An estimated one million people in the U.S. are diagnosed with cancer each year. There are more than 100 known types of cancer, many of which can be treated and forced into submission with the right type of treatment. All cancers begin when normal cells within the body become damaged and grow out of control to form new, abnormal cells that often invade or impact other tissues. When normal cells are damaged, the cells either repair the damage or die off. However, cancer cells do not repair or die off; instead, several things can happen:
- The cancer cells multiply and form tumors that invade or impact nearby normal tissue.
- The cancer cells circulate through the bloodstream or lymph vessels to other parts of the body where they grow and form tumors that affect normal tissue. The spreading of cancer is referred to as metastasis.
Oncologists, hematologists, and other physicians treat cancer patients according to the type of cancer they have and the rate at which the cancers are growing. These physicians often refer patients to SIR for procedures that assist in the diagnosis and treatment of cancer and relieve complications from cancer.
Biopsies are performed at SIR to diagnose some cancers, provide additional information about an existing cancer, and evaluate the effectiveness of chemotherapy or other treatments. Biopsies are short medical procedures to collect a piece of tissue or sample of cells for further analysis.
Biopsies are frequently used to look for the following types of cancer:
- Lymph Node
Most biopsies use a needle to access the suspicious area. A CT-guided (or ultrasound-guided) biopsy is used to collect images that help determine the exact position of the needle in the targeted area. At SIR, all biopsies are performed with CT guidance and conscious sedation, making the biopsies safer, more accurate, and less painful for patients.
Bone Marrow Biopsy with Conscious Sedation
Bone marrow is the soft, spongy material located in the center of most large bones that plays a very important role in producing cells that are necessary for proper body function:
- Red blood cells that send oxygen and nutrients to other tissues
- White blood cells that fight infection and support the immune system
- Platelets that enable the blood to clot
A Bone Marrow Biopsy is performed to collect and examine marrow from inside bone for testing for infection, disease, or other problems including:
- Blood disorders, such an anemia (low red blood cell count)
- Blood cell conditions, such as leukopenia or polycythemia
- Blood or bone marrow cancers, such as leukemia or lymphoma
- Bone marrow diseases, such as myelofibrosis or myelodysplastic syndrome
- Infections, such as sepsis
Because some people feel a dull pain or discomfort during the biopsy, it is performed with conscious sedation by SIR’s board-certified anesthesiologists. Conscious sedation combines medicines (a sedative and an anesthetic) to help the patient relax and feel minimal pain and discomfort during the procedure. The patient is usually able to stay awake and respond to verbal cues but may not be able to speak. The patient’s heart rate, blood pressure, breathing, oxygen level and alertness are carefully monitoring during and after the biopsy. Conscious sedation is safe and effective and allows patients to recover quickly.
Selective Internal Radiation Therapy
Selective Internal Radiation Therapy (SIRT) is a form of radiologic treatment that delivers millions of tiny microscopic radioactive beads called SIR-Spheres (microspheres) directly to liver tumors. Qualifying patients are those with non-resectable (cannot be treated surgically) liver cancer, with the liver as the primary site or as a result of metastatic disease. The microspheres are small enough to flow through the hepatic arteries to deliver a radioactive element called yttrium-90. They become permanently lodged in the tumor bed where they deliver beta-radiation over the first two weeks following treatment. With this targeted application, SIRT can deliver up to 40 times more radiation to the liver tumor than conventional radiation.
SIRT involves a three-step process for each lobe of the liver that requires treatment:
- The first step is an outpatient procedure performed at SIR. This includes a comprehensive mesenteric angiogram for evaluation of the vascular supply to the lobe of the liver requiring treatment. This angiogram also searches for any anomalous vessels from the hepatic artery that may be on a course to any portion of the gastrointestinal tract. Any such anomalous vessels will be embolized with coils to prevent delivery of the microspheres to these non-targeted areas.
- The second procedure, also an outpatient procedure, is performed at nearby Lakewood Ranch Medical Center. The mesenteric angiogram is repeated, and a microcatheter is placed within the vessel at the site of the intended treatment to permit infusion of technetium 99m MAA particles for nuclear medicine lung and liver scanning. After the lung-liver shunt index is determined to be a value within a safe range, the planned dosage of microspheres is ordered.
- The third and final procedure involves the actual infusion of the microspheres directly into the branch of the hepatic artery that supplies blood to the liver lobes, segments, or sub-segments intended for treatment, while minimizing exposure to the remaining healthy tissue. The patient is kept overnight in the hospital in a private room and discharged the next day.
The patient continues to follow-up with imaging studies and office visits for evaluation of SIRT. Throughout the entire process, close collaboration is maintained with SIR’s registered nurse case manager, the patient’s primary care physician, radiation and surgical oncologists, and associated departments at Lakewood Ranch Medical Center.
SIR-Spheres were granted regulatory approval in the United States in 2002. The treatment of thousands of patients has now been accomplished in numerous research studies and centers of excellence around the world. Dr. Grubbs, SIR’s founder and leading interventional radiologist, is passionate about cutting-edge imaging technology and minimally invasive procedures with a special interest in selective internal radiation therapy. He has over 20 years of previous experience doing targeted therapy for liver cancers and has been performing SIRT effectively since 2008 with considerable success and positive patient outcomes.
Irreversible Electroporation (IRE) is a tissue ablation technique that involves the delivery of strong electrical impulses to undesirable tissue to cause the desired effect of irreversible damage and destruction to the unwanted cells. IRE is a minimally invasive alternative to thermal ablation as it does not rely on extreme heat or cold to destroy unwanted cells. It is appropriate for patients who have inoperable or difficult-to-reach tumors, including those located close to major blood vessels or other vital organs in the body. At this time, IRE is being used to treat liver cancer and also has been performed in the kidneys, lung, prostate, and pancreas.
