Lec 14 - Interventional Radiology Flashcards
cryo ablation - what is it? Adv? Disadv?
“1) freezing the tumor with gases –> let cell thaw –> cell pops –> do another cycle
2) advantages: (over thermal) can monitor ablation zone during procedure; outpatient procedure; preserves renal function; no anesthesia needed; can be repeated for residual tumors
3) disadv: cryoshock=systemic inflammatory response leading to hypotension, resp compromise, DIC and multiorgan failure”
history of stage 1 renal cell cancer
“1) 2% of all adult cases
2) discovered during imaging for something else
3) tumor less than 4cm in dimension - confined to kidney
4) treatment of choice: laproscopic partial nephrectomy (5 yr cancer free)
5) second choice treatments: CT or Ultrasound guided cryoablation (3 year cancer free)”
hepatocellular carcinoma - epidemiology, history, and therapy
“1) cell from hepatic liver cell - 90% are from cirrhosis; highly fatal tumor; incidence is increasing - HEP B and C and alcoholism are huge factors
2) therapy options: transplant; resection (few qualify); systemic chemo(not super effective); local regional therapy(most go here)
3) 5 year survival
“
Hep B and hepatocellular carcinoma
“HBV DNA incorporated into host gemone - greater DNA levels = greater risk
HCC can develop without cirrhosis”
Hep C and hepatocellular carcinoa
“It takes 15-20 years to develop from time of HCV infection
Needs cirrhosis to dev HCC”
Alcoholism and HCC
“1) usually goes hand in hand with HBV or HCV
2) HCC can develop without cirrhosis”
Non Alcoholic fatty liver disease and HCC
“1) associated with diabetes, obesisty, and met syndrome
2) HCC risk doubled in diabetics
3) high BMI in men over 35 = 5x higher risk for HCC mortality”
Curative HCC treatments:
“transplant
surgical resection
percutaneous ablation”
Non-curative HCC treatments
“1) transarterial chemoembolization: chemoembolization, radioembolization, drug eluting beads
2) systemic chemo”
transarterial chemoembolization ( TACE )what is it?
“delivery of highly concentrated chemo in a lipid medium combined with arterial embolization resulting in tissue hypoxia and death
2) takes advantage of liver dual blood supply
3) chemo concentrated 10-40x
4) avg survival = 24 months”
hepatomas get their blood supply from? Advantage?
hepatic artery! We can use artery to deliver chemo without killing all the good cells and function
cant ablate HCC tumors when they are?
greater than 3cm
where do HCC mets go most often?
lungs, bones, lymph nodes
side effects of chemoembolization
"postembolization syndrome: nausea/vomiting abd pain fever anorxia fatigue 10-14 days self limited and managed supportively"
drug eluting bead embolization:
“1)300-700 micron beads loaded with chemo drug are put into tumor via artery
2) better to use oily contrast bc beads arent small enough to penetrate small vessels”
doxorubicin is often used for what?
drug eluting bead embolization -HCC
irinotecan is often used for what?
drug eluting bead embolization -colorectal mets
radiofrequency ablation - what is it?
direct alternating current to create ionic agitation,frictional heat, and ultimately cell death (egg shaped heat zone)
microwave ablation - what is it?
electromag radiation causing agitation of the water molecules surrounding tissue producing friction and ehat resulting in cell death (spherical heat zone)
which is better - microwave or radiofrequency- and why?
microwave bc biger kill zone, spherical, and FASTER
radioembolization? What is it? What tumors used for?
“1) intra-arterially delivery micropheres that emit high dose of radiation (yttrium90) for treatment of unresectable liver tumors
2) pretty selective for tumor and doesn’t damage too much liver
3) met colon, primary hep, met neuroendocrine cancer to the liver”
radioactive compound used in radioembolization?
yttrium 90
what to use if HCC has gone into the portal vein? (Portal embolization)
use radioembolization - better than reg chemotherapy and TACE
which has less post-radioembolization syndrome - TACE or radioembolization?
Radioembolization patients get sick less! BUT THESE PATIENTS ARE MORE FATIUGED
most common cancers that produce malignant pleural effusion?
“lung
breast
ovarian
poor prognosis (4 mo left)”
what are tunneled pleural/peritoneal catheters?
“tunneled semi permanent catheters placed in the pleural or peritoneal cavity allowing the patient to perform home self drainage
OUTPATIENT
immediate use
need anasthesia”
