What is chemoembolization?

Transarterial chemoembolization is a minimally invasive procedure to treat certain cancers within the liver. It is a nonsurgical approach performed by the interventional radiologist who will deliver a combination of chemotherapeutic medications into the arteries supplying the tumors followed by an embolic agent to trap the chemotherapy within the tumor.

What kind of cancers can be treated by chemoembolization?

• Primary liver cancer (hepatocellular carcinoma)
• Cholangiocarcinoma
• Metastasis from:
  • Colorectal cancers
  • Carcinoid/neuroendocrine tumors
  • Primary kidney cancer (renal cellular carcinoma)
  • Uveal Melanoma
  • Certain soft tissue cancers (i.e. sarcomas)
  • Other vascular cancers

What are the benefits of chemoembolization?

Chemoembolization is a procedure designed to limit the growth of certain cancers of the liver or even cause them to shrink. In effect, this potentially allows for normal healthy liver tissue to be preserved, allowing the patient to maintain a relatively normal quality of life. Additionally, the medications are delivered directly into and trapped within the tumor, decreasing the exposure of the rest of the body by the chemotherapeutic drugs, limiting side effects commonly seen with systemic infusion of chemotherapy.

What happens during and after the procedure?

The procedure is performed in a state of the art angiography lab equipped with both fluoroscopic and ultrasound imaging. Using these two types of medical imaging, the interventional radiologist will perform a detailed angiogram of the liver to map out the arteries supplying the liver and the tumors within the liver. This is performed by accessing another artery, usually within the groin, and injecting contrast (dye) directly into those arteries. Once the artery or arteries supplying the tumors are identified, the chemotherapeutic medications and embolic agents are infused directly into the artery or arteries.

Afterwards, the patient will be watched overnight within the hospital and given around the clock nursing care to treat common symptoms of abdominal tenderness and nausea after the procedure, with the full expectation of going home the next morning.

What are the risks of chemoembolization?

With any procedure performed in the hospital, there carries a risk of bleeding and infection. Additional risks include reactions to contrast and medications used in the procedure, including the chemotherapeutic mixture, that could potentially cause injury to the liver or kidneys.

How effective is chemoembolization?

In more than two-thirds of cases, tumors treated with chemoembolization have been shown to stop growing or even become smaller. Additional treatments can be performed to further control the disease. Every patient is unique and each treatment is tailored to the specific patient and tumor. The procedure works best in patients who have liver predominant disease with otherwise good function of the liver and kidneys.

What are Uterine Fibroids?

Uterine fibroids are benign lumps that grow on the uterus. They are very common and can be symptomatic in some people. Symptoms may include: Heavy periods, cramping, painful sex, Increased urge to urinate. Treatment options include hysterectomy, embolization, and hormone therapy.

What is Uterine Fibroid Embolization?

Uterine Fibroid embolization (UAE) is a minimally invasive procedure that injects small beads into the arteries that supply the uterus and fibroids. The procedure is done with X-ray guidance. A MRI is usually performed before the procedure to look at anatomy and to establish a baseline for future monitoring. The procedure is low risk and has a faster recovery time compared to surgical hysterectomy or myomectomy. Patients with a history of kidney disease or a desire to have children in the future may not be good candidates for this procedure.

What should I expect after the procedure?

An overnight stay is recommended after the procedure to ensure proper monitoring. Pain and discomfort will be the worst during the first 24 hours. A patient controlled pain pump (PCA) will be provided for pain relief. Patients are typically discharged home the following day with oral pain medications. Post embolization syndrome can occur after the procedure and includes pain as well as flu like symptoms. This should improve day after day and patients are usually back to their normal level of function after about 2 weeks. Fibroids will shrink over time and patients can expect an improvement in their symptoms beginning after one month.

Is Uterine Fibroid Embolization effective?

Symptom relief after uterine fibroid embolization is well documented in the medical literature and many studies that show it is a safe and effective option for appropriately selected women who wish to retain their uterus. The procedure is supported by the American Congress of Obstetrics and Gynecology.

What is a vertebral compression fracture?

The spine is made up of many individual bones called vertebrae that stack together in a column. Just like other bones in the body, these vertebrae can fracture. A vertebral compression fracture is an injury that occurs when the main part of the vertebra, the vertebral body, experiences too much pressure and collapses in height. These fractures happen most often in the thoracic (upper back) and lumbar (lower back) regions of the spine.

What causes vertebral compression fractures?

Compression fractures in the spine generally occur when a vertebral body has been weakened due to osteoporosis or cancer. When a vertebra is weakened, everyday activities such as lifting a child, bending down to pick something up, or even sneezing can cause a fracture. When these fractures occur, the vertebral body collapses into a wedge shape. Vertebral compression fractures may cause severe back pain and limited mobility.

What are the treatment options?

Left to their own, vertebral compression fractures may heal on their own with conservative treatment and pain control. These may take up to several months. Vertebroplasty can speed up recovery time by stabilizing the fracture fragments. This can reduce pain allowing a patient to return sooner to their normal activities.

Who is a candidate for vertebroplasty?

A physical examination as well as addition imaging may be needed to tell if someone is a good candidate for vertebroplasty. Typically, our doctors recommend a MRI to look at the bones to tell if the procedure is technically possible and to see if there is active inflammation (edema). The ideal vertebroplasty patient is someone who is not improving with conservative therapy who has active inflammation on MRI.

What are the risks of vertebroplasty?

Vertebroplasty requires general anesthesia which carries its own risks. These risks can be higher in patient’s with additional medical conditions such as heart disease or other cardiovascular conditions. Additional risks include damage to the spinal cord or leakage of cement into the bloodstream. Our doctors will explain all of the risks of the procedure in detail during your consultation.

What happens during the procedure?

The procedure will be performed in an angiography suite. The patient is given anesthesia and placed faced down on the operating table. The skin is then cleaned and numbed. Using a real time x-ray (fluoroscopy), a needle is carefully passed into the vertebral body. Depending on the fracture, one or two needles may be used. Once the needles are in the correct position, cement is slowly injected. When the fracture has been filled, the needles are removed. For one fracture the procedure usually takes less than one hour. If a patient has multiple fractures, these can usually be treated during the same session.

After the procedure, the patient will remain in the recovery area for about 5 hours for observation and allow the cement to set. Most patients go home the same day, however sometimes an overnight stay is needed. Improvement in pain should occur within the first 1-2 days.

How effective is vertebroplasty?

While a study performed in 2009 showed no difference between vertebroplasty and conservative treatment, newer trials have shown that vertebroplasty is better than conservative treatment in the correct patients. The most recent VAPOUR trial published in the British Medical Journal Lancet in 2016, further confirms the effectiveness of vertebroplasty @ www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31341-1/fulltext