Interventional radiology (IR) is a procedural specialty defined by image guided, minimally invasive techniques. IR interacts with most medical specialties from the brain to the tips of the toes as well as anything in between. IR is constantly changing and evolving because it can offer treatments that have less risk over traditional techniques. For example, procedures that required large operations involved a week in the hospital and a month of recovery are now done on an outpatient basis, enabling patients to go home the same day with less pain and shorter recovery.
There are a many approaches used with interventional radiology to diagnose and treat cancer. To diagnose cancer, interventional radiologists perform biopsies using image guided, minimally invasive techniques to extract tissue from an area based upon a prior image or clinical concern to determine if cancer is present. From there a physician will provide a recommendation on treatment. There are a multitude of approaches interventional radiologists use to treat patients with cancer. In one example, an interventional radiologist can locate and treat a tumor in the body using hair thin wires to guide catheters to a tumor. Once a tumor is located, the physician will use all sorts and manners of particles and devices to cut off its blood supply or deliver radiation therapy, which will kill the tumor completely or decrease its size. This can be used to slow or reverse tumor growth or to stop dangerous bleeding from certain tumors.
Thermal ablation is another cutting-edge technique used to destroy abnormal tissue. For example, microwave ablation can be used to treat types of cancers in the kidney and liver. With this sophisticated technique, an interventional radiologist will insert a probe using image guidance into the body through a tiny skin nick. The probe will contain either a cooling element in cryoablation or heating element in microwave ablation, which will freeze or burn a tumor to destroy it.
In addition, interventional radiologists assist medical oncologists with inserting mediports in patients who receive chemotherapy or immunotherapy as part of their cancer treatment.
Traditionally, the standard treatment for colon cancer patients with large tumors and a good operative risk profile was surgery. However, this is changing with interdisciplinary approaches including medical oncology, radiotherapy, and thermal ablation techniques. Microwave ablation therapy is a minimally invasive technique used by interventional radiologists to treat colon cancer patients, particularly with tumors that are less than 3 cm in size and few in number. With this cutting-edge technique, tumors can be treated in one session, enabling a patient to return home the same day. While surgery and microwave ablation render the same outcomes for small tumors, there are fewer complications with the latter techniques.
Angioplasty and stenting are minimally invasive techniques used by interventional radiologists to restore blood flow in vessels throughout the body. These approaches are used to treat certain lung cancer patients with large tumors compressing the veins in the chest. Using this technique, an interventional radiologist will thread a wire beginning in the groin through the veins of the pelvis into the vena cava, across the heart into the superior vena cava, all the way up into the base of the neck. With the wire in place, a balloon is used to open the space so a stent can be placed, enabling blood to resume flowing properly. From there a lung cancer patient can begin treatment.
Most interventional radiology procedures require moderate sedation consisting of a combination of fentanyl and versed. Some patients may remember, while others may not, or just experience drowsiness. For example, microwave ablation will often require anesthesia because this type of procedure can be more painful. Most vascular procedures require sedation while superficial biopsies close to the skin will only require local anesthesia.
Dr. Steffen Haider, MPH, recently spoke about interventional radiology and its use in diagnosing and treating cancer at a “What’s Up Doc?” presentation hosted by Concord Hospital Trust’s Donor Lecture Series. The monthly series, supported by the Walker Lecture Fund, features members of Concord Hospital’s medical staff speaking to Concord Hospital Trust donors about new and innovative medical treatments and services. You can watch Dr. Steffen’s presentation on Concord Hospital’s YouTube channel at youtube.com/concordhospital.
Dr. Steffen Haider, MD, MPH, interventional radiologist at Concord Hospital, discusses leading edge treatments to help cancer patients using minimally invasive techniques.