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What's Chemoembolization?
A procedure in which the blood supply to the tumor is blocked
surgically or mechanically and anticancer drugs are administered directly into the tumor. This permits a higher
concentration of drug to be in contact with the tumor for a longer period of time.
Chemoembolization of the hepatic artery involves blocking the
hepatic artery (the major artery that supplies blood to the liver) and then injecting chemotherapy drugs between
the blockage and the liver, using the liver's arteries to deliver the chemotherapy throughout the liver.
How does Chemoembolization work?
Dr. Niedzwiecki
inserts a tiny catheter into an artery in the leg. Using x-ray guidance, Dr.
Niedzwiecki moves the catheter into the hepatic artery.
Dr. Niedzwiecki
injects an anticancer drug into the artery and then uses tiny particles to block the flow of blood through the
artery. Without blood flow, the drug stays in the liver longer. Depending on the type of particles used, the blockage
may be temporary or permanent. Although the hepatic artery is blocked, healthy liver tissue continues to receive
blood from the hepatic portal vein, which carries blood from the stomach and intestine. Chemoembolization requires
a hospital stay and generally takes about two hours.
What is Accomplished?
1) The tumor becomes deprived of oxygen and nutrients once the
blood supply is blocked.
2) Because these drugs are injected directly at the tumor site, this dosage is 20 to 200 times greater than that
achieved with standard chemotherapy injected into a vein in the arm.
3) Because the artery is blocked, no blood washes through the tumor. As a result, the drugs stay in the tumor for
a much longer time — as long as a month.
4) There is a decrease in side effects because the drugs are trapped in the liver instead of circulating throughout
the body.
What are the risks and side effects of chemoembolization?
There are many possible side effects from chemoembolization,
since it involves both chemotherapy and the possible destruction of normal liver tissue as well as tumor. Most
people experience some pain, fever, loss of appetite and fatigue. They are generally in the hospital for three
to five days but then feel quite tired and may have low grade fevers for up to four weeks afterwards. It is possible
that more serious side effects may occur.
Side effects from chemotherapy may include: nausea;
hair loss; decrease in white blood cells; decrease in platelets; anemia; weakening of the heart muscle; diarrhea;
mouth sores or allergic reactions.
Cutting off the blood supply to the tumor may cause
abdominal pain, nausea, vomiting, fever, bloating, fluid accumulation in the abdomen or in the lung, confusion,
infection, pneumonia, damage to the gallbladder (which may need to be removed), temporary kidney damage, worsening
liver function, and death.
The overall risk of serious complication is related
to a person's general underlying health, as well as the overall function of their liver. People with jaundice,
severe cirrhosis, blockage of the portal vein in the liver, or very rapidly growing tumor are at significantly
higher risk for complications and death. People without these problems usually tolerate the chemoembolization much
more easily.
What to expect while you are in the hospital
In some instances, you will be admitted to the hospital
on the day before your procedure. Adequate hydration is required to protect the kidneys during chemoembolization.
Therefore, an intravenous will be started and you will receive intravenous fluids in preparation for the procedure.
In addition, you will be given a medication called Allopurinol which is used to further protect the kidneys from
the chemotherapy and the products produced by the dying tumor cells. Your nurse will instruct you in how to use
a breathing apparatus called an incentive spirometer. The purpose of this is to help you inflate your lungs so
that you will not develop pneumonia.
Prior to the procedure, you will be given additional
medications to prevent nausea and pain; you will also be given an antibiotic to prevent infection.
After the procedure, you may experience some side
effects. If you do experience pain in the area of your liver or if you become nauseated, medication will be made
available to you. If you experience confusion or disorientation after the procedure, please report this to your
doctor or nurse immediately.
After the chemoembolization, you may be given a medication
called Lactulose. This medication helps the body rid itself of metabolic waste that is usually excreted through
the liver. This drug may cause you to have loose stools for several days.
It is important that you spend as much time as possible
in bed for one or two days after the chemoembolization to improve the blood flow to your liver. In the days following
your procedure, you may experience pain or high fevers. This is a result of the tumor breakdown and is normal after
chemoembolization. You will be given Tylenol to alleviate the fevers and other medication as needed for the pain.
What can I expect following Chemoembolization?
The most common problem following a successful chemoembolization
is extreme fatigue for three to four weeks following the procedure. This is a result of the liver not working normally
as it regenerates. Appetite will be poor and many people lose a significant amount of weight before it starts to
return. Fevers up to 101 degrees may last for one to two weeks and these can be treated safely with Tylenol. The
liver pain usually improves within the first week; rarely, people with very large tumors or with tumors near the
outside surface of the liver may require narcotics for longer periods.
In general these are all signs of a normal recuperation
following chemoembolization, as the tumor is dying and shrinking within the liver. During the first month following
embolization, it is important to check in routinely to let the physician know how your recovery is progressing.
If the pain suddenly changes in degree or character, or if the fever becomes suddenly higher than it had been,
it is important to let your physician know right away. Any other unusual change should also be communicated immediately.
Most people are back to their usual state of health
one month after the procedure. They then return for a CT scan and blood tests to determine the size of the treated
tumor and how well the chemoembolization worked. If there is tumor on both sides of the liver, only one half will
be treated at first, and after one month, patients will return to the hospital for the second half of the chemoembolization.
In that case, a CT scan will be done after the completion of the second chemoembolization.
CT scans will be performed every three months thereafter
to determine how much the tumors ultimately shrink, and to see if and when any new tumors arise in the liver. The
average time before a second round of chemoembolization is necessary (because of new tumor) is between eight and
twelve months. Chemoembolization can be repeated many times over the course of many years, as long as it remains
technically feasible and the patient continues to be healthy enough to tolerate repeat procedures.
Where do I Call for a Consultation?
Please Call
us TODAY at 727-791-7300 if you have any questions.
We're looking forward to helping you .
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