Frequently Asked Questions About Chemoembolization
What is chemoembolization?
Chemoembolization is used to treat certain types of liver cancer, whether the tumor began in the liver or spread to it from another organ. It involves injecting chemotherapy directly into the blood vessles which feed the liver tumor.
How does chemoembolization work?
Under X-ray guidance, a small catheter is inserted through a needle into the femoral artery, located in the groin. The radiologist then threads the catheter up through the aorta and into the artery in the liver that feeds the tumor. Chemotherapy, mixed with a special oil which is taken up specifically by the tumor, is then injected directly through the catheter into this artery and into the tumor. Immediately afterwards, tiny protein sponge particles are injected which get caught up in the tiny blood vessels and block them. The intent, therefore is to kill the tumor in two ways: by giving a high concentration of chemotherapy directly into the tumor, and by cutting off the blood supply to the tumor. The entire procedure generally takes about two hours.
What are the risks and side effects of chemoembolization?
There are many possible side effects from chemoembolization, since it involves both chemotherapy and the possible destruction of normal liver tissue as well as tumor. Most people experience some pain, fever, loss of appetite and fatigue. They are generally in the hospital for three to five days but then feel quite tired and may have low grade fevers for up to four weeks afterwards. It is possible that more serious side effects may occur.
Side effects from chemotherapy may include: nausea; hair loss; decrease in white blood cells; decrease in platelets; anemia; weakening of the heart muscle; diarrhea; mouth sores or allergic reactions.
Cutting off the blood supply to the tumor may cause abdominal pain, nausea, vomiting, fever, bloating, fluid accumulation in the abdomen or in the lung, confusion, infection, pneumonia, damage to the gallbladder (which may need to be removed), temporary kidney damage, worsening liver function, and death.
The overall risk of serious complication is related to a person's general underlying health, as well as the overall function of their liver. People with jaundice, severe cirrhosis, blockage of the portal vein in the liver, or very rapidly growing tumor are at significantly higher risk for complications and death. People without these problems usually tolerate the chemoembolization much more easily.
What should I know before I am admitted?
- No food or drink after midnight (sips of water are allowed).
- Take all usual medications as prescribed. If you are taking Coumadin or Glucophage please speak with your physician.
- Do not take any aspirin for at least one week before the procedure.
- If you are on insulin, take half of the NPH dosage, and no regular.
What can I expect when I am in the hospital?
In some instances, you will be admitted to the hospital on the day before your procedure. Adequate hydration is required to protect the kidneys during chemoembolization. Therefore, an intravenous will be started and you will receive intravenous fluids in preparation for the procedure.
In addition, you will be given a medication called Allopurinol which is used to further protect the kidneys from the chemotherapy and the products produced by the dying tumor cells.
Your nurse will instruct you in how to use a breathing apparatus called an incentive spirometer. The purpose of this is to help you inflate your lungs so that you will not develop pneumonia.
Prior to the procedure, you will be given additional medications to prevent nausea and pain; you will also be given an antibiotic to prevent infection.
After the procedure, you may experience some side effects. If you do experience pain in the area of your liver or if you become nauseated, medication will be made available to you. If you experience confusion or disorientation after the procedure, please report this to your doctor or nurse immediately.
After the chemoembolization, you may be given a medication called Lactulose. This medication helps the body rid itself of metabolic waste that is usually excreted through the liver. This drug may cause you to have loose stools for several days.
It is important that you spend as much time as possible in bed for one or two days after the chemoembolization to improve the blood flow to your liver.
In the days following your procedure, you may experience pain or high fevers. This is a result of the tumor breakdown and is normal after chemoembolization. You will be given Tylenol to alleviate the fevers and other medication as needed for the pain.
What can I expect following Chemoembolization?
The most common problem following a successful chemoembolization is extreme fatigue for three to four weeks following the procedure. This is a result of the liver not working normally as it regenerates. Appetite will be poor and many people lose a significant amount of weight before it starts to return. Fevers up to 101 degrees may last for one to two weeks and these can be treated safely with Tylenol. The liver pain usually improves within the first week; rarely, people with very large tumors or with tumors near the outside surface of the liver may require narcotics for longer periods.
In general these are all signs of a normal recuperation following chemoembolization, as the tumor is dying and shrinking within the liver. During the first month following embolization, it is important to check in routinely to let the physician know how your recovery is progressing. If the pain suddenly changes in degree or character, or if the fever becomes suddenly higher than it had been, it is important to let your physician know right away. Any other unusual change should also be communicated immediately.
Most people are back to their usual state of health one month after the procedure. They then return for a CT scan and blood tests to determine the size of the treated tumor and how well the chemoembolization worked. If there is tumor on both sides of the liver, only one half will be treated at first, and after one month, patients will return to the hospital for the second half of the chemoembolization. In that case, a CT scan will be done after the completion of the second chemoembolization.
CT scans will be performed every three months thereafter to determine how much the tumors ultimately shrink, and to see if and when any new tumors arise in the liver. The average time before a second round of chemoembolization is necessary (because of new tumor) is between eight and twelve months. Chemoembolization can be repeated many times over the course of many years, as long as it remains technically feasible and the patient continues to be healthy enough to tolerate repeat procedures.