Chemoembolization

HOW SHOULD I PREPARE FOR THE PROCEDURE?

You will receive instructions from staff at the interventional radiologist's office at least a day before the procedure. You may have blood drawn for pre-procedure testing at either the hospital or clinic. Staff will advise you if changes in your regular medication schedule are necessary. Make sure you let the staff know if you have any allergies to medication. You will be asked to not eat or drink anything after midnight on the night before your procedure. If you are on any blood thinning medication such as Coumadin, you should check with the staff about it and when you should stop the medication. Make sure someone will be available to drive you home afterwards.

HOW DOES THE PROCEDURE WORK?

The liver is unique because it has two blood supplies, the hepatic artery and the portal vein. The normal liver receives about 75 percent of its blood supply through the portal vein and only 25 percent through the hepatic artery. When a tumor grows in the liver, it receives almost all of its blood supply from the hepatic artery. Chemotherapy drugs injected into the hepatic artery reach the tumor directly, without harming the healthy liver tissue. Then, when the artery is blocked, the blood is no longer supplied to the tumor, while the liver continues to be supplied by blood from the portal vein.

Once the blood supply is cut off by embolization and the chemotherapy begins its work, the tissue begins to break down and, in successful cases, the tumor dies.

HOW IS THE PROCEDURE PERFORMED?

A sedative will be injected through an IV to relax you. The interventional radiologist will numb the groin area with a local anesthetic. A thin catheter is guided through a small incision into the artery, and guided by TV monitoring into the arteries that feed the liver. Contrast material is then injected and the catheter is guided into the branches feeding the tumor and the chemoembolic material is injected.

At the end of the procedure, the interventional radiologist removes the catheter and pressure will be applied to the groin area. You can expect to stay in bed for approximately six hours afterward.

WHAT WILL I EXPERIENCE DURING THE PROCEDURE?

The sedative you are given will make you feel relaxed during the procedure, but you will most likely remain awake throughout. You may feel slight pressure when the catheter is inserted but no serious discomfort. Most patients experience some side effects after chemoembolization., consisting of pain, nausea, vomiting and fever. Pain is the most common side effect and occurs because the blood supply to the treated area is cut off. It can be controlled by oral pain medication. Most patients leave the hospital within 24 to 48 hours of the procedure.

Fevers may occur normally for up to a week after the procedure. Fatigue and loss of appetite are common for up to two weeks. These are all normal symptoms. If your pain suddenly changes in degree or character, or if your fever becomes suddenly higher then it had been, it is important to let your physician know right away. Most patients can resume their normal activities within a week.

You will return for a CT scan or MRI and blood test to determine the size of the treated tumor and how well the chemoembolization worked. CT scans or MRI will be performed in follow up to determine how much the tumors ultimately shrink, and to see if and when any new tumors arise. Chemoembolization can be treated many times over the course of many years, as long as it remains technically possible and you continue to be healthy enough to tolerate repeat procedures.