Chemoembolization
What is chemoembolization?
Chemoembolization is a palliative treatment
for liver cancer. This can be a cancer originating
in the liver or a cancer that has spread ("metastasized")
to the liver from other areas of the body. During
chemoembolization, three chemotherapy drugs are
injected into the artery that supplies blood to
the tumor in the liver. The artery is then blocked
off ("embolized") with a mixture of
oil and tiny particles. This procedure accomplishes
four things:
- The tumor becomes deprived of oxygen and nutrients
once the blood supply is blocked.
- 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.
- 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.
- There is a decrease in side effects because
the drugs are trapped in the liver instead of
circulating throughout the body.
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Will your physician
recommend you for this procedure?
Remember, chemoembolization only treats tumors
in the liver and will have little or no effect
on any other cancer in the body. For example,
the following liver cancers may be treated by
chemoembolization:
- hepatoma (primary liver cancer)
- metastasis (spread) to the liver from:
- colon cancer
- carcinoid
- ocular melanoma
- sarcomas
- a primary tumor in another part of the
body
Your physician may recommend that you have several
tests, including liver function blood tests, and
a CAT scan or an MRI of your liver prior to the
chemoembolization procedure. Your doctor needs
to check these test results to make sure you do
not have:
- any blockage of the portal vein
- cirrhosis of the liver
- a blockage of the bile ducts
If you have any of these complications, your
doctor may not allow you to have the chemoembolization
procedure.
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How do you prepare for
the procedure and what is it like?
The evening before the exam you may not eat
or drink anything (NPO). You will arrive at the
Hospital of the University of Pennsylvania early
in the morning. Once at the Hospital you will
receive an intravenous (IV) line, placed in your
arm, which allows large amounts of fluids to drip
into your body. These fluids consist of antibiotics
and other medications that are needed prior to
your chemoembolization procedure.
You will then be sent to the Interventional Angiography
Suite in the Department of Radiology. Here you
will meet doctors (radiologists) and technologists
trained in this procedure.
First, the radiologist will place a small catheter
(a small tube) in an artery in your groin and
perform an arteriogram that will specifically
look at the arteries in your liver. After these
arteries are identified, the catheter is directed
into the branch of the artery supplying blood
to the tumor, and the chemoembolization mixture
is injected.
Once this is completed, you are sent back to
your room where you will lie flat in bed for six
hours. More IV fluids are given to you overnight.
Most patients are discharged from the hospital
the following day.
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Are there any side effects
or complications?
Following the procedure you may have varying
degrees of pain, fever and nausea. These symptoms
may last a few hours to a few days, and are easily
treated by various medications. You may also notice
a slight hair loss, rarely perceived by anyone
other than yourself.
Serious complications from chemoembolization
are rare. In less than 3% of the procedures, the
liver tumor killed by the procedure may become
infected and abscess. There has been one fatality
in 100 procedures due to liver failure.
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Will chemoembolization
help me?
Remember this is a treatment, not a cure.
Approximately 70% of the patients will see improvement
in the liver and, depending on the type of liver
cancer, it may improve your survival.
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How does chemoembolization
work?
The liver is unique in having two blood supplies
- an artery (the hepatic artery) and a large vein
(the portal vein). The normal liver gets about
75% of its blood from the hepatic artery. 
When a tumor grows in the liver, it receives
almost all of its blood supply from the hepatic
artery. Therefore, chemotherapy drugs injected
into the hepatic artery at the liver reach the
tumor very directly, sparing most of the healthy
liver tissue.
Then, when the artery is blocked, nearly all
of the blood supply is taken away from the tumor,
while the liver continues to be supplied by blood
from the portal vein.
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Reviewed by:
Michael Soulen, MD
April, 2004
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