EXAM #2: INTERVENTIONAL RADIOLOGY Flashcards
What is radiofrequency ablation?
Sound waves to increase heat and kill tumors
What is microwave ablation?
Use of microwaves to kill tumors
What is cryoablation?
Freezing of tumors to kill them
What is the most likely diagnosis for a 70 year-old with a renal mass?
Renal cell carcinoma
What do you need to do after identifying a renal mass on CT?
Biopsy
Describe how cryoablation works.
- Delivery of cold to the tumor
- Formation of intracellular ice and osmotic COAGULATIVE necrosis
1) Freeze= cell shrink/ dehydration w/ pore formation
2) Thaw= rush of water back into cell via pores–>cells burst
3) Delayed= immune response (macrophages) to damaged tissue
What are the advantages of cyroablation?
Ability to monitor ablation zone (vs. thermal ablation)
What are the disadvantages of cryoablation?
Cryoshock
What is cryoshock?
Systemic inflammatory response leading to:
- Hyotension
- Respiratory compromise,
- DIC
- Mutliorgan failure
What is the Jules Thompson principle?
Use of Helium and Argon to cause freezing
What is the most common type of renal cell carcinoma (RCC)?
Clear cell variant (83-88%)
How common is renal cell carcinoma overall (RCC)?
Only seen in 2% of all adult cancers
When is RCC typically discovered?
Incidentally during imaging for other indications
What is stage 1A RCC?
Tumor less than 4cm confined to kidney
What is the treatment of choice for stage 1A RCC?
Laproscopic partial nephrectomy
Note that this is shifting to cryoablation
What is the secondary treatment of choice for 1A RCC in poor surgical candidates?
CT or US guided cryoablation
What are the advantages of cryoablation?
1) Outpatient procedure
2) Doesn’t require general anesthesia
3) Preserves renal function/ nephron sparing
4) Few complications
5) Can be repeated for residual tumor
What is a hepatoma?
Malignant tumor that is derived from hepatocytes
Also called hepatocellular carcinoma
What patient population is highly susceptible to develop a hepatoma?
Alcoholics/ cirrhosis
What is unique about a hepatoma from a diagnostic standpoint?
Doesn’t require biopsy, can be diagnosed with imaging only
What does ECOG stand for? What is an ECOG score?
Eastern Cooperative Oncology Group
- This is a score of how well a patient functions
- 0 is the highest i.e. normal, 5 is dead
- Only intervene in patients with a score of 0,1, or 2
What is the treatment of choice for hepatoma?
Local regional therapy
What are the risk factors for hepatocellular carcinoma i.e. hepatoma?
1) Hepatitis (B or C)
2) Alcoholic liver disease/ non-alcoholic fatty liver disease (NAFLD)
3) Metabolic Syndrome
4) Aflatoxin exposure
Where is HBV most common?
SE Asia
Where is HBC most common?
US
What is the prognosis for HCC without treatment?
Less than 10% 5-year survival rate
What are the local regional therapies available for HCC treatment?
1) Radio-frequency
2) Microwave
3) Transarterial therapy- chemoembolization
4) Radioembolization
5) Drug eluting bead embolization
What is Transarterial Chemoembolization (TACE)?
Delivery of concentrated chemotherapy in lipid medium combined with arterial embolization
Describe the “dual blood supply” of the liver.
1) Portal venous blood supply –major
2) Hepatic arterial supply –minor
How is the dual blood supply manipulated in TACE of a HCC?
Nearly all HCCs derive vascular supply from the the hepatic artery
When is TACE indicated for HCC?
Patients that aren’t candidates for
- Transplant
- Resection
- Local ablation i.e. tumors greater than 3 cm
What are the side effects of TACE?
Postembolization Syndrome
What is postembolization syndrome?
- Nausea and vomiting
- Abdominal pain
- Fever
- Anorexia
- Fatigue
All seen secondary to embolization; thought to be secondary to immune response to ablation.
What is Drug-Eluting Bead Embolization?
Small beads loaded with chemotheraputic drug for delivery to HCC via the hepatic artery
What drug is most commonly used in Drug Eluting Bead Embolization?
Doxorubicin
What molecules are being agitated in radio-frequency and microwave ablation respectively?
Radiofrequency= ionic Microwave= water
For HCC less than 3cm, what is the preferred treatment?
Radiofrequency or microwave ablation
What size of an ablative zone must be achieved with a HCC of 3cm?
4-5cm i.e. you want a normal margin or negative margin of at least 10mm
What is radioembolization?
Use of intra-arterially delivered microspheres emitting high dose radation
What is radioembolization or Y90 utilized for?
- Unresectable liver tumors
- Metastatic colorectal tumors
- Neuroendocrine tumors
Why is radioembolization a good option for unresectable liver tumors?
Microspheres emitting radiation preferentially lodge in noevasculature of the tumor
What is the advantage of radioembolization over TACE?
Can be performed on HCC with portal vein invasion, which in a contraindication for TACE
What is a malignant pleural effusion? What is the prognosis?
This is a pleural effusion related to a malignancy
- Lung
- Breast
- Ovarian
Prognosis is 4 months
What is the IR procedure for a malignant pleural effusion?
Tunneled Pleural Catheter
