Chemoembolization

What is Chemoembolization?

Chemoembolization treats tumors in the liver. Chemoembolization is often a palliative treatment. Palliative means that it is done to lessen your symptoms and help your quality of life. It is often not used to cure cancer.

Chemoembolization can help with a tumor that started in the liver (primary liver cancer or hepatoma) or a tumor that has metastasized (spread) from another area of the body to the liver. Chemoembolization can be used alone or with chemotherapy, radiation therapy, or radiofrequency ablation.

Chemoembolization puts chemotherapy straight into the liver tumor. The chemotherapy goes through the artery that supplies blood to the tumor. The artery is then blocked ("embolized") to cut off blood flow to the tumor. This helps do a few things:

• Keeps oxygen and nutrients away from the liver once the blood flow is blocked.
• Because chemotherapy is given directly into the tumor, the dose is higher than what can be given through a vein (IV).
• Because the artery is blocked, no blood can go through the tumor. The chemotherapy can stay in the tumor for a much longer time (as long as a month).
• There are fewer side effects than with chemotherapy given in a vein because the medications stay in the liver and do not move throughout the body.

How does chemoembolization work?

The liver has two blood supplies – an artery (hepatic artery) and a large vein (the portal vein). The normal liver gets about 75% of its blood from the portal vein. When a tumor grows in the liver, it gets almost all of its blood supply from the hepatic artery. Chemotherapy medications given into the hepatic artery reach the liver tumor directly, keeping most of the healthy liver tissue safe from chemotherapy. When the artery is blocked with embolization, almost all of the blood supply is taken away from the tumor. The liver keeps getting blood flow from the portal vein.

Is chemoembolization right for me?

Chemoembolization only treats tumors in the liver. Chemoembolization may be used with other treatments that can reach cancer cells in other areas of the body. Tumors that may be treated by chemoembolization are:

• Hepatoma (primary liver cancer).
• Metastasis (spread) to the liver from solid tumors (i.e. lung, breast, colon cancers, sarcoma, melanoma).

You may need to have liver function tests (LFTs) and a CT scan or MRI to see if this procedure is right for you. In some cases, there may be blockage of the portal vein or bile ducts, or cirrhosis (scarring) of the liver, which may prevent the use of chemoembolization.

How is the procedure done?

Chemoembolization is done in the interventional radiology (IR) department by an interventional radiologist. An interventional radiologist is a physician with training in minimally invasive treatments that use radiology imaging (like X-rays and CT scans) to guide them. There are also nurses, radiology technicians, and nurse practitioners in this department.

You will be told to not eat or drink after midnight the night before the procedure. Patients often stay in the hospital anywhere from 1-4 nights after the procedure.

You will have an IV placed and will be given medications, including IV fluids, antibiotics, and sedative medication (to relax you).

Once in the procedure room, a small catheter (IV) will be placed into an artery in your groin (femoral artery). Your provider will do an arteriogram, which places dye through the catheter into the hepatic artery. X-rays will be done to map the arteries feeding blood to your liver. The dye can make you feel flushed or warm, but the feeling will pass in a few minutes. Once the arteries are found, the catheter is moved into the branch of the artery that supplies blood to the tumor. The chemoembolization mixture is then injected. More X-rays may be done to confirm that the tumor has been treated. The catheter is removed, pressure is applied to the site, and a gauze dressing is placed over the site where the catheter went in. The procedure takes about 1.5 to 2 hours.

Once the procedure is done, you will be taken to a hospital room where you will be watched closely. You will be given IV fluids and medications for nausea and pain if needed. Most patients are able to go back to normal activities within a week.

What are the side effects of chemoembolization?

You may have a fever, pain, and/or nausea afterward. These may last a few hours to up to a week and can be treated with medications. You may have fatigue (feeling tired) or loss of appetite for 2 weeks or more. You may also have some hair loss. More serious effects happen in less than 3% of chemoembolization procedures. These can be infection, an abscess in the liver, and bleeding.

How will chemoembolization help me?

Chemoembolization is a treatment, but not a cure. About 70% of patients will have their liver tumors stop growing and/or shrink, which may improve quality of life and survival.