Interventional Oncology

What types of symptoms will warrant a biopsy?

Common symptoms that will warrant a biopsy include consistent liver tests that are abnormal; yellowing of the skin, any abnormalities detected from an ultrasound or CT scan, and an enlargement of the liver.

Are there any complications with a liver biopsy?

In most cases, there are no complications, but in some instances there may be some internal bleeding.

Pancreas

A biopsy is done on the pancreas to determine whether or not pancreatic cancer exists. There are a few ways to do this:

• Percutaneous biopsy

The doctor will perform a fine needle aspiration (FNA), where a thin, hollow needle is inserted through the skin using imaged from an ultrasound or CT scan. The insertion will go over the abdomen and into the pancreas. A small piece of the tumor is removed.

• Endoscopic biopsy

You will be sedated. A small, flexible tube with a small video camera on the end is inserted down the throat and into the small intestine near the pancreas. This is called an endoscope. The images are then used to pass a needle into the tumor to remove cells from the pancreatic ducts or bile.

• Surgical biopsy

This is a keyhole surgery, or laparoscopy. You will be sedated or asleep during the procedure. Several small incisions are made in the abdomen. Long, thin instruments are inserted. A video camera is on the end of one to show images of the abnormal areas. Samples are taken of these areas.

There are little, to no complications with a pancreatic biopsy, but if the needle misses its target, this could lead to a noncancerous diagnosis, even when cancer cells are present.

Abdominal

This type of biopsy is performed to determine whether or not a lump in the abdomen is cancerous, whether ulcers are present, or other stomach complications. It is also called a gastric tissue biopsy.

Symptoms that warrant an abdominal biopsy

• Nausea
• Vomiting
• Pain in the upper stomach
• Unexplained weight loss
• Black stools
• Loss of appetite

Are there complications with an abdominal biopsy?

There are not really any complications, but there are a few risks in getting the procedure done. These include: bleeding from where the tissue was collected, perforation in the stomach or esophagus, reaction to anesthesia (slow heartbeat, difficulty breathing, excessive sweating, low blood pressure).

You must not eat or drink until your gag reflex returns. Your throat may also feel sore, and you may have bloating or some gas.

Lymph node

There are three ways to perform a biopsy on the lymph nodes:

• Needle biopsy

This is a short procedure that takes about 15 minutes. The site is cleaned and numbing medication is applied to the area. A fine needle is inserted into the lymph node and a sample is removed.

• Open biopsy

This procedure takes up to 45 minutes. A small cut is made to remove the lymph node. The area is stitched and a bandage applied. Mild pain may occur for a few days after this procedure. It should heal in about 14 days.

• Sentinel biopsy

This is usually for those patients who have been diagnosed with cancer. A blue dye is injected near the cancer site, which travels to the closest lymph node. The lymph node is removed and checked for cancerous cells.

Thyroid

This procedure is done using an ultrasound-guided fine needle aspiration. The neck is cleaned and numbed with medication. The ultrasound transducer will be placed on your neck over the thyroid nodule. The need is then inserted through the skin using direct imaging guidance. A sample is taken and the needle is removed.

Are there any complications with this procedure?

Complications of this procedure include bleeding at the site of the procedure, infection, and injury to other areas adjacent to the thyroid gland.

Bone

This type of biopsy is done to confirm the determination of a bone disorder, distinguish between different bone masses, examine the cause of ongoing bone pain, dig deeper to see why a bone infection exists, or investigate bone issues seen through an X-ray.

During this procedure, a small bone sample is removed from the body. There are two ways to accomplish this:

• Closed or needle biopsy

A needle is inserted through the skin and directly into the bone. The patient will have numbing medication at the site, or will be given a sedative through an IV.

• Open biopsy

An incision is made through the skin to expose an area of the bone. General anesthesia or a nerve block is given to the patient during this procedure.

There are not many risks involved, but there are the chances of:

• The biopsy needle breaking, injuring a nerve, organ or blood vessel near the site.

• Skin infection
• Excessive bleeding

Kidney

This is also called a renal biopsy. This procedure extracts kidney tissue for analysis to determine if you have kidney disease, what type, how far along it is, and what is needed for treatment. There are two different ways to perform this type of biopsy:

• Percutaneous biopsy

This is also called a renal needle biopsy. The doctor inserts a thin needle through the skin, removing the kidney tissue. An ultrasound or CT scan may be used to properly direct the need to the area of concern.

• Open biopsy

This is also called a surgical biopsy. The doctor will make an incision near the kidneys to take a closer look and determine where the samples should be extracted from.

Complications that would warrant a biopsy

• Indications of an abnormal level of waste products in the blood
• To see how well a kidney transplant is working
• To create a viable treatment plan
• Investigate blood in the urine

What is Chemoembolization?

