Interventional Radiology (IR) is a medical field that utilises minimally-invasive, real-time image- guided techniques to diagnose and treat various conditions, like cancer. Using keyhole incisions and advanced imaging, precision instruments are guided to the target area for precise treatment with minimal damage to surrounding tissue. The absence of large incisions, general anaesthesia and significant blood loss help the patient by reducing recovery time, pain and discomfort. In liver cancer treatment, IR offers localised therapies like ablation, TACE and TARE. Ablation uses extremes of temperature to destroy liver cancer cells. TACE and TARE deliver chemotherapy directly to the tumour, while simultaneously cutting off its blood supply. These procedures are effective for inoperable tumours and can be used in combination to tackle complex cases. PTDB is another IR technique used to relieve bile duct obstructions caused by liver cancer. IR has several advantages over surgical resection, including fewer complications, shorter recovery times and minimal side effects. Furthermore, IR techniques are suitable for patients who are not eligible for open surgery.
Interventional Radiology is a branch of medicine that uses minimally invasive techniques to diagnose and treat cancer. The cancer in question can be local or metastatic, i.e. it has spread to other parts of the body. Interventional radiology uses keyhole, image-guided procedures to perform interventions that conventional surgical resection cannot accomplish successfully.
Instruments are inserted into a keyhole incision and guided to the correct location using real-time X-rays or ultrasound scans for guidance. The procedures are more precise and targeted only at the diseased organ, resulting in less collateral damage to other parts of the body. There are no large incisions, loss of blood or general anaesthesia involved. This benefits patients greatly, in terms of recovery time.
Systemic treatments are drug therapies that are delivered through the blood stream. This means they affect cells throughout the body. Chemotherapy and immunotherapy are systemic treatments, and are the appropriate course of treatment for certain types of cancer. However, systemic treatments can, in some cases, limit the dosage of the drug that finally reaches the targeted tumour. This is where interventional radiology enters the picture. Interventional radiology is a targeted approach, that allows the doctor to deliver the medication directly and exclusively to the tumour. The drugs delivered through this approach are more concentrated to the targeted tumour and help dissolve and destroy it without affecting surrounding tissues and other body parts.
The procedures are performed by a specialised team consisting of an interventional radiologist, imaging technologists and trained surgical nurses. Real-time imaging technology, like a CT scan, fluoroscopy or ultrasound, is used to guide laparoscopic instruments and locate the tumour. There are various interventional radiology techniques that can be applied to cancerous liver tumours.
Ablation is a technique that destroys liver cancer cells using extreme heat. This can be accomplished in multiple ways- using radio frequency radiation or microwave radiation. Ablation can also be done using very cold temperatures. This technique is called cryoablation. Ablation is a minimally-invasive technique, and is often recommended for small, inaccesible tumours. It is also recommended to patients who are not healthy enough to withstand surgery. Ablation may also be used in combination with other treatments to tackle larger tumours.
During ablation therapy, a needle-shaped probe is guided to the liver tumour using real-time scans. Once in contact with the cancer cells, the probe is activated and emits radio frequency waves or microwaves. This kills the cells it comes in contact with. The whole procedure can take anywhere from 30 minutes to a couple of hours depending on the size of the tumour.
Patients are usually advised to stay overnight in the hospital for observation after the procedure. Some patients experience discomfort or mild pain at the incision site. They may also experience some bleeding. If patients develop fever or any other signs of infection, they are advised to go to the hospital immediately. Most patients recover fully and get back to their regular routine within a week. With ablation, there is a small risk that the entire tumour isn’t completely destroyed, leading to recurrence. In such cases, the ablation procedure may be repeated a few week after the initial session.
Chemoembolisation is a technique used to deliver chemotherapy drugs directly into a cancerous tumour. The chemotherapy delivered in this way also cuts off the tumour’s blood supply. Deprived of oxygen and nutrition, the cancer cells die. Transarterial Chemoembolisation (TACE) is a specific type of chemoembolisation in which the hepatic artery is blocked. This technique is especially effective in the treatment of liver cancer. TACE is only recommended to patients who have good liver function, and no free fluid in the abdomen (ascites). TACE may be used to treat cancers that can’t be removed surgically, or treated with ablation therapy. It is usually used to shrink liver tumours that are larger than 5cm, while the patient is waiting for a liver transplant (bridging therapy).
TACE is performed by an interventional radiologist, while the patient is under local or general anaesthesia. A catheter is inserted into an artery in the groin (femoral artery), and manoeuvred up into the hepatic artery in the liver. A dye is injected into the catheter to make visualising the arteries through X-rays easier. The artery feeding the liver tumour is identified. The catheter is then guided into the feeder artery. Once in place, a gelatine sponge soaked in chemotherapy drugs or drug-eluting beads are injected into the artery. The injected material blocks the artery, cutting off the tumours blood supply, while simultaneously releasing chemotherapy into the tumour.
