Interventional Radiology :: Procedures :: Vascular :: ChemoEmbolization (TACE) for Liver Cancer
Procedures & Treatments
 
Procedures Vascular ChemoEmbolization (TACE) for Liver Cancer
 
About the Procedure

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Liver cancer is common in regions that are endemic for Hepatitis B and C . India and most of Asia are regions with a high incidence of this problem. Thus these regions contribute to the majority liver cancer patients in the world.
Like most internal malignancies liver cancer is detected late since they hardly produce any symptoms in the early stage.

Procedure Details

Liver cancer is common in regions that are endemic for Hepatitis B and C . India and most of Asia are regions with a high incidence of this problem. Thus these regions contribute to the majority liver cancer patients in the world.
Like most internal malignancies liver cancer is detected late since they hardly produce any symptoms in the early stage.

Treatment options

When the tumor size is less than 5 cms both surgery and RF ablation offers good results. However as the size of the tumor increase the chances of recurrence increase with very poor results when it crosses 10 cms.
Surgery cannot be performed when there is underlying cirrhosis of the liver .Here the normal liver tissue is replaced by tough fibrous ones when is associated with poor liver function and portal hypertension. Hepatitis B and C can finally result in cirrhosis in addition consumption of alcohol can also produce similar liver damage.
Thus a large number of patients have other hope at the time of detection except chemotherapy with its side effects and extremely poor results. Chemoembolization offers hope for this sub group of patients who are not ideal candidates for surgery
Chemoembolization : is the a combination of regional chemotherapy and embolization . The Liver receives oxygen rich blood from two sources .30% from the hepatic artery and 70% from the the portal vein . The tumor cells on the other receive blood only from the hepatic artery . Thus if a catheter is placed in the blood vessel supplying the tumor then an anti cancer drug can be delivered precisely in the culprit region avoiding normal tissue. This is regional chemotherapy . If the anti cancer drug is loaded on to an agent that simultaneously blocks the tumor blood vessels we will have the benefits of regional chemotherapy and in addition increase the contact time between the drug and tumor which would result in better results. Chemoembolization is thus the technique of using a combination of an anticancer drug and embolic agent to treat cancer liver. Since the liver has dual supply blocking the artery alone does not adversely affect the normal liver.
Chemoembolization can be performed by several means of the most accepted techniques is mixing the anti cancer drug with a lpoidol (iodinated poppy seed oil) this is shown to be effective by several studies from japan and Korea . The anti cancer drug can be cisplatinum,adriamycin ,mitomycin C or a combination of these drugs.
In the recent years two other techniques show great promise D C beads and radioactive beads the former is a excellent vehicle for doxorubicin and gives a sustained release of the drug for about 14 days to the tumor .

DC Bead

DC Bead product shot

Patient preparation and post procedure

For the patient the procedure is very similar to angiography

A small amount of blood will be drawn before starting the procedure to make sure that your kidneys are working and that your blood will clot normally. A small dose of sedative may be given through the IV line to lessen your anxiety during the procedure.The area of the groin or arm where the catheter will be inserted is shaved.

The are most commonly the upper thigh is cleaned, and numbed with local anesthetic. The radiologist will make a small needle puncture in the skin where the catheter can be inserted into an artery. The catheter is then guided through the arteries to the area to be examined. After the contrast material is injected through the catheter and reaches the blood vessels being studied, several sets of x-rays are taken.During injection of the contast agent you may be asked to hold your breath for a few seconds. Most people get a warm feeling in the region of examination during injection of contrast

Following the procedure the tubes are taken out from the puncture site and compression given for a few minutes to stop the bleeding . The patient is advised to keep the leg that was punctured straight for 6 – 8 hours . The patient is allowed to walk after 12 hours. At times a closure device may be used to close the puncture site enabling the patient to walk after an hour.
Most patients may have some pain in the region embolized for the next few days .The pain will respond to pain killers

Complications

Though rare any vascular Interventional procedure carries the following risks.

1. The procedure may fail and one may have to resort to surgery.
2. A normal vessel may get blocked and the patient may suffer due to lack of supply to that region.
3. The liver function may get worse due to the effect of the drug on the liver and may even result in liver failure and death
4. Drugs including the dye used for angiography can produce an allergic reaction which can rarely be severe and dangerous to life.

5. Patient may develop bleeding from the site of puncture for angiography in the leg or arm, this can be stopped by compression for a few minutes


For Further Information Contact : dr.mathewcherian@gmail.com
Phone : +91 9600900373
 
 
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