Chemoembolization

Definition

Utilized to treat tumors in the liver, chemoembolization is the process of injecting chemotherapy directly into the blood vessels which feed the tumor.

Purpose

Chemoembolization is a treatment that can be focused on cancerous cells that have spread to the liver but does not expose the rest of the body to the effects of chemotherapy. It is not a cure but does offer relief (palliative) and preserves the quality of life. The technique is minimally invasive and approximately 70% of patients will experience improvement in liver function and survival time.

Precautions

The referring physician will probably recommend several tests prior to the procedure, such as, liver function blood tests and a CAT scan or an MRI of the liver. These tests insure there is no blockage of the portal vein in the liver; there is no cirrhosis of the liver; and there is no blockage of the bile ducts. Any of these complications may prevent the procedure from being performed.

Description

A radiologist performs this procedure in a hospital under x-ray guidance by inserting a small catheter (tiny tube) through a hollow needle into the femoral artery, located in the groin. It is then threaded up through the aorta and into the artery in the liver that feeds the tumor. During chemoemolization, three chemotherapy drugs are injected directly into this artery and it is then "embolized" or blocked off with a mixture of oil and tiny particles. Since the drugs are injected directly into the tumor, the dosage is 20-200 times greater than that received with standard treatment via a vein in the arm. Since the tumor is blocked off, the drugs stay in it for a much longer time. Also, with the blood supply blocked, the tumor is deprived of oxygen and nutrients, which serves to hasten its destruction. The liver has two blood supplies, a hepatic artery and a large portal vein so it can still function with one blocked off.

The procedure takes approximately three hours to perform, occurs while the patient is under conscious sedation, and usually involves an overnight stay in the hospital. It is usually performed on a monthly basis with three sessions being the average treatment regimen.

Preparation

The evening before the procedure nothing may be taken by mouth after dinner. Generally, a patient must arrive at the hospital early in the morning to permit the infusion of large amounts of fluids by an intravenous (IV) line placed in the arm. These fluids contain antibiotics and other medications needed prior to the procedure. The patient is then taken to the Department of Radiology for the treatment.

Aftercare

Immediately following the injection of the chemotherapy mixture, the patient is returned to a hospital room and must lie flat in bed for at least six hours. More IV fluids are provided during this time as well as overnight. Most patients are discharged the next day. It is important to spend as much time as possible in bed 1-2 days following the procedure in order to improve blood flow to the liver.

Risks

Serious complications are extremely rare from this procedure. Some statistics have quoted that in less than 3% of the procedures, the liver tumor that was destroyed became infected and abscessed. Others have noted approximately one fatality per 100 procedures due to liver failure.

Normal results

The patient may experience varying degrees of pain, fever and nausea following the treatment, which may last any where from a few hours to a few days. Pain or high fevers the first few days following the treatment are a result of the tumor breaking down and is normal. Frequently, one of the laxatives called Lactulose is given to help the body rid itself of metabolic waste usually eliminated by the liver. This may cause loose stools for several days. Extreme fatigue is a common problem for 3-4 weeks after the procedure. With the tumor now blocked, liver function should improve and thus, the quality of life.

Follow-up scans may be performed in order to determine any changes in the tumor and to look for the appearance of any new tumors. Chemoembolization can be repeated many times over a period of many years depending on the status of the patient.

Abnormal results

A sudden change in the degree of pain and/or fever that persists after the first week should be reported to a physician. Any unusual changes should be communicated immediately.

Resources

BOOKS

American Cancer Society's Consumer's Guide to Cancer Drugs. Published by Jones and Bartlett, 2000.

ORGANIZATIONS

American Society of Clinical Oncology, 1900 Duke Street, Suite 200, Alexandria, VA 22314. Phone: 703-299-0150. <http://www.asco.org>.

American Cancer Society, P.O. Box 102454, Atlanta, GA30368-2454. <http://www.ca.cancer.org>.

OTHER

Montgomery, Sue. Chemotherapy Delivered Directly to Liver Tumors Doubles Life Expectancy. University of Pennsylvania Cancer Center, April 13, 2001.

Linda K. Bennington, C.N.S., M.S.N.

KEY TERMS

CAT

—Computerized axial tomography, also called computed tomography.

Chemotherapy

—The treatment of illness by chemical means, by medications.

Liver function tests

—Laboratory procedures that measure some aspect of liver functions and involves a wide range of tests.

MRI

—Magnetic resonance imaging

cirrhosis

—A liver disease characterized by the loss of normal microscopic structures within the liver that are replaced by fibrous tissue that cause the organ to constrict and divide into irregular nodules.

Palliative

—Any treatment that offers relief but does not cure.

QUESTIONS TO ASK THE DOCTOR

• Am I a good candidate for this procedure?
• Do I have any contraindications that should be considered before having the procedure?
• Will I experience any improvement in my quality of life?
• What are the advantages and disadvantages of the procedure?
• Does the physician performing the procedure do this often or just once in awhile?