Physicians on the medical staff at The George Washington University Hospital treat most cancers with surgery, chemotherapy, radiation therapy or some combination of these treatments. Interventional radiologists often work with oncologists to perform innovative procedures to treat many cancer patients and to improve quality of life.
Chemoembolization / Radioembolization
Embolization is an interventional technique used to deliver chemotherapy or radiotherapy directly to liver tumors—either primary tumors that originated in the liver (Hepatoma or Hepatocellular Carcinoma) or those that have metastasized from another area of the body such as colon cancer, breast cancer, carcinoid tumors and other neuroendocrine tumors, islet cell tumors of the pancreas, ocular melanoma, sarcomas, other vascular primary tumors in the body.
Depending on the number and type of tumors, embolization may be used as the sole treatment or may be combined with other types of therapy, such as tumor ablation, chemotherapy or radiation, to control the tumor.
When cancer is confined to the liver, most deaths occur due to liver failure caused by the growing tumor, not due to the spread of cancer throughout the body. Embolization can help prevent this growth of the tumor, potentially preserving liver function and a relatively normal quality of life.
Blood is supplied to the live in two ways: hepatic artery and the portal vein. When a tumor grows in the liver, it receives almost all of its blood supply from the hepatic artery. Doctors begin the procedure by inserting a catheter into the femoral artery in the patient's groin, and then advancing the catheter into the liver. Then, they inject a dye, and use X-ray images to help visualize the blood supply to the tumor. Physicians then inject chemotherapy or radioactive material into a catheter that has already been placed into the hepatic artery.
Embolization is usually completed within 90 minutes. Most patients leave the hospital after an overnight stay. Sometimes these procedures can be performed on an outpatient basis.
Physicians often order follow up CT scans or MRI images to determine if the tumors have shrunk, and to see if new tumors have occurred in the liver. The average time before a second round of embolization is necessary (because of a new tumor) is between 10 and 14 months. Embolization can be repeated many times over the course of many years, as long as it remains technically possible and the patient continues to be healthy enough to undergo the procedure.
Embolization is not for every patient with liver tumors. Those who have blockages of the portal vein or of the bile ducts may not be eligible for this form of therapy. In some cases, despite liver dysfunction, embolization may be done in small amounts to help minimize the effect on the normal liver.
Embolization is a treatment, not a cure. Most patients will see improvement in their liver and, depending on the type of liver cancer, it may even improve survival rates.
Tumor ablation involves interventional techniques that apply heat, cold or chemicals to destroy a tumor. During this procedure, doctors use imaging from a CT scanner or ultrasound machine to help them insert a small needle-type probe through the skin and precisely into the tumor. The probe is then attached to an energy source that delivers heat (using radiofrequency, laser or microwave energy) or freezing (a treatment called cryoablation). A special needle, called an infusion needle, is used to inject chemicals into the tumor.
Relief of Obstructions
Interventional radiologists use imaging techniques, such as CT, X-ray, ultrasound or MRI, to visualize a patient’s anatomy to determine where cancers have obstructed the normal flow of urine or bile. Without treatment, such obstructions can cause not only pain, could cause infection or even liver or kidney failure.
While watching images on a screen, doctors insert a catheter into the obstructed area to drain excess fluids. A stent might also be inserted into the organ to bypass the obstruction and permit fluids to drain normally.
Many cancers are now diagnosed by a needle biopsy. During this procedure, interventional radiologists use imaging techniques, such as CT, X-ray, ultrasound or MRI, to guide a fine needle into a patient's tumor. A small amount of tissue is removed through the needle so that a pathologist can examine it to determine if cancer cells are present. Needle biopsies provide an alternative to many conventional surgical biopsy procedures, and may be less painful and result in a shorter recovery times