Interventional Oncology Flashcards
What is cryoablation?
GIving cold stuff to tumor to stimulate intravascular ice formation.
Adv - can see on CT and monitor
Disadv - cryoshock - systemic reaction leading to hypotension, DIC, resp compromise and multiorgan failure
Cells burst on thawing, water rushes into cell and bursts.
fewer complications than partial nephrectomy,
Outpatient procedure, preserve renal function
Tell me about Renal Cell Carcinoma
related to smoking and obesity
Clear cell variant
What are the stages of Renal cell carcinoma?
Stage 1A - Good. tumor less than 4 cm in diameter in kidney. Tx: laparascopic partial nephrectomy, also can do cryoablation. Chance is low that it will progress to a really bad ca.
Hepatocellular Carcinoma
Is able to be diagnosed on imaging. Takes up dye a ton and shortly after gets rid of that dye faster than the rest of the liver.
RF - Hep B is biggest, HCV (we have good drug for hep c), Cirrhosis, Non alcoholic fatty liver disease, alcoholic liver dz, aflatoxin, Genetic dz (wilson, hemachrom)
5 yr survivial
Hepatitis B
DNa virus, incorporates into genome and develops HCC without cirrhosis,
Common in asian countries
Hep C - pnts have cirrhosis
Hep C
Pnts have cirrhosis first then Hep C usually,
Alcoholic Liver dz
Do not need cirrhosis to develop HCC, but the effects are synergistic with HCV and HBV - so if you have these and you drink = BAD.
Non Alcoholic Fatty Liver Disease
Associated with DM, Obesity and metabolic syndrome
HCC risk 5x greater in men with BMI >35
HCC incidence doubled in DM
What is the ideal therapy for HCC?
Liver transplant –70-80% 5 yr survival. Must meet Milan criteria ( 1 tumor less than 5cm, or 3 tumors less than or equal to 3 cm each)
Surgical resection ok - only in non cirrhotic livers, 50-60% 5 yr survival, temporary cure many times where tumors will regrow in bad liver, better for single tumors.
Local Regional Therapy - ok. mainstay for HCC tx bc of small percentage of sx candidates,
- transarterial chemoembolization - deliver high concentrated chemo injected into arterial vessels, induces death, takes advantage of livers dual blood supply, survival 24 mo. tumors almost exclusively have supply from Hepatic artery. Inpatient.
Expect Postembolization syndrome - effects from chemo.
- Drug eluting Bead emboliztion, loaded with doxorubicin, survival same as TACE, Ironotecan for colon mass,
- radiofrequency/microwave ablation - deliver current to irritate tumor and cause cell death. can ablate more tissue with microwave. IDEAL THERAPY FOR SINGLE TUMORS LESS THAN 3CM
- Radioembolization - high dose radiation beads into artery, good for liver and colorectal mets, lodge in microvessels. Yttrium 90, outpatient, if has Portal Vein invasion - this has survival advantage over TACE, put coils in arteries to block beads from flowing there, IE the ones leading to the gut, Postembolization syndrome happens but less severe than Chemoembolization (TACE), fatigue dominates
Malignant Pleural Effusion
Poor prognosis, median life expectancy 4 mo, Lung, breast, ovarian most common original tumors,
Tx: periodic thora/paracentesis, CHest tube drainage and inject Talc, or tunneled pleural/peritoneal catheter placement for drainage at home.