TACE is effective at hampering the growth of liver tumours and causing shrinkage in about two- thirds of cases treated. It can be used in combination with tumour ablation or radiation therapy, depending on the size and location of the liver tumour. Side effects of TACE include post- embolisation syndrome, bruising or bleeding at the catheter-insertion site, hair loss and inflammation of the call bladder or bile ducts.
Transarterial radioembolization (TARE) is an advanced interventional radiology technique to treat liver cancers. This technique uses radioactive microbeads to cut off the liver tumour’s blood supply, and deliver targeted radiation to kill the cancer cells. It is an effective two-prong approach to treat liver cancer patients who are not eligible for surgery or a liver transplant. TARE is effective at treating large liver tumours or a cluster of multiple liver tumours.
TARE is similar to TACE in its approach. However, research has indicated that patients treated with TARE protocols have better quality of life after recovery. In general, patients tolerate TARE better than TACE, resulting in lower pain, fever and deteriorating of liver function. TARE also results in lower rates of post-embolisation syndrome compared to TACE. Although TARE has a higher cost per procedure, overall patients end up with lower treatment costs due to fewer sessions, less time spent at the hospital, less side effects and reduced pain management needs.
Liver cancer can sometimes block the bile duct. The obstruction causes the bile duct in the liver to dilate and affects liver function. It can cause jaundice and severe itching. Percutaneous trans- hepatic biliary drainage (PTBD) is a minimally invasive procedure that is performed to diagnose and treat bile duct obstructions. It is performed under real-time image guidance, making it an interventional radiology procedure. The procedure is performed under local anaesthesia. The radiologist will insert a thin needle through the skin of the abdomen, into the bile duct in the liver. A fluoroscopic contrast dye is injected into the bile duct so the X-ray can distinguish it clearly from surrounding tissues. This also helps locate the obstruction easily. Once the blockage is located, the biliary drain (a thin flexible tube with perforations along the side) is inserted into the bile duct. The backed-up bile is drained into a bag outside the abdomen, similar to a colostomy bag. This bag will need to be drained multiple times a day. The duration for which the biliary drain needs to be kept in place varies from patient to patient. To prevent further liver damage due to the obstruction, a stent may be placed. PTBD can improve the patient’s quality of life and reduce risk of complications due to the obstruction. However, it is associated with other risks such as haemorrhage, bile leaks, catheter dislodgement and pancreatitis.
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Interventional radiology techniques have gained popularity and wide acceptance among medical practitioners as a complementary strategy to surgical resection for treating cancerous liver tumours. Both approaches can be effective, however, interventional radiology offers some important benefits over surgical resection:
Minimally Invasive – The techniques used target the tumour through catheters or needles under x- ray fluoroscopy or other real-time image-guided techniques. They only require small incisions or punctures in the skin, instead of large incisions. This minimises blood loss and pain. There is a lower risk of infection too.
Targeted Treatment – IR techniques generally deliver treatment like chemotherapy directly to the tumour. This targeted treatment is very effective, and minimises damage to surrounding tissues or other body parts. Smaller doses of chemotherapy can be given, while still achieving superior results.
Lower Recovery Time – Interventional radiology procedures are less invasive and often allow for patient discharge on the same day or the next day. Surgical resection often requires a much longer hospital stay.
Lower risk of complications – Since the IR procedures are minimally invasive, they often result in fewer complications such as bile leaks, wound infections etc.
Suitable for high-risk patients – Interventional radiology procedures are a good option for patients who aren’t eligible for surgery. There is less risk involved for patients with liver cirrhosis, old age or poor general health.
Trust in the experienced and highly trained professionals at Kauvery Hospital, with branches across Chennai, Hosur, Salem, Tirunelveli, and Trichy, to provide advanced and effective Interventional Radiology techniques for liver cancer treatment. Our priority is your health, safety, and satisfaction through every step of your journey. Get in touch with us today and take the first step towards a healthier future.
What is Interventional Radiology (IR) in liver cancer management? IR uses minimally-invasive, image-guided techniques to treat liver cancer without large incisions or extensive surgery.
How does ablation work for liver cancer? Ablation destroys cancer cells by using extreme heat (or cold) delivered through a needle probe, targeting the tumor directly.
What is TACE and how does it treat liver cancer? TACE (Transarterial Chemoembolization) delivers chemotherapy directly to the tumor and blocks its blood supply, causing the cancer cells to shrink.
How does TARE differ from TACE? TARE (Transarterial Radioembolization) uses radioactive beads to deliver targeted radiation to the tumor, often resulting in fewer side effects and better recovery.
What is PTBD and when is it used? PTBD (Percutaneous Trans-hepatic Biliary Drainage) relieves bile duct blockages caused by liver cancer, helping to improve liver function.
What are the benefits of IR over surgical resection for liver cancer? IR offers targeted treatment with minimal incisions, less blood loss, shorter recovery times, and fewer complications, making it ideal for high-risk patients.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
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