Dr Ian McCafferty is a leading interventional radiologist and here he uses examples of cancer in different parts of the body to help explain how interventional radiology treatments benefit the patient.
There are a number of different techniques used to impart thermal energy to cause cancer cell destruction and death. They all use the same image-guided method for the placement of the needles. So, what does this actually mean for patients? Well let’s use a couple of examples of cancers in different parts of the body to help explain. Remember virtually all these techniques can be performed as a day case or a single night’s stay in hospital.
Renal cancer is common and often picked up by chance on a scan done for another reason. Traditionally this would have been treated by surgery with either a nephrectomy (removal of the kidney) or partial nephrectomy (removal or part of the kidney). However, now we can use thermal ablation by inserting a few small needles through the skin into the cancer under CT or ultrasound guidance and either heat or cool to cause thermal damage and eventually cause destruction of the cancer cells. There is no incision. Ablation targets the cancer with a safe margin that is able to preserve the maximal amount of normal kidney tissue. The dead tissue does not need to be removed by surgery. Generally, these types of treatment are used for small renal tumours, usually between 2 to 5cm in diameter.
Colorectal cancer is also a common cancer that can spread to the liver which is known as liver metastasis. This can be treated by surgery with liver resections often combined with chemotherapy administered via a cannula in a vein. Interventional oncology delivered by IRs can treat these liver lesions in two ways. We can use thermal ablation techniques as described above, typically microwave (MWA), to target and kill the metastasis using CT imaging to guide the needles. We can also treat these via a special tube, called a catheter, inserted via the artery in your groin to select the arteries that supply the metastasis. We can then send little particles into the artery to block it (embolisation) and kill the metastasis by starving it of blood. This can be combined with the administration of chemotherapy agents, which is known as TACE (trans-arterial chemotherapy embolisation). This allows a higher dose of chemotherapy to be administered with less side-effects. In some situations, we can administer small radioactive beads directly into the heart of the metastases to kill them, which is known as SIRT (selective internal radioembolisation therapy).
Both renal and colorectal cancers can spread to the lungs in a condition called lung metastases. If there are only one or two then potentially these can be removed with surgery, but generally speaking the treatment would involve chemotherapy via a cannula in an arm vein. We can now use the ablation techniques with image guidance in CT to treat these metastases and kill them in one treatment episode.
These new developments in interventional oncology delivered by interventional radiologists offers patients many new options for the treatment of their cancers. These treatments are delivered in a minimally-invasive way, without the need for invasive surgery and many nights in hospital with a long recovery period. The published results of these methods are on par with surgery and gives a fantastic choice to patients. Pictured below is a CT image of a left renal tumour having completed treatment with microwave ablation (single needle), and a picture of a number of cryotherapy needles placed through the skin to treat a large renal cancer, all performed as a day case.
If you have recently received a cancer diagnosis and would like to discuss potential treatment options, make an appointment with an expert.