Interventional radiology (IR) is the use of radiation (such as x-rays) or other imaging technologies (such as ultrasound and magnetic resonance imaging) to diagnose or treat disease.
At MMC Cancer Institute, IR offers minimally invasive procedures for diagnosing and treating cancer and cancer-related complications. These procedures are becoming increasingly important in the management of patients with cancer, and MMC Cancer Institute has the largest and most experienced team of doctors in Maine who are specially trained as interventional radiologists.
Types of Cancer Treated
Interventional radiology plays a role in the treatment of various types of cancer, including:
- Liver cancer (primary and metastatic)
- Kidney cancer
- Lung cancer
IR also helps alleviate the pain caused by certain cancers that have metastasized (spread) to the bones without surgery, as well as stabilize bones that have been weakened by metastatic cancer. We treat spine fractures, for example, with cement injection called kyphoplasty or vertebroplasty.
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Diagnosing Cancer with IR
Some diseases have a similar appearance on imaging studies such as a Cat scan. Differentiating between benign (not cancer) and malignant (cancer) conditions is essential for determining the best course of treatment, and IR can help to diagnose or exclude cancer in several ways:
- Image-guided biopsy
Under fluoroscopy, Cat or ultrasound guidance, small needles are placed in a suspicious area to take tissue samples for testing (biopsies). With the precision of imaging guidance, the interventional radiologist can perform these biopsies while avoiding nearby vital structures such as blood vessels or the bowel. In addition, an image-guided biopsy avoids the risks, discomfort and longer recovery of a more invasive surgical biopsy procedure.
- Transjugular liver biopsy
This is a specialized procedure designed to decrease the risk of post-biopsy bleeding from the liver. A long, thin biopsy device is inserted into the jugular vein and moved into the right or middle hepatic (liver) vein, and biopsy samples can then be obtained from the "inside-out" of the liver.
- Image-guided fluid aspiration
In this procedure, either CT or ultrasound is used to place a small needle into an area where fluid has collected to determine whether the fluid is benign (not cancer) or malignant (cancer). If indicated, a drainage catheter may be placed at the same time, avoiding more invasive surgical drainage. Substances called sclerosing agents may also be injected into the catheter, decreasing the chances that fluid will build up again.
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Treating Cancer with IR
Recent IR advances include delivering chemotherapy and radiotherapy directly to a tumor:
- Transcatheter chemoembolization
In this procedure, chemotherapy medication is mixed with small sponge-like particles and injected into an artery that supplies a tumor. With this direct-delivery technique, much higher dosages of chemotherapy are delivered to the tumor with much less delivered to the rest of the body in comparison to conventional intravenous or oral administration. Plus, the injection of the sponge-like particles slows blood flow to the tumor, causing it to become hypoxic (starved of oxygen), weakening its defense against the chemotherapy.
- Chemoembolization is particularly useful in patients with primary liver cancer and those with certain types of cancer that have metastasized (spread) to the liver. Patients who undergo this procedure typically stay in the hospital for only one or two days, and they experience minimal side effects. The procedure may be repeated multiple times.
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Destroying Tumors with IR
Radiofrequency ablation (RFA), the process of destroying tumors using radiofrequency (RF), is a relatively new treatment method in which a small needle is attached to an RF device that heats the end of the needle. Under image guidance, the needle is inserted into a tumor and the RF energy causes the cancerous tissue to die (a process called necrosis). This procedure may be a treatment option for both primary and metastatic liver cancer if the tumor is small or there are fewer than three tumors. In the liver, RFA has equivalent success to surgical resection for small tumors (under 3 centimeters). RFA also is being offered to patients with primary or metastatic lung cancer who are unwilling or unable to have surgical resection.
Cryoablation is similar to radiofrequency ablation. Instead of "cooking" the tumor, however, this procedure freezes cancerous tissue, also causing it to die. Cryoablation is performed most often on small kidney tumors. While surgery remains the gold standard for treating these types of tumors, cryoablation has exhibited similar rates of success with little to no recovery time.
Both RFA and cryoablation procedures are performed under conscious sedation, and require only an overnight hospital stay.
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When a patient requires repeated doses of chemotherapy by injection, doctors may recommend the placement of a port or catheter (flexible tubing) to reduce the number of needle sticks. Interventional radiologists commonly perform image-guided placement of these ports and catheters. This is a less invasive alternative to surgical placement of the devices.
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Our IR Experts
The MMC Cancer Institute's five fellowship-trained interventional radiologists perform some of the most advanced diagnostic and therapeutic procedures currently available in cancer care, including:
percutaneous cryoablation - destroying tumors by freezing them in a nonsurgical manner;
transcatheter chemoembolization - a procedure in which the blood supply to the tumor is blocked and anticancer drugs are administered directly into the tumor, allowing a higher concentration of drug to be in contact with the tumor for a longer period of time;
and radiofrequency ablation (RFA) of tumors – the process of destroying tumors using radiofrequency
In fact, MMC Cancer Institute is the only hospital in the state to offer all three of these procedures, giving patients access to these state-of-the-art treatment methods. What's more, these procedures can be performed on an outpatient basis or during a short hospital stay, so recovery time is fast and side effects are minimal.
With specialized procedures such as these, experience counts. The more procedures a physician or surgeon performs, the better patient outcomes are. With Maine's most experienced team of interventional radiologists, MMC Cancer Institute demonstrates outstanding patient outcomes on a par with any major medical center in the U.S.
In addition, the MMC Cancer Institute's interventional radiologists are part of a multidisciplinary team of cancer specialists that includes medical, surgical and radiation oncologists, pathologists, nurses, care coordinators and other clinicians. This team meets regularly to review cases, sharing their expertise to create the best plan of care for each patient.
MMC Cancer Institute also engages in cutting-edge IR research, comparing newer, potentially more effective treatment approaches to the current standard of care.
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MMC Cancer Institute
22 Bramhall Street
Portland, Maine 04102-3175