Chemoembolization

What Is Chemoembolization, When Is It Indicated And Who Is Eligible?

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 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 side effects of conventional chemotherapy, such as hair loss and nausea. Chemoembolization cannot cure cancer, but it can increase the length of life. Chemoembolization is often used with other interventional cancer therapies, including radiofrequency ablation, cryoablation, chemical ablation and some intravenous chemotherapies.

Chemoembolization is indicated in patients who have liver cancer and are candidates for the procedure. Chemoembolization also may be used to shrink liver tumors while the patient waits for an organ donor. A liver biopsy helps determine the type and severity of 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
• 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.

Before The Procedure

The physician will order tests to determine the location, type and severity of the cancer. These tests may include:

• Biopsy
• Blood tests
• Computed Tomography (CT) scan
• Spiral CT scan
• MRI
• Liver function tests
• Arteriography
• Do not eat 8 hours before and drink 4 hours before your procedure is scheduled. You may take medications with a sip of water.

Patients may be given one or more of the following drugs the day of the procedure:

• Antibiotics
• Anti-nausea drugs
• Painkillers
• Sedatives
• Intravenous fluids

During The Procedure

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 10-15 minutes to prevent bleeding.

After The Procedure

Vital signs are monitored for the first 5 to 6 hours after the procedure. Initially, some patients may experience abdominal pain. Antibiotics and anti-nausea drugs are administered as needed.

Chemoembolization typically requires a hospital stay of 1 to 2 days. Resume home medications immediately, unless otherwise directed. Limit your physical activity as directed by the radiologist. Do not lift more than 10 pounds for 1 week following your procedure. Watch your puncture site (groin) for bleeding or swelling. You may remove your dressings/bandages after 24 hours. You may shower after 24 hours, but do not soak the site for 48 hours. Chemoembolization patients typically have lower energy levels for 2 to 3 weeks following the procedure.

Patients return for a follow-up CT scan, MRI or blood tests. A second treatment, if needed, is usually performed 1 to 2 months after the first.

Possible Complications

In general, chemoembolization is safe and commonly associated with only minor side effects, including low-grade fever, nausea, or pain. 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 or hemorrhage or bleeding.

When To Call Your Doctor

Contact your provider if you have a temperature greater than 101 degrees or chills; if there is redness, swelling, bleeding, or drainage at the puncture site(s); you have unrelieved or increasing pain; or if you have shortness of breath or difficulty breathing.