Radiology &

Imaging

During ablation procedures, interventional radiologists use heat, cold or substances such as alcohol to kill cancer cells by injecting them through catheters directly to the site of the tumor. One relatively new ablation technique called radiofrequency ablation (RFA) has good results in controlling the spread of cancer in some patients. RFA typically is used to treat cancers than cannot be removed by surgeons because of their size or location or because the patient is not healthy enough to have open surgery. RFA is primarily used to treat cancer in the liver, but it is being studied for use in the kidney, adrenal glands, lung, bone and prostate. Although RFA is not a cure, there are several benefits of its use:

• Provides a local treatment option when surgery is too risky or not possible
• Shrinks larger tumors to a size that makes it possible to remove them surgically or to perform transplantation
• Relieves pain and other side effects to improve the quality of life of people with cancer
• Treats small tumors in conjunction with surgery of a large mass elsewhere in the liver

During the procedure, an interventional radiologist uses ultrasonography to located the tumor. Once located, the doctor makes a small nick in the skin through which a needle is passed. Through the tip of the needle, the doctor extends several prongs into the tumor. Radiofrequency energy is sent to the prongs to deliver a precise round ball of heat throughout the tumor, killing the cancerous cells with little risk to adjacent normal structures. The dead tumor tissue shrinks and slowly forms a scar.-

After the procedure, you will receive prescriptions for pain and possibly nausea. Most RFA procedures can be performed on an outpatient basis or with a brief overnight stay. Once home, you may experience pain and a low-grade fever for one or two days. Most patients experience few significant side effects beyond these, but depending on the size of the tumor treated and its location, some patients may be fatigued or tired.

You should be able to resume all normal activities within a day or two, depending on how you are feeling. If any symptoms recur or become worse instead of improving, notify your doctor.

Eventually, you will receive a follow-up CT (computed tomography) or MRI (magnetic resonance imaging) scan, as well as blood tests, to determine the size of the treated tumor and how well the RFA worked. CT and MRI scans will continue every three months thereafter to determine how much the tumor ultimately shrinks. RFA is often repeated to treat multiple lesions or multiple parts of a larger tumor. Your doctor will keep you apprised of the need for additional treatment.

Chemoembolization is a palliative treatment for liver cancer. This can be a cancer originating in the liver or a cancer that has spread (metastasized) to the liver from other areas in the body. During chemoembolization, three chemotherapy drugs are injected directly into the artery that supplies blood to the tumor in the liver. The artery is then blocked off (embolized) with a mixture of oil and tiny particles.

The liver is unique because it has two blood supplies. The portal vein provides 75% of the liver’s blood supply and the hepatic artery supplies the remaining 25%. Tumors that grow in the liver typically receive their blood supply from the hepatic artery, making chemoembolization possible. The drugs can be injected into the artery feeding the tumor while sparing most of the healthy liver tissue that feeds from the portal vein.

The treatment works in three ways to attack the cancer. First, because the chemotherapy is delivered directly to the tumor and does not spread throughout the body, stronger doses of cancer-killing drugs can be administered compared to the doses used for standard systemic chemotherapy, which is injected through a vein in the arm. Secondly, the tiny particles embolize, or block, the artery and decrease the flow of blood to the tumor, causing it to shrink. Finally, by blocking the artery, the particles help contain the chemotherapy, keeping it in direct contact with the tumor for a longer period of time — in some cases as long as a month.

This technique also may reduce some of the side effects of standard chemotherapy because the drugs are trapped in the liver instead of circulating throughout the body.

Ablation therapy is used as part of the treatment for cancer of the liver. The cancer itself is removed by surgery. However, experience has shown that there is a high chance that the cancer will reappear at a later date. For this reason, cancer specialists like to deactivate all of the liver tissue. Radioiodine can be used to do this. Radioiodine treatment uses a form of iodine that is radioactive. It deactivates liver tissue without the need for surgery. The liver takes up most of the iodine. The rest of the iodine mainly passes out of your body in the urine.