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Hematology and Oncology > EXAM #2: INTERVENTIONAL RADIOLOGY > Flashcards

EXAM #2: INTERVENTIONAL RADIOLOGY Flashcards

1
Q

What is radiofrequency ablation?

A

Sound waves to increase heat and kill tumors

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2
Q

What is microwave ablation?

A

Use of microwaves to kill tumors

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3
Q

What is cryoablation?

A

Freezing of tumors to kill them

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4
Q

What is the most likely diagnosis for a 70 year-old with a renal mass?

A

Renal cell carcinoma

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5
Q

What do you need to do after identifying a renal mass on CT?

A

Biopsy

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6
Q

Describe how cryoablation works.

A
  • 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
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7
Q

What are the advantages of cyroablation?

A

Ability to monitor ablation zone (vs. thermal ablation)

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8
Q

What are the disadvantages of cryoablation?

A

Cryoshock

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9
Q

What is cryoshock?

A

Systemic inflammatory response leading to:

  • Hyotension
  • Respiratory compromise,
  • DIC
  • Mutliorgan failure
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10
Q

What is the Jules Thompson principle?

A

Use of Helium and Argon to cause freezing

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11
Q

What is the most common type of renal cell carcinoma (RCC)?

A

Clear cell variant (83-88%)

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12
Q

How common is renal cell carcinoma overall (RCC)?

A

Only seen in 2% of all adult cancers

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13
Q

When is RCC typically discovered?

A

Incidentally during imaging for other indications

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14
Q

What is stage 1A RCC?

A

Tumor less than 4cm confined to kidney

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15
Q

What is the treatment of choice for stage 1A RCC?

A

Laproscopic partial nephrectomy

Note that this is shifting to cryoablation

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16
Q

What is the secondary treatment of choice for 1A RCC in poor surgical candidates?

A

CT or US guided cryoablation

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17
Q

What are the advantages of cryoablation?

A

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

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18
Q

What is a hepatoma?

A

Malignant tumor that is derived from hepatocytes

Also called hepatocellular carcinoma

19
Q

What patient population is highly susceptible to develop a hepatoma?

A

Alcoholics/ cirrhosis

20
Q

What is unique about a hepatoma from a diagnostic standpoint?

A

Doesn’t require biopsy, can be diagnosed with imaging only

21
Q

What does ECOG stand for? What is an ECOG score?

A

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
22
Q

What is the treatment of choice for hepatoma?

A

Local regional therapy

23
Q

What are the risk factors for hepatocellular carcinoma i.e. hepatoma?

A

1) Hepatitis (B or C)
2) Alcoholic liver disease/ non-alcoholic fatty liver disease (NAFLD)
3) Metabolic Syndrome
4) Aflatoxin exposure

24
Q

Where is HBV most common?

A

SE Asia

25
Q

Where is HBC most common?

A

US

26
Q

What is the prognosis for HCC without treatment?

A

Less than 10% 5-year survival rate

27
Q

What are the local regional therapies available for HCC treatment?

A

1) Radio-frequency
2) Microwave
3) Transarterial therapy- chemoembolization
4) Radioembolization
5) Drug eluting bead embolization

28
Q

What is Transarterial Chemoembolization (TACE)?

A

Delivery of concentrated chemotherapy in lipid medium combined with arterial embolization

29
Q

Describe the “dual blood supply” of the liver.

A

1) Portal venous blood supply –major

2) Hepatic arterial supply –minor

30
Q

How is the dual blood supply manipulated in TACE of a HCC?

A

Nearly all HCCs derive vascular supply from the the hepatic artery

31
Q

When is TACE indicated for HCC?

A

Patients that aren’t candidates for

  • Transplant
  • Resection
  • Local ablation i.e. tumors greater than 3 cm
32
Q

What are the side effects of TACE?

A

Postembolization Syndrome

33
Q

What is postembolization syndrome?

A
  • Nausea and vomiting
  • Abdominal pain
  • Fever
  • Anorexia
  • Fatigue

All seen secondary to embolization; thought to be secondary to immune response to ablation.

34
Q

What is Drug-Eluting Bead Embolization?

A

Small beads loaded with chemotheraputic drug for delivery to HCC via the hepatic artery

35
Q

What drug is most commonly used in Drug Eluting Bead Embolization?

A

Doxorubicin

36
Q

What molecules are being agitated in radio-frequency and microwave ablation respectively?

A 
Radiofrequency= ionic 
Microwave= water
37
Q

For HCC less than 3cm, what is the preferred treatment?

A

Radiofrequency or microwave ablation

38
Q

What size of an ablative zone must be achieved with a HCC of 3cm?

A

4-5cm i.e. you want a normal margin or negative margin of at least 10mm

39
Q

What is radioembolization?

A

Use of intra-arterially delivered microspheres emitting high dose radation

40
Q

What is radioembolization or Y90 utilized for?

A
  • Unresectable liver tumors
  • Metastatic colorectal tumors
  • Neuroendocrine tumors
41
Q

Why is radioembolization a good option for unresectable liver tumors?

A

Microspheres emitting radiation preferentially lodge in noevasculature of the tumor

42
Q

What is the advantage of radioembolization over TACE?

A

Can be performed on HCC with portal vein invasion, which in a contraindication for TACE

43
Q

What is a malignant pleural effusion? What is the prognosis?

A

This is a pleural effusion related to a malignancy

  • Lung
  • Breast
  • Ovarian

Prognosis is 4 months

44
Q

What is the IR procedure for a malignant pleural effusion?

A

Tunneled Pleural Catheter

Hematology and Oncology (38 decks)

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