A PICC (peripherally inserted central catheter) line is a means to administer medications or chemotherapy to cancer patients by providing intravenous access that can be used for an extended period of time. The PICC line is a long, thin hollow tube that is inserted above the elbow into the patient’s vein and channeled into a large vein in the chest. It stays in place until treatment has concluded.
A port is an implanted device placed under the skin to provide long-term intravenous access for chemotherapy and medications. It is made up of a small reservoir and a catheter that provides access to the larger veins.
Complications from Cancer
While not cures for cancer, minimally invasive interventional radiology procedures are proving to be valuable weapons in the fight against complications from cancers, including pain, bleeding, blood clots, obstruction of vital organs, and infections. At SIR, these procedures are performed to extend and dramatically improve quality of life for cancer patients.
Often the result of a tumor spreading into surrounding nerves and tissues, pain not only may affect quality of life and ability to function but also can lower tolerance for treatment.
Thermal ablation is a term that encompasses several new noninvasive procedures that promise major results for those with cancer. While thermal principles have been used successfully for nearly two decades to treat chronic nerve-related pain, recent developments have allowed doctors to apply these principles to create more and more cancer remission success stories.
Thermal ablation is becoming increasingly important to treat liver, lung, kidney and bone cancers because it targets cells and destroys them with minimal damage to nearby tissue. Thermal ablation is used to:
- provide a local treatment option for small tumor removal when surgery isn’t possible or is too risky
- shrink larger tumors to a size that makes it possible to remove them surgically
- shrink tumors to relieve debilitating pain and suffering associated with tumors that interfere with organs or press against nerves
Specific types of thermal ablation include Radiofrequency Ablation, Microwave Ablation, and Cryoablation.
Radiofrequency Ablation (RFA) uses high levels of heat for tissue ablation and relies on electrical conduction through the tissue. RFA provides large zones of ablation that can treat both primary and secondary tumors in a relatively short period of time.
Microwave Ablation involves the delivery of heat through a process known as dielectric hysteresis. It is gaining attention because it generates heat quickly, and microwave ablation research is ongoing to determine the types of tumors best suited for this type of ablation.
Cryoablation is the delivery of extreme cold to destroy tissue. It has proved effective is treating solid tumors in the lung, liver, breast, kidney and prostate.
During thermal ablation, a needle is inserted through the skin to the site of the tumor, and energy is then delivered to through the needle to kill the diseased cells. One of the great advantages of this type of localized treatment is that surrounding healthy tissue is left unharmed. This is in contrast to systemic treatments such as chemotherapy, which travel through the entire body and sometimes cannot be given in doses high enough to kill cancer cells because of intolerable or life-threatening side effects. While not a cure for cancer, thermal ablation can be combined with other treatment options, used before or after surgery or radiation, and used in addition to other treatments such as chemotherapy.
Other advantages of thermal ablation are:
- Can be done as an outpatient procedure, which means recoveries are quicker and hospital stays, when needed, are shorter
- Is less risky and has fewer complications than surgery
- Can usually be performed using a local anesthesia
- Allows patient to resume normal activities within a few days
- Can be repeated as needed
Celiac Ganglion Block and Superior Hypogastric Ganglion Block—Pain from cancer sometime results from the spread of the tumor into a network of nerves and blood vessels, particularly with cancer of the pancreas or stomach. Interventional radiology uses these procedures to treat this often-debilitating pain by inserting a catheter into the affected area and introducing an agent that destroys the affected nerves, thus providing pain relief.
Paracentesis/Thoracentesis—These procedures are performed to remove excess fluid that has accumulated in the body to improve comfort for cancer patients and, in some cases, to improve organ function.
- Paracenteses removes fluid from the abdominal cavity (peritoneal fluid), referred to as ascites. It is used for certain types of cancer, such as liver cancer.
- Thoracentesis removes fluid from the space between the lungs and the chest wall, called pleural effusion. It is used for lung cancer patients.
PleurX & Catheter Placement—This procedure involves placement of a catheter to drain fluids from the abdominal area (ascites) or the lungs (pleural effusion). It provides relief from the painful symptoms of fluid buildup and stays in place to allow patients to drain these fluids in the comfort of their own home. This procedure is often used in conjunction with paracentesis and thoracentesis.
Transcatheter Embolization—One of cancer’s most painful complications occurs when the disease spreads, or metastasizes, to bones. Using a minimally invasive technique called transcatheter embolization, the interventional radiologist injects tiny particles the size of grains of sand through a catheter into the artery that supplies blood to the tumor. These particles decrease the tumor’s blood supply, reducing pain and also reducing the likelihood of a bone fracture.
Transcatheter Embolization—When cancer spreads to blood vessels and causes hemorrhaging, minimally invasive transcatheter embolization has proven effective in controlling bleeding.
Blood clots are one of cancer’s most common side effects and can be life threatening if they travel to the brain, heart, or lungs. Interventional radiology offers treatments to reduce the risks posed by blood clots:
Intra-arterial thrombolysis—By guiding a catheter to the site of the clot and delivering a clot-busting drug, the interventional radiologist is able to break up the clot.
Filter placement—Used when a blood clot is detected in the leg, the interventional radiologist guides a small filter to the vessel that receives blood from the lower body and carries it to the heart. The filter traps the clot if it dislodges before it reaches the heart.
Organ Obstruction and Infection
Cancer can obstruct the normal flow of urine or bile, leading to buildups in the body that left untreated are not only painful but also can result in infection and lead to organ failure. Several procedures, using a catheter guided by x-ray, are performed at SIR to drain the fluid buildup. These procedures are:
- Percutaneous Transhepatic Drainage
- Necrotic Tumor Drainage