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What is Chemoembolization?
Chemoembolization is a procedure in which chemotherapy drugs and embolic agents are delivered directly to a tumor via a long, thin tube called a catheter. Tiny particles in the embolic agents block the blood vessels leading to the tumor, which deprives it of blood flow. Embolic agents also increase the concentration and toxicity of the chemotherapy drugs.
Chemoembolization kills cancer tumors but spares healthy tissue, minimizing the side effects of conventional chemotherapy, such as hair loss and nausea.
Currently, the procedure is mainly used to treat patients with primary liver cancer or other types of cancer that have spread to the liver.
Chemoembolization cannot cure cancer, but it can increase the length and quality of life. Chemoembolization is often used with other interventional cancer therapies, including radiofrequency ablation, cryoablation, chemical ablation, and some intravenous chemotherapies.
WHEN IS IT INDICATED?
Chemoembolization is indicated in patients who have liver cancer and are candidates for the procedure.
Chemoembolization may also be used to shrink liver tumors while the patient awaits a donor organ.
The physician will order tests to determine the location, type, and severity of the cancer. These tests may include:
Computed tomography (CT) scan;
Spiral CT scan;
Liver function tests; and
The night before the procedure, the patient is not usually allowed to eat. However, water is often allowed up to 2 hours before the procedure.
Patients may be given one or more of the following drugs the day of the procedure:
WHO IS ELIGIBLE?
Eligible patients have primary or secondary liver cancer.
Patients who have severe cirrhosis may be ineligible for chemoembolization.
The following conditions increase the risk of complications from the procedure:
A blockage in the portal vein in the liver;
Bile duct obstruction;
Poor liver function;
Poor kidney function;
Diabetes mellitus; and
A tumor that is greater than 50 percent of the liver volume.
If disease outside the liver (such as colon cancer) is the main source of symptoms, other treatments should be considered because chemoembolization only treats the liver.
WHAT TO EXPECT
The physician will locate the tumor using arteriography and choose an insertion point for the catheter, usually above the femoral artery in the groin.
Interventional procedures are generally painless. Because there are no nerve endings inside the arteries, people cannot feel the catheters as they move through their body.
Using an imaging technique called fluoroscopy, the physician steers the catheter through the arteries to the tumor, administers chemotherapy and embolic agents, and removes the catheter.
Once treatment is complete, pressure is applied on the insertion site for 15 to 30 minutes to prevent bleeding.
POST-TREATMENT GUIDELINES AND CARE
The patient's vital signs are monitored for the first 5 to 6 hours after the procedure. Initially, some patients may experience abdominal pain. Antibiotics and antinausea drugs are administered as needed.
Chemoembolization typically requires an overnight hospital stay.
Patients can usually resume normal activities within 1 week. Chemoembolization patients typically have lower energy levels for 2 to 3 weeks following the procedure.
Patients return for follow-up CT scan, MRI, or blood tests. A second treatment, if needed, is usually performed 1 to 2 months after the first.
In general, chemoembolization is safe and commonly associated with only minor side effects including:
These side effects are usually controlled with medication. Other minor complications include hair loss and bruising or bleeding at the insertion site.
Rarely, chemoembolization causes serious complications, such as:
Injury to the liver;
Allergic reaction to the contrast material used in arteriography;
Liver abscess; and
Hemorrhage, or bleeding.
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