Chemoembolization

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Chemoembolization is a combination of local delivery of chemotherapy and a procedure called embolization to treat cancer, most often of the liver. In chemoembolization, anti-cancer drugs are injected directly into the blood vessel feeding a cancerous tumor. In addition, synthetic material called an embolic agent is placed inside the blood vessels that supply blood to the tumor, in effect trapping the chemotherapy in the tumor.

Need to Know

Nice to Know
  • You will be asked to sign a consent form before the procedure is performed
  • Tell your radiologist about any allergies, especially to local or general anesthetics and contrast materials (“x-ray dye”)
  • If you are taking a blood thinner or aspirin product, the physician will instruct you when to stop taking these medications
  • Inform your radiologist if you are pregnant
  • If you are diabetic, the physician will give you insulin and/or anti-diabetic medication dosing instructions
  • You should plan to have someone take you home after the procedure as you will not be able to drive after sedation
  • Wear comfortable, loose-fitting clothing
  • You will be given a gown to wear during your treatment
  • You can go home after the procedure if vitals are stable
  • Most patients feel minimal discomfort after the procedure

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How Does It Work?

Chemoembolization attacks the cancer in two ways. First, it delivers a very high concentration of chemotherapy, or anti-cancer drugs, directly into the tumor, without exposing the entire body to the effects of those drugs. Second, the procedure cuts off blood supply to the tumor, trapping the anti-cancer drugs at the site and depriving the tumor of the oxygen and nutrients it needs to grow.

The liver is unique because it has two blood supplies—an artery (the hepatic artery) and a large vein (the portal vein). The normal liver receives about 75 percent of its blood supply through the portal vein and only 25 percent through the hepatic artery. But when a tumor grows in the liver, it receives almost all of its blood supply from the hepatic artery.

Chemotherapy drugs injected into the hepatic artery reach the tumor very directly, sparing most of the healthy liver tissue. Then, when the artery is blocked, the blood is no longer supplied to the tumor, while the liver continues to be supplied by blood from the portal vein. This also permits a higher concentration of the anti-cancer drugs to be in contact with the tumor for a longer period of time.

What Happens — Before, During, and After?

A clinical staff member will bring you into the pre-procedure area and ask you to change into a gown. An intravenous (IV) line will be inserted into a vein in your hand or arm. Your doctor will greet you, review the procedure, and answer any questions you may have. You will be brought into the procedure room, and you‘ll be positioned on the procedure table. You will be connected to a monitor for your heart rate, blood pressure, and pulse. The technologist will shave, sterilize, and cover the area of your groin where the catheter will be inserted with a surgical drape. A very small nick is made in the skin at the site.

Using x-ray guidance, a thin catheter is inserted through the skin and into the femoral artery and advanced into the liver. Then a contrast material is injected through your IV and another series of x-rays will be taken.Once the catheter is positioned in the branches of the artery that are feeding the tumor, the anti-cancer drugs and embolic agents are mixed together and injected.

Additional x-rays will be taken to confirm that the entire tumor has been treated.

At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed.

You can expect to stay in bed in the recovery room for six to eight hours. On some occasion you can spend the night in the hospital for observation.

Chemoembolization is usually completed within 90 minutes.

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How Should I Prepare?

There are things you can do to make your experience more comfortable, and many of these will depend on your individual preferences. You might like to keep a list of questions or – as you’re doing now- educate yourself about the procedure.

Another important part of your preparation will be guided by your doctor:

  • Several days before the procedure, you will have a consultation with the interventional radiologist.
  • Your doctor may ask you to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or blood thinners (such as Coumadin, Warfarin, Plavix, Fragmin) for a time before the procedure.

Some of your preparation will need to be timed to the procedure:

  • The day before the procedure (or the Friday before, if you’re scheduled for a Monday procedure), a clinical staff member from the Interventional Radiology Department will call you. The clinical staff member will give you any additional instructions, and will ask if you have any questions.
  • Take your medications as instructed.
  • When you arrive, make sure the clinical staff member and radiologist know about any allergies you may have, especially allergies to local anesthetics (such as lidocaine), general anesthetics, or x-ray dye (contrast media). If there’s any chance you might be pregnant, tell your radiologist.
 
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What Should I Bring?

  • Wear comfortable, loose-fitting clothes
  • Wear comfortable shoes
  • A list of your current medications with dosage
  • Avoid bringing jewelry or valuables
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What Are the Benefits and Risks?

Chemoembolization is not recommended in cases where severe liver or kidney dysfunction, abnormal blood clotting or a blockage of the bile ducts. In some cases—despite liver dysfunction—chemoembolization may be done in small amounts and in several procedures to try and minimize the effect on the normal liver.

Chemoembolization is a treatment, not a cure. Approximately 70 percent of the patients will see improvement in the liver and, depending on the type of liver cancer, it may improve survival rates.

The benefits of Chemoembolization could be:

  • In about two-thirds of cases treated, chemoembolization can stop liver tumors from growing or cause them to shrink. This benefit lasts for an average of 10 to 14 months, depending upon the type of tumor, and usually can be repeated if the cancer starts to grow again
  • Other types of therapy (tumor ablation, chemotherapy, radiation) may be used in combination with chemoembolization to control the tumor
  • When cancer is confined to the liver, most deaths that occur are due to liver failure caused by the growing tumor, not due to the spread of cancer throughout the body. Chemoembolization can help prevent this growth of the tumor, potentially preserving liver function and a relatively normal quality of life

Risks you should be aware of include:

  • Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000
  • Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection
  • There is always a chance that embolization material can lodge in the wrong place and deprive normal tissue of its blood supply
  • There is a risk of infection after embolization, even if an antibiotic has been given.
  • Because angiography is part of the procedure, there is a risk of an allergic reaction to the contrast material
  • Because angiography is part of the procedure, there is a risk of kidney damage in patients with diabetes or other pre-existing kidney disease
  • Reactions to chemotherapy may include nausea, hair loss, a decrease in white blood cells, a decrease in platelets and anemia. Because chemoembolization traps most of the chemotherapy drugs in the liver, these reactions are usually mild
  • Serious complications from chemoembolization occur after about one in 20 procedures. Most major complications involve either infection in the liver or damage to the liver. Reporting indicates that approximately one in 100 procedures result in death, usually due to liver failure

Keep in mind that this information is general. Your radiologist is the best source of information about how these risks and benefits may apply to you.

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