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Interventional Oncology

When cells grow abnormally and develop the potential to invade or spread to other parts of the body, they are called “cancer”. There are many types of cancer, and different types are treated differently.

From diagnosing of tumor type to treating tumors directly, we Interventional Radiologists at HRA help medical and surgical oncologists at every stage.

Image Guided Biopsy

If a patient has a new or enlarging mass, we may need to obtain a sample to determine if it is cancer or not.

Using real-time image guidance (usually ultrasound and/or computed tomography), we can find the find the mass, use a tiny needle to numb overlying skin and soft tissues; then, we can advance a bigger needle into the mass and obtain pieces of the mass for pathologists to review.

The procedure usually has a mild to moderate risk of bleeding, infection, and damage to nearby organs. Depending on the location, most patients should refrain from eating and drinking for at least 6 hours prior to the procedure so that we may give them medications to help them relax (moderate sedation). We perform this procedure for both inpatients and outpatients. Usually, 1-3 hours after the procedure, inpatients can return to their room and outpatients also usually can return home.

Vascular Access

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Liver Directed Therapy

Some types of cancer can occur in the liver (such as hepatocellular carcinoma or cholangiocarcinoma). Other types of cancer can metastasize (move) to the liver.  We can perform certain procedures that help stop/slow the spread of the tumor and/or increase the size of the normal liver so that the tumor can be surgically removed.

Chemoembolization

One way to stop/slow tumors in the liver is to find the blood vessels that supply the tumor and block it off from the inside with plastic beads and medications. First, using ultrasound and x-ray guidance, a small needle is used to enter the artery of the leg or wrist. Then, small catheters and wires are used to find the arteries that supply the liver and tumor. Finally, chemotherapy and plastic beads are slowly injected to block blood flow to the tumor and cause it to die.

The procedure has a low risk of bleeding, infection, and damage to nearby organs. Patients should refrain from eating and drinking for at least 6 hours prior to the procedure so that we may give them medications to help them relax (moderate sedation). We typically perform for the procedure for outpatients, who will then remain in the hospital overnight.

Radioembolization

Just like chemoembolization, another way to stop/slow tumors in the liver is to find the blood vessels that supply the tumor and use them to deliver radioactive beads to the tumor. The procedure is done with x-ray and ultrasound guidance, in the manner detailed above. It is usually done in at least two stages.

In the first stage, the blood vessels supplying the tumor are mapped. A tiny test dose of radiation is administered to the treatment areas. Then, after the procedure, the patient is sent to nuclear medicine for additional imaging to see if the test radiation stayed in the tumor. Afterwards, the patient is sent home.

The patient then returns for the second stage. The treatment dose of radiation is given to the arteries supplying the tumor. After the procedure, the patient is kept in the hospital overnight and the following morning additional imaging ensures that the treatment dose stayed in the tumor.

The procedure has a low risk of bleeding, infection, and damage to nearby organs. Patients should refrain from eating and drinking for at least 6 hours prior to the procedure so that we may give them medications to help them relax (moderate sedation). We typically perform the procedure for outpatients as well.

Percutaneous Thermal Ablation

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Portal Vein Embolization

If the tumor has metastasized (moved) to only one part of the liver, surgeons may be able to remove the affected part of the liver if there will be enough normal liver left behind. If there is not be enough liver left behind, we can encourage the normal liver to grow by blocking a portion of the portal vein from the inside, diverting blood from the abnormal liver to the normal liver.

Under ultrasound and x-ray guidance, a needle is introduced through belly and liver into the portal vein. Catheters and wires are introduced into the portal vein. Portions of the vein are blocked from the inside with various agents such as plastic beads and coils or even glue. All wires and catheters are then removed.

The procedure has a mild to moderate risk of bleeding, infection, and damage to nearby organs. All patients should refrain from eating and drinking for 6 hours prior to the procedure and will undergo general anesthesia (i.e be put to sleep). Finally, all patients remain in the hospital overnight after their procedure.

Pain Management

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Percutaneous Ablation

Sometimes cancers of the liver, kidney, and/or bone can be treated surgically. Sometimes, these cancers cannot be surgically removed - due to size, location, or the patient’s health. In such situations, using ultrasound and/or computed tomographic guidance, needles can be advanced into the tumor. These needles can get very cold (cryoablation) or very hot (radiofrequency or microwave ablation) and thus freeze or cook the surrounding tumor. The needles are then removed.

Depending on tumor type, location, and size, the procedure has a mild to moderate risk of bleeding, infection, and damage to nearby organs. All patients should refrain from eating and drinking for 6 hours prior to the procedure and will undergo general anesthesia (i.e. be put to sleep). Finally, all patients remain in the hospital overnight after their procedure.

PleurX Catheter Placement

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