In the last few years, there has been a steady rise in the number of Americans diagnosed with liver cancer. According to the CDC, about 24,500 men and 10,000 women are diagnosed with liver cancer every year.
Though tumor resection surgery and liver transplant are effective treatments for liver cancer, they might not be an option for many patients. Fortunately, with recent developments in cancer research, we now have access to several other treatments like cryotherapy, ablation, and chemoembolization.
If you’re diagnosed with liver cancer, it’s essential to do extensive research and talk to your doctor about the benefits, possible risks, and side effects of different treatment options. Here, you’ll find everything you need to know about chemoembolization and how it can help with liver cancer treatment.
Chemoembolization is a minimally invasive medical procedure performed by an interventional radiologist to treat liver cancer. It is an ideal alternative option for liver cancer patients who have inoperable tumors.
The treatment involves the delivery of high concentration chemotherapy and a blocking agent, called emboli, directly to the liver tumor through your blood vessels. The embolus cuts off oxygen supply and nutrients to the tumor, making it more susceptible to chemotherapy.
It is important to note that chemoembolization is a palliative treatment and not a cure. It may provide relief from symptoms and improve the quality of life of patients and their families. When combined with other treatment options like surgery or radiation therapy, the procedure can be extremely effective in treating primary and metastasis (cancer spread to the liver from other organs) liver cancer.
Your physician will recommend several tests, including liver function blood tests, CAT scan, and an MRI of your liver to ensure chemoembolization is the right option for you. The doctor might advise against the procedure if the results show that you have
● Liver Cirrhosis
● Blockage of the Portal Vein
● Blockage of Bile Ducts
Please note that chemoembolization only works against liver tumors. It will have little or no effect on other cancers in the body.
Before the Procedure
Before the procedure, your doctor will test your blood to check your kidney function and determine if your blood clots normally. You will also have an office consultation with the interventional radiologist who will be performing your procedure.
Get all your doubts and questions about the treatment cleared before the day of the procedure. Let your doctors know about all the medications and herbal supplements you take. You might be advised against taking blood thinners like Aspirin, Coumadin, or Plavix in the days leading up to the procedure. Also, don’t forget to tell your doctor about any allergies you may have, especially to local anesthesia, general anesthesia, or contrast materials. Patients should always inform their medical team if they are pregnant, as several tests can be unsafe for the fetus.
Your surgeon will provide you with specific instructions on the precautions you need to take before the chemoembolization process.
● You will find out about any changes you need to make to your regular medications.
● You will have to avoid eating or drinking anything for eight hours before your treatment.
● You will not be allowed to drive after the procedure. So, at least have one family member or friend accompany you to and from the hospital
● Be prepared to stay overnight at the hospital for a day or two.
During the Procedure
As an image-guided, minimally invasive medical procedure, chemoembolization is usually performed by experienced interventional radiologists in an interventional radiology suite.
The chemoembolization procedure lasts around 90 minutes. The surgeon will first make a tiny incision at the site. Then, using X-ray guidance, they will insert a thin catheter through the groin into the artery that supplies blood to the liver tumor. Once the catheter is in place, the chemotherapy drugs, and embolic agents are mixed and injected.
The doctor will numb the area of the incision. You might feel slight pressure when they insert the catheter, but you will not be under severe discomfort. You will also be given Allopurinol to help protect the kidneys from the chemotherapy and the byproducts produced by the dying tumor cells.
After the procedure is complete, the doctor will remove the catheter and apply pressure to stop the bleeding. They might use a closure device to seal the small hole in the artery, allowing you to move around quickly. Depending on which artery was accessed and whether a closure device was used, your stay in the recovery room can vary between two to six hours.
How It Works
A normal liver receives 75% of its blood supply through the portal vein and only 25% through the hepatic artery. But, a liver tumor receives almost all its blood from the hepatic artery. This is why during chemoembolization, high concentration chemotherapy is injected straight into the tumor through the hepatic artery—without exposing the rest of the body to its effects. Following this, the embolus stops blood circulation to the cancerous cells while the rest of the liver continues to get blood from the portal vein.
This allows the procedure to attack the tumor at two levels. By cutting off blood supply to the affected cells, you are not only depriving the tumor of the oxygen and nutrients it needs to grow, but you are also permitting a higher concentration of anti-cancer drugs to be in contact with the tumor for a long time. This two-pronged approach can help slow or stop tumor growth, and in some cases, even cause significant shrinkage of the tumor.
After the Procedure
If all goes well, you should be able to return to normal activities within a week after chemoembolization. After the treatment, you should get CT scans and blood tests done every three months to determine the size and status of the treated tumor. This will also allow your physician to keep track of your recovery process.
If there is a tumor in both the right hepatic lobe and left hepatic lobe of the liver, your physician might administer the procedure in stages. Only one lobe is treated in the first session, followed by the second lobe a month later.
It usually takes 10 to 14 months before you would need a second round of chemoembolization to treat a new tumor growth. This procedure can be repeated multiple times over several years, as long as your body is healthy enough to withstand repeat procedures.
After the procedure, most patients experience post-embolization syndrome, which includes fever, pain, and nausea. These symptoms might last between 2 days to a week and can be easily treated with medications.
Side effects are usually milder than chemotherapy because the medications are trapped at the tumor site away from the rest of the body. But, you might still experience fatigue, loss of appetite, and hair loss for two or more weeks. Other complications like infections, bleeding, and liver abscess are extremely rare.
When you’re cleared to go home, your doctor will prescribe oral antibiotics to help you manage pain and nausea. You might also need an incentive spirometer to help inflate your lungs and avoid pneumonia. Your nurse will be able to instruct you on how to use it.
If your body temperature suddenly spikes, your pain gets more intense, or you notice any other unusual changes post chemoembolization, you should contact your physician immediately.
● It causes live tumors to shrink or even stop growing entirely. The results last for about 10–14 months.
● If the tumor starts growing again, chemoembolization can be performed again as long as you don’t have any health complications that can interfere with the procedure.
● Growing tumors can impede liver function and is the primary cause of liver cancer deaths. By stunting tumor growth, chemoembolization not only preserves liver function but also helps patients improve their quality of life.
Chemoembolization is a treatment, not a cure. Depending on the type of liver cancer, it can improve survival rates and quality of life. It is also not an ideal treatment option for people with severe liver or kidney dysfunction, abnormal blood clotting, or prior surgery or blockage of the bile duct. In some cases of liver dysfunction, chemoembolization is done in several small procedures to try and minimize the damage caused to the rest of the liver.
If you have liver cancer and standard treatment options are not suitable for you, don’t give up hope. Schedule a consultation with the specialists at Georgia Vascular Institute and discover other avenues of treatment. Our team of interventional radiologists and vascular surgeons use minimally invasive techniques like chemoembolization to treat liver cancer and improve your quality of life.
We have various locations across the Metro Atlanta area, including Stockbridge, Camp Creek, and Lithonia. Call us at (770) 506-4007 or contact us today to find out if you are a candidate for chemoembolization.