Chemoembolization is a procedure that uses chemotherapy drugs to attack cancer in two different ways. It directly treats tumors in the liver while minimizing exposure and effects on the surrounding healthy tissue and other areas of the body. This treatment can be used alone, or in combination with chemotherapy, radiation therapy, surgery, or radiofrequency ablation.

What occurs during Chemoembolization?

The procedure is performed with x-ray equipment, a catheter, and embolic agents, in addition to a standard IV line, ultrasound machine and devices to monitor your heart and blood pressure.

Initially, small skin incision is made at the site of entry. Then, a small catheter is placed into the femoral artery that supplies blood to the liver through a blood vessel in your groin. Then, high doses of chemotherapy and synthetic materials are delivered to the blood vessel feeding the cancerous tumor. This cuts off the tumor’s blood supply, keeping the chemotherapy present without exposing the entire body to other effects of the drugs. This works to slow or deter tumor growth, with the possibility of eventual shrinkage.

An interventional radiologist usually performs this procedure, with X-ray images being taken to map the exact path of the blood vessels that are feeding the tumor. Patients are often given Allopurinol, or another substance to assist in protecting the kidneys from the chemotherapy.

X-rays will be taken during the procedure to make sure the tumor has been treated. Once the procedure is finished, the catheter is removed and the opening in the skin is covered with bandages. This procedure is usually completed in about 90 minutes, but recovery is between four and six hours.

CT scans or MRI should be performed every three months after the initial procedure to determine the state of the treated tumors, and monitor whether or not any new tumors form. A second treatment may be necessary within 10 and 14 months if a new tumor is present.

What kind of liver cancers can be treated by chemoembolization?

The following liver cancers can benefit from this treatment:

· Metastasis

· Hepatoma

· Colon cancer

· Sarcomas

· Ocular melanoma

· Carcinoid

What side effects may occur during Chemoembolization?

Side effects may include liver infection, gallbladder inflammation, abdominal pain, fever, and blood clots in main blood vessels of the liver.

Who is a good candidate for RFA?

Good candidates for this procedure include:

· Those who have additional medical conditions that will compromise your safety during surgery.

· Those who have tumors that are difficult to reach.

· Those who would not have enough liver tissue left for ordinary functions following the surgery.

· Those who have liver tumors that are not responding to chemotherapy.

· Those who have liver tumors that have recurred after being surgically removed.

· Those who have several small tumors that are too spread out to be surgically removed.

How do you know if you are a candidate?

The process is different for everyone, but several tests are performed, including liver function blood tests, an MRI and CAT scan of your liver to determine whether or not this procedure is the best one for you. Certain complications like cirrhosis of the liver, blockages in the bile ducts, and any blockages of the portal vein could prevent being able to have this procedure.

There are some instances where chemoembolization is performed in small amounts and over several different procedures to minimize the effect on the liver.

What is Radiofrequency Ablation (RFA)?

Radiofrequency ablation is a minimally-invasive therapeutic treatment using high-frequency electrical currents to destroy cancer cells without removing them. This procedure is recommended for those patients that may have issues with surgery, or their tumors are less than one-and-a-half inches in diameter. This is also used in patients who are waiting for a liver transplant.

What occurs during Radiofrequency Ablation?

Radiofrequency ablation is performed using one of three methods:

· Percutaneous, where needle electrodes are inserted through the skin into the site of the tumor (MOST USED).

· Surgery.

· Laparoscopic, where needle electrodes within a thin, plastic tube is threaded through a small hole in the skin.

High-energy radio waves are used in this treatment. Imaging techniques are used to insert a needle-like electrode probe into the tumor. A high-frequency current is passed through the tip of the probe to heat and destroy the cancerous cells. The heat from the radio frequency will also close any small blood vessels to lessen the risk of bleeding. Any dead tumor cells are usually replaced with scar tissue that will shrink over a period of time.

Large tumors may have multiple ablations. This occurs by repositioning the needle electrode into different areas of the tumor to ensure the entire area is treated.

Once the procedure is completed, the needle electrode is removed and the skin is covered with bandages. This procedure usually takes about 10 to 30 minutes, with additional time needed if multiple ablations take place. Recovery is one to three hours.

Common uses for Radiofrequency Ablation

This is used to treat different types of liver cancer, but the most common types are:

· Colon cancer that metastasizes from the colon to the liver

· Hepatocellular carcinoma

How do I prepare for Radiofrequency Ablation?

The first step in preparing for the RFA procedure is to mention any medications you are currently taking, whether they are prescribed or unprescribed. You may be advised to stop taking anything for a specific period of time prior to the procedure.

Your blood should be tested to determine whether or not your kidneys are functioning properly, and if your blood has any problems clotting.

What are the side effects of RFA?

In every procedure, there are possible side effects. These include abdominal pain, bleeding in the chest cavity or abdomen, and infection in the liver.

You will receive the recommendation that will best meet your situation once a complete diagnosis and check up is completed.