Endovascular and biliary therapeutics in liver cancer and metastases are applied at Hospital da Luz Aveiro While adapting to the latest necessities of the oncologic patient, Hospital da Luz Aveiro offers now a highly valuable functionality in the field of oncology. In result of the acquisition of the most recent imaging technology, interventional radiology has now the capability to apply endovascular and biliary therapeutics, through a minimally invasive process. The area of oncology, namely in liver neoplasms, counts with the most recent and innovative vascular intervention, in what concerns the treatment of hepatic metastases, hepatocellular carcinoma and bile duct carcinoma. Now it is possible to offer dedicated treatment in articulation with chemotherapy, immunotherapy (both long available in this establishment) and surgery. In these interventional radiology techniques, with a small puncture of a blood vessel or directly on the skin, it is possible to access a tumor (catheterism) and provide treatment with chemotherapy directed precisely to that tumor and/or reduce its vascularization. This is done using medical devices smaller than a millimetre, which occlude the blood vessels (embolization). These can, simultaneously, carry a chemotherapeutic pharmac and act locally on the tumor, in a much more effective way. These devices can be microparticles, microspheres or metallic nets (endoprostheses or stents). In what concerns benign tumors, this embolization technique is also often used in the treatment of uterine myomas and in the treatment of prostate benign hypertrophy. In this context, Hospital da Luz Aveiro offers now the most modern and innovative instruments in cancer treatment, to be used by articulated teams. To understand and integrate this new concept offered to our patients, we must learn more about the epidemiology of these tumors and the more modern standard treatments. Liver tumors Metastases are the more frequent form of liver cancer. In advanced stages, 30 to 70% of patients with cancer have metastases of the liver. Colorectal cancer is by far the type of cancer that originates more liver metastases. By the time they are diagnosed, 25% of patients have liver metastases. And 25 to 30% of patients will probably develop metastases in the years to follow, even after surgery or colorectal tumor removal. In what concerns primary liver cancer, the numbers indicate about 782 thousand new cases at world level, in terms of incidence, and 745 thousand cases in terms of mortality. It is the sixth more common digestive tumor. In Portugal, the annual incidence is of about 1000 new cases and 900 cases of mortality. It is predominant in individuals with chronic hepatitis C or B or simply associated to cirrhosis. Available treatments In initial stage, the purpose is the cure and the most common processes used are: Surgical removal of tumor and metastasis Liver transplant (in case of primary liver cancer) Local ablation (destruction by heat – puncture technique guided by computed tomography or ultrasound) In intermedium or advanced stage, the purpose can be merely palliative (to reduce the tumor and avoid its development in the liver) or allowing it to become curable (reducing the tumor and making it operable or transplantable). Here, embolization (release of microscopic spheres in liver blood vessels, to occlude the blood circulation to tumors or apply localized chemotherapy) can have an essential role as adjuvant of other local treatments, converting non-operable tumors in operable ones. Embolization, when associated to chemotherapy is designated chemoembolization. When associated to radiotherapy/brachytherapy is designated radioembolization. Also in this stage of the disease, if there is obstruction of the biliary flow (jaundice – yellow tone of the skin and mucous membranes) by the progression of these tumors or due to primary tumor of the biliary duct, such techniques guided by imaging (percutaneous transhepatic cholangiography and bile duct stenting, among others) allow the reestablishment of biliary flow, previously obstructed and impeding chemotherapy or tumor surgery. Image : Dr Belarmino Gonçalves (interventional radiology) and nurse João Paulo Belo.
