrasound, or magnetic resonance (MR) to guide the procedure. In the most difficult cases, needle biopsies are performed with the aid of equipment that creates a computer-generated image and allows radiologists to see an area inside the body from various angles. This "stereotactic" equipment helps them pinpoint the exact location of the abnormal tissue and to avoid injuring normal tissue.
Biopsies may involve techniques called "fine needle biopsy" or "core biopsy," depending on the amount of material needed, the consistency of the tissue, and whether infection or other diagnoses are being considered. Both require use of long skinny needles, skinnier than an IV. Most are performed with local anesthetic and sedation only without the need for general anesthesia. Patients go home with nothing more than a band-aid.
Needle biopsy is typically an outpatient procedure with very infrequent complications; less than 1 percent of patients develop bleeding or infection. In about 90 percent of patients, needle biopsy provides enough tissue for the pathologist to arrive at a diagnosis.
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