What is Chemoembolization? Chemoembolization is a method for delivering cancer therapy directly into a malignant tumor in the liver. Using this technique, chemotherapy is injected into the liver through a catheter placed into the artery to the tumor, followed by particles that embolize or block the blood flow to the malignancy. Chemoembolization attacks the cancer in two ways. First, it delivers a very high concentration of chemotherapy directly into the tumor. Second, the procedure eliminates the blood supply to the tumor which deprives it of oxygen, damages the tumor cells, and enhances the effects of the chemotherapeutic agents., Tumors, like all tissues, depend on the supply of oxygen and nutrients carried by the blood. The combined action of intra-arterial chemotherapy and embolization can destroy malignant cells normally resistant to intravenous chemotherapy. What are the indications for the procedure? Chemoembolization is most beneficial to patients whose malignancy is limited to the liver, whether the tumor began in the liver or spread to it (metastasized) from another organ. Cancers most often treated by chemoembolization include: Hepatoma (hepatocellular carcinoma) - a primary liver cancer Metastasis (spread) to the liver from: Colon cancer Carcinoid and islet cell tumor Ocular melanoma Sarcoma Renal adenocarcinoma (hypernephroma) In order to prevent liver damage and maximize effectiveness, only a portion of the liver is treated at one time. Treatment of the entire liver usually requires 2 to 3 sessions. After the patient has recovered from the first treatment, additional sessions can be performed, usually 2-3 weeks apart. Depending on the number and type of malignancies, chemoembolization may be used as the sole treatment or may be combined with other treatment options such as surgery, radiofrequency ablation, radiation, or intravenous chemotherapy. How should I prepare for the procedure? Several days before the procedure you will have an office consultation with the physician performing it - an Interventional Radiologist. You will have blood drawn at the hospital or a local clinic to evaluate your liver and kidney function. Be sure the physician is aware of all medications you take regularly, particularly blood thinners such as Coumadin or Plavix which affect clotting. You will be admitted to the hospital the morning of the procedure. How is the procedure performed? The first step is to radiograph the arteries to the liver and the tumor by performing angiography. The radiologist will anesthetize an area of over the hip. A thin catheter is introduced into the femoral artery and guided under fluoroscopy into the hepatic arteries. Radiographic contrast is injected and x-rays are taken allowing the vessels to be visualized. A catheter is then guided into the branches feeding the tumor and the chemotherapeutic agents and embolic material are injected. At the end of the procedure, the Interventional Radiologist removes the catheter and pressure is applied to the groin area for a short time to prevent bleeding. You can expect to stay in bed for 4-6 hours afterwards. What will I experience during the procedure? Patients are typically well sedated. Most patients experience some side effects after chemoembolization. This is called post-embolization syndrome, and consists of pain, nausea, and fever. Pain is the most common side effect and can be controlled by oral or intravenous medication. Most patients leave the hospital within 24-48 hours of the procedure, after their pain and nausea have improved or subsided. You may be sent home with prescriptions for pain or nausea. Fever may occur normally for up to a week after the procedure. Fatigue and loss of appetite can occur for a few weeks. If your pain suddenly changes in degree or character, if your fever becomes suddenly higher or you notice any other unusual changes, it is important to notify your physician. Most patients can resume their normal activities within a few days. What are the benefits versus the risks? Chemoembolization is a treatment not a cure. Only occasionally does it completely eliminate the cancer. When cancer is confined to the liver, death is frequently due to liver failure caused by the growing tumor. Chemoembolization can help prevent this growth and potentially preserve liver function. The success of chemoembolization depends on the time, size, and the extent of tumor. It can often destroy 70% to greater than 90% of the cancer. Typically, it slows or stops tumor growth for 6 to 12 months and can often be repeated if the cancer starts to grow again. As with any type of procedure, risks exist. Reactions to chemotherapy may include nausea, hair loss, decrease in white blood cells, decrease in platelets, and anemia. Because chemoembolization traps most of the chemotherapeutic drug in the liver, these reactions are usually mild. Because angiography is part of the procedure, there is a risk of reaction to the contrast material and a risk of kidney damage in patient's with diabetes or other pre-existing kidney disease. Serious complications from chemoembolization occur in less than 5% of procedures. Most major complications involve either abscess formation in the liver or damage to the liver. Death from liver damage and failure occurs in less than 1 % of patients, most often in those with severe underlying liver disease. Rarely an embolus can lodge in an adjacent organ and deprive if it of its normal blood supply. This can cause injury to the gallbladder or bowel and may require surgical resection.