Interventional Oncology (Heme 3) Flashcards
Cryoablation
Delivery of cold to the tumor resulting in intracellular ice formation and necrosis. Can visualize the ice ball on CT.
Cryoshock
a systemic inflammatory response leading to hypotension, respiratory compromise, DIC and multiorgan failure.
Risks of Cryoablation
Cryoshock, Hemorrhage, pleural effusion, pneumothorax, urine leak
Heptocellular Carcinoma Risk Factors
HBV and HCV, NAFLD and NASH, Alcoholic liver disease, aflatoxin exposure, genetic disease: wilsons, alpha 1 antitrypsin deficiency, hemochromatosis.
Hepatocellular Carincoma
5 year survival less than 10%. Depends on stage and liver function. 20% are surgical candidates. Chemo largely ineffective. Curative treatment: transplant, resection, percutaneous ablation.
Transarterial Chemoemolization
Delivery of highly concentrated chem in a lipid medium. Takes advantage of dual blood supply (hepatic artery), chemo can be concentrated to 10 to 40x normal. Average survival 24 months.
Post embolism syndrome
Follows TACE in 90% of people, nausea vomiting abdominal pain fever anorexia fatigue. Self limiting. Last 10-14 days.
Radiofrequency Ablation
Delivery of directed alternating current to create ionic agitation, frictional heat and cell death.
Microwave Ablation
Delivery of electromagnetic radiation causing agitation of the water molecules in the surrounding tissue producing friction, heat and cell death.
Radioembolization
Delivery of microspheres emitting high dose of radiation to unresectable liver tumors. Uses Yttrium 90 delivering beta particles which penetrate 2.5 mm. Advantage over TACE when portal vein involved. Causes fatigue.
Renal Cell Carcinoma
2-3% of adult cancers. usually discovered incidentally. 85% are the clear cell variant.
Stage 1A Renal Cell Carcinoma
Tumor less than 4 cm in greatest dimension. Tx: laproscopic partial nephrectomy. 95-97% 5 year survival.
Poor operative candidate for 1A renal cell carcinoma
CT or ultrasounds guided cryoablation. 94-95% 3 year cancer free survival.
Liver Transplant
70-80% 5 year survival. Must have 1 lesion less than 5cm or 3 lesions all less than 3cm.
Liver Resections
50-60% survival. Can perform on cirrhotic livers. Better if tumor is less than 5 cm.
Drug Eluting Bead Embolization
300 to 700 micron beads loaded with chemo drug. Usually Doxorubicin.
Malignant PE
15% of patients with advanced malignancy. ~4mo life expectancy.
Tunneled Pleural/Peritoneal Catheters
Placed in the pleural or peritoneal cavity to allow the patient to preform home self drainage.
