Chemoembolization, which can be applied in many types of cancer that spreads to the liver, especially liver tumors, can be defined as the process of administering chemotherapy and vaso-occlusive drugs directly to the vessels feeding the tumor. The chemoembolization process applied by interventional radiologists is performed by the locoregional treatment method in the treatment of cancer disease, that is, by administering drugs directly to the cancerous tissue. In the chemoembolization method, where chemotherapy and embolization treatment are applied simultaneously, the drug is administered only to the cancerous tissue at a much higher dose, unlike the classical chemotherapy method. In the chemoembolization treatment, the drug given to the person is injected into the vein where the cancer cells are fed. Thus, while the drug reaches the cancerous tissue rapidly, it is prevented from going to healthy tissues. In the embolization process, which is the second part of the treatment, the blood flow to the cancerous tissue is embolized (cut) and the feeding of the cancerous tissue is prevented.
Chemoembolization
It can be applied in many types of cancer that metastasizes to the liver, especially liver tumors. Chemoembolization can also be defined as the process of administering chemotherapy drugs directly to the vessel feeding the tumor and closing the relevant vessel. This interventional treatment method, in which the whole body is not exposed to chemotherapy drugs, can be applied to selected cases who have good general health, have a mass due to liver cancer or metastasis, and do not benefit from systemic chemotherapy.
In the 1st, 3rd and 6th months after the chemoembolization procedure, the person's control is made with MR imaging. In people with high enzyme levels, weekly laboratory follow-up is required. Depending on the patient's response to the treatment, the chemoembolization process is repeated with different chemotherapy drugs when necessary. Frequently asked questions "Chemoembolization can be applied to which types of cancer?" Before answering the question "What is chemoembolization?" It is necessary to answer the question. Cancer cells develop and multiply rapidly. It requires a large amount of energy for this. So strong veins It is fed through the bee. In the classical chemotherapy procedure, the drug is given to the patient through the arm vein.
The chemotherapy drug that spreads throughout the body reaches the cancerous tissue through the circulatory system. However, in the classical method, since the chemotherapy drug spreads throughout the body, it may cause some side effects. The chemoembolization method is performed in two stages, namely chemotherapy and embolization.
Different from the classical chemotherapy method, higher dose chemotherapy drug is injected directly from the inguinal region into the vessels feeding the tumor formed by cancerous cells. Thus, all the drug penetrates the cancerous tissue and the drug is prevented from reaching other healthy tissues, thus protecting the patient from possible side effects of chemotherapy. After the chemotherapy drug is given intravenously with microspheres, the embolization process also takes place. Thanks to this process, the artery leading to the cancerous tissue is embolized. In other words, the blood flow to the tumor is cut off. Thus, the nutrition of the relevant tissue is prevented and the cancer cells die.
The purpose of the chemoembolization process is to both prevent the blood supply of the cancerous area and to administer chemotherapy drugs directly into the tissue. High-dose chemotherapy drug is loaded into microspheres and given to the patient. Since the microspheres remain in the cancerous tissue and prevent the tissue from being supplied with blood, the death of cancer cells is accelerated.
Chemoembolization, the effectiveness of which has been proven by scientific studies, is the first preferred treatment method in some liver cancer cases. It is also frequently used in liver cancer cases that do not respond to classical chemotherapy and/or are not suitable for surgical treatment.
What are the Types of Chemoembolization?
Chemoembolization is applied in two different types.
- In the TAKE method, Lipiodol is given to the liver tissues together with the chemical chemotherapy drug Lipiodol during the procedure. Then, through the microspheres given to the patient, the vascular feeding of the tumor is prevented.
- In DEB-TAKE (Drug Eluting Beads Trans-Arterial Chemoembolization) method, chemotherapy drug is loaded into microspheres.
Which Cancer Types Is Chemoembolization Applied to?
Chemoembolization can be applied in the treatment of HCC (hepatocellular carcinoma) and cholangiocarcinoma, one of the primary liver cancer types. It is successfully performed in liver metastases caused by NET (neuroendocrine tumors) originating from the gastrointestinal tract. Another condition in which chemoembolization is frequently used is the cases in which large intestine cancer spreads to the liver, that is, metastasizes. In other words, chemoembolization can be applied for the treatment of liver cancer only if tumors located in the liver or other types of cancer metastasize to the liver.
It is known that chemoembolization process, which has been performed for 25 years worldwide, is much more effective than classical chemotherapy. The biggest advantage is that the vessels that feed the cancerous tissue are blocked and their nutrition is prevented and the chemotherapy drug stays in the cancerous tissue for a long time. Chemoembolization is mostly applied in middle stage liver tumors. Tumor treatment in early stage liver cancers can be performed with surgery or radiofrequency methods.
How is Chemoembolization Procedure?
Although the chemoembolization procedure is performed by specialists in the interventional radiology department, the decision for chemoembolization treatment is based on oncology. It is given by the council consisting of branch physicians who follow the patient such as gastroenterology, general surgery. The decision of the applicability of the chemoembolization procedure in the relevant case is again made by the interventional radiologist.
After the patient's admission to the chemoembolization procedure, hospitalization is performed. After giving detailed information to the patient about the procedure, the patient is taken to the angiography room. In order for the patient not to feel pain and to reduce their anxiety during the procedure, sedative drugs are given from the arm vein and / or local anesthesia is applied. As in other angiography procedures, angiography is performed by entering the groin in the chemoembolization process. A thin tube called a
catheter is entered into the hepatic artery and angiography of all the vessels of the liver is drawn. Thus, the vessels feeding the cancerous tissue in the liver are determined. With a thinner catheter Microspheres, that is, the drug contained in special particles, is delivered to the tissue that feeds the tumor. A portion of the drug is left to the entire region of the liver. Microspheres that release chemotherapy drugs reach the tumor formed by cancer cells and close the vessels feeding the tissue.
After the completion of the procedure, the patient should rest in the hospital for 4 to 6 hours. However, since side effects such as pain, nausea and vomiting may occur due to the chemoembolization process, the patient is discharged the next day. The chemoembolization procedure is not different from a normal angiography procedure for the patient.
The person does not feel pain or pain during the procedure. However, after the completion of the procedure, the person may feel pain in the upper right abdomen where the liver is located. In the presence of such complaints, pain medication is given to the person to reduce the patient's complaints. While the chemoembolization process provides complete destruction of the tumor in some patients, it leads to shrinkage of the tumor in others. In both conditions, the patient's quality of life is increased and life expectancy is extended.
A follow-up examination is planned for the evaluation of the liver in the first month after the chemoembolization procedure. In the 3rd month following the procedure, CT, MR or PET CT is taken to monitor the response of the tumor to treatment. Blood tests are performed to monitor the patient's enzymes.
What are the Side Effects of the Chemoembolization Procedure?
Postembolization syndrome, which is characterized by abdominal pain, weakness, fatigue, nausea, vomiting and fever, may be seen in the patient after the chemoembolization procedure. . In some patients, these complaints may last for 3 to 4 days. Complications such as abscess formation and liver failure may rarely occur.
Patient selection is of great importance in reducing complications. Therefore, some patients cannot undergo chemoembolization.
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