Minimally Invasive Solutions for Cancer
Ablation
Image-guided ablation refers to using chemicals, heat, cold, or other energy to destroy tumors/cancer. A skinny wand or needle is placed through the skin into the tumor(s) using imaging to position it and avoid damaging other structures. The tumor/cancer is destroyed and needle/wand removed. This is an outpatient procedure where people usually go home the same day. It is >90% effective in completely killing the cancer when the tumor(s) are small. It does not work as well when the tumors are very large. The main alternative is surgery to cut it out, which is more invasive with longer recovery but can be a better option for some patients.
What are the risks and recovery?
The risks of ablation vary depending upon where the tumor is what other structures are around it. It is generally a safe procedure where you go home the same day. You may feel a bit sore in the area the next couple days, so I give you some medications to help with that. The main risks tend to be bleeding or damaging surrounding normal structures while trying to kill all the tumor cells. In the lungs, air can also leak out of the lung requiring a small tube (chest tube) while the lung heals.
Radioembolization / CHEMOEMBOLIZATION
Radioembolization is an option for liver cancers or cancers that have spread to the liver. It involves injecting little beads that emit radiation a very short distance directly into the arteries feeding the tumor. This allows much higher amounts of radiation to hit the tumor than is possible with radiation from outside the body. Chemoembolization is similar except the beads emit chemotherapy rather than radiation. It tends not to quite work as well as radioembolization, but is not as hard on the liver. So chemoembolization is a good option when someone’s liver would not be able to tolerate radioembolization. These are outpatient procedures where most people go home the same day. They can completely destroy the cancer like an ablation but are more often palliative, to slow the cancer.
What are the risks and recovery?
Most people are able to go home the same day. Some people feel completely normal after the procedure, but up to half of people will have some abdominal pain and feel like they have the flu for a few days with a low grade fever, nausea, tiredness, and not wanting to eat as much. I will give you some medications to help with this. Rarer complications include damaging the liver causing worsening liver function, infection, and issues from beads going somewhere else like the stomach causing an ulcer. These are very rare.
Chronic Cancer pain
Certain cancer in certain locations can cause terrible pain that is difficult to control with medications alone. Sometimes the nerves transmitting the pain to the brain can be safely destroyed with medications or ice to help relieve the pain. Other times the tumor itself is eating through bone causing the pain. These can be helped with ablation (similar to what’s described above) and sometimes filling to tumor with cement (called “cementoplasty”). External radiation is another option but tends to take longer to work, so it is often nice to do the minimally invasive treatment followed by external radiation. These are outpatient procedures where you go home the same day.
What are the risks and recovery?
These are generally safe procedures where you go home the same day without any specific recovery related to the procedure itself. The risks vary depending upon the nerve being destroyed or the location of the tumor being treated. For example, destroying the celiac plexus, which helps with abdominal pain from certain cancers can cause diarrhea and low blood pressure and dizziness when going from sitting to standing. This tends to only last a few days while the body adjusts.