What is an Interventional Radiology?
One of the most technologically advanced and fastest growing specialties of modern medicine
Interventional Radiology procedures provide minimally invasive, targeted treatment and diagnosis of cancer. Image guidance is used in combination with the most current innovations available to treat cancerous tumors while minimizing possible injury to other body organs.
These techniques are most often recommended for patients whose cancer cannot be surgically removed or effectively treated with chemotherapy. These procedures are also frequently used in combination with other interventional techniques or treatments.
How is Interventional Radiology used in cancer treatment?
Personalized treatment approach
Our priority is to treat you with the most appropriate, least invasive treatments available for your cancer type. Below are some of the most common interventional radiology procedures we perform. Most procedures are done on an outpatient basis or during a short hospital stay.
A chemotherapy port or portacath, is a vascular access device that is implanted under the skin so that people with cancer can be given chemotherapy. A port is usually placed surgically under the skin of the chest or upper arm. Conditions for port location and implant vary from patient to patient. Before the procedure, you will have an IV line placed in your arm. The area where the port will be inserted will be cleaned and numbed with local anesthetic. You will be given local anesthetic in two places, your neck and your chest. During your procedure, your doctor will make a small incision above your collarbone and another incision under. They will make a tunnel under your skin between the two openings. The catheter will be passed through this tunnel and then gently threaded into your vein. Your doctor will make a pocket under your skin, where the port will be placed. This pocket and your incisions will then be closed.
TACE is used to treat liver tumors, both primary hepatocellular carcinoma and secondary, or metastatic liver lesions. The procedure involves placement of a small catheter into the blood vessel of the groin, which is then threaded through the blood vessels into the liver using video fluoroscopy, real-time x-ray. Contrast dye is injected through the catheter to define the anatomy and location of the tumor. Once the blood vessels are mapped properly, a mixture of concentrated chemotherapy is injected through the catheter and directly into the blood vessels that feed the tumor. To help concentrate the chemotherapy, microspheres are injected into the same vessels that feed the tumor to block any further blood flow to tumor. This serves to not only trap the chemotherapy mixture in the tumor but also to deprive the tumor of oxygen and nutrients it needs to grow, thus hopefully both treating and killing the tumor.
For most types of cancer, a biopsy is one of the main way to diagnose cancer. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. Your doctor may recommend a biopsy if something suspicious is found during a physical exam or other test. Sometimes, a biopsy may be performed with the help of an imaging test, such as an ultrasound, CT scan, or MRI. Occasionally, surgery may be needed to get a tissue sample. The type of biopsy you receive depends on where the possible tumor is located. Types of biopsy are such as fine needle aspiration, core needle, vacuum-assisted, image-guided, incisional, excisional, shave, endoscopic and bone marrow biopsys.
Radiofrequency Ablation (RFA) is an invasive procedure that uses electrical pulses to heat a probe that is placed in a tumor. The probe can be a single, straight rod-like structure or it can be a hollow rod that contains several smaller wires. Once inserted into the tumor, the smaller wires can be pushed out to reach a larger amount of the tumor. RFA can be performed in an open procedure with full anesthesia or by insertion of the probe through the skin. Placement of the probe can be guided by ultrasound, magnetic resonance imaging and or computer assisted tomography. After the treatment, the cells in the tumor will die, leaving behind only a scar. Cancers treated with RFA include liver cancer, metastatic colorectal cancer, lung cancer and kidney cancer.
Percutaneous Transhepatic Biliary Drainage (PTBD)
Percutaneous transhepatic biliary drainage is a procedure where a small, flexible, plastic tube is placed through the skin into the liver in order to drain an obstructed bile duct system. If the bile duct becomes blocked, the bile cannot drain normally and backs up in the liver. Signs of blocked bile ducts include ‘jaundice’ yellowing of the skin, dark urine, light stools, itching, nausea and poor appetite. This is a potentially serious condition that needs to be treated. It is possible to relieve the obstruction by inserting a fine plastic drainage tube, catheter, through the skin into the obstructed bile duct, past the obstruction and into the duodenum. This relieves the congestion in the blocked duct by allowing the bile to drain.
Peripherally Inserted Central Catheters (PICC)
Peripherally inserted central catheters (PICCs) are frequently used to obtain central venous access for patients in acute care, home care and skilled nursing care. PICCs are a reliable alternative to short-term central venous catheters, with a lower risk of complications. Early assessment of hospitalized patients is essential to assure that individuals who will benefit the most from a PICC receive one as soon as possible in their treatment. However, PICCs are not appropriate for every patient. Indications, contraindications, and potential complications must be considered prior to insertion of a PICC. A PICC line is a long, thin, hollow tube that a radiologist puts into a vein above the bend of your elbow.
Drainage of Pleura Effusion
The pleura is a membrane that covers the lungs. It has two layers and produces fluid that helps the lungs move when we breathe. Sometimes cancer cells spread to the pleura. This can cause fluid to build up and press on the lungs, causing breathlessness. You will normally have a chest x-ray or ultrasound scan to diagnose a pleural effusion. To treat a pleural effusion, the fluid has to be slowly drained. This is usually done by putting a tube into your chest through a small cut. You may spend a couple of days in hospital afterwards. If the fluid builds up again, you will need to have it drained more than once. You may have a drain left in place to collect fluid. To stop the fluid from building up again, you may need chemotherapy or hormonal therapy to treat the cancer.
The paracentesis procedure is done to take the peritoneal fluid out from your stomach to relieve belly pressure or pain in people with cancer or cirrhosis. This fluid buildup is called ascites. Ascites may be caused by infection, inflammation, an injury, or other conditions, such as cirrhosis or cancer. The fluid is taken out using a long, thin needle put through the belly. The radiologist or nurse will numb the area before gently and slowly putting the paracentesis needle in where the extra fluid is likely to be. Other blood tests may be done before a paracentesis to make sure that you do not have any bleeding or clotting problems. You might have to empty your bladder before the procedure.