Chemoembolization of the liver is carried out in accordance with the position of the tumor and the age of the patient. Most often, in order to completely anesthetize, local sedoanalgesia is sufficient. In some situations, anesthesia is required. Oncologists reach the hepatic veins through the inguinal ducts, which is facilitated by the use of angiographic equipment. The vessels and neoplasm are filled with special particles containing chemotherapeutic drugs. After this procedure, pain in the liver is possible.
It takes about two days to completely relieve side symptoms through mild medications in a hospital setting. Then patients return to normal life, they feel a slight fatigue for a week. In one percent of cases, chemoembolization of the liver in the presence of cancer can be complicated by bleeding, blood clots, or an infectious abscess. The deficiency of this body accounts for two and a half percent. The risk directly depends on the complexity of therapy.
Basic concepts
Chemoembolization of the liver is a combined treatment for malignant tumors. Such treatment involves local chemotherapy and an embolization procedure. Anticancer drugs are injected directly into the blood vessels that feed the cancer. In addition, a synthetic substance called an embolizing material, which holds the chemotherapy inside the tumor, is injected into the vessel that supplies the tumor with blood.
Subtleties of diagnosis
All patients will need tests to evaluate liver function. It is imperative to perform magnetic resonance imaging with intravenous administration of a contrast agent, and computer tomography is also required. In most situations, metastases are detected by performing a radiological study in combination with a biopsy. As part of the diagnosis of primary liver tumors and vascularized formation in patients with high levels of alpha-fetoprotein, a biopsy may not be necessary.
Indications
Assign chemoembolization of the liver in a number of the following situations:
- Treatment of inoperable tumors.
- Decrease in concentration of chemotherapy drugs in healthy tissue.
- Maintaining a high concentration of drugs in the tumor structure.
- Restructuring of various vascular formations.
Prospects for the development of the procedure depend on studies that give an objective assessment of the possibilities of combining it with radiation therapy. Comparing different methods of treating hepatic tumors is very difficult, since there is little accurate data. When choosing a therapy, one must rely on highly qualified specialists. And most importantly, you must be able to use such a modern method as chemoembolization of the liver. In Russia, it is not yet very common.
How to prepare?
A few days before the transarterial chemoembolization of liver tumors, the patient is consulted by a specialist related to interventional radiology, which will be treated. As a rule, immediately before the procedure, a series of blood tests are performed to evaluate the functions of the liver and kidneys along with the coagulation system.
It is very important to inform the doctor about all medicines taken by the patient, including herbal origin, as well as allergies, especially local anesthetics, as well as all kinds of drugs for anesthesia or iodine-containing contrast material. For a short time before the procedure, you must stop using Aspirin or other blood-thinning medications, as well as anti-inflammatory non-steroid drugs. In addition, it is necessary to inform the doctor about recently transferred pathologies or other dangerous conditions.
Women need to inform the attending doctor and radiologist about the possibility of pregnancy. As a rule, a study using x-ray radiation during pregnancy is not carried out in order to avoid a possible negative effect on the fetus. If there is a need for an X-ray examination, all measures should be taken to minimize the effect of such radiation on the developing baby.
The doctor should provide the patient with detailed instructions on how to prepare for chemoembolization of the tumor on the liver, including reporting any required changes in the usual regimen of drug treatment. In the event that it is planned to use sedatives during therapy, then it is recommended to stop the use of food and liquids 8 hours before the procedure. In addition, a relative or friend should be invited to the hospital to help the patient get home after therapy. Chemoembolization is carried out in a hospital, which will require short-term hospitalization for several days (usually no more than 3 days). During treatment, you will need to wear a hospital special shirt.
Oily chemoembolization of the liver is a procedure consisting in the introduction into the lumen of a vessel that feeds a tumor, an oil radiological substance (most commonly used is lipiodol and etiodol) with further ligation of the vessel. This technique is the least effective, since there is a high probability of a new outbreak. In addition, oil embolization does not allow for a long time to clog the vessel, which often causes cases of incomplete death of the tumor.
What is the basis of the procedure?
Its antitumor effect is due to two factors. First of all, it is the delivery of very high doses of a chemotherapy drug directly to the tumor itself without the negative effect of this drug on the human body as a whole. In addition, the cessation of blood flow is noted in the tumor itself, which deprives it of the nutrients and oxygen that are necessary for cell growth. In addition, a delay in the antitumor drug is achieved within the neoplasm.
The liver acts as a unique organ, since it receives blood supply from two sources: the portal vein and the hepatic artery. Normally, about 75% of the blood enters the liver through the portal vein, while only 25% of the blood flow is provided by the hepatic artery. True, a tumor that grows in the tissues of the liver receives almost all the nutrition it needs through the hepatic artery.
It is in connection with this that the chemotherapy administered directly into the hepatic artery immediately enters the tumor and practically does not act on the healthy tissue of the organ. After clogging of such an artery is achieved, the tumor no longer receives blood supply, while blood flow remains in the liver due to the portal vein. In addition, chemoembolization of liver metastases ensures the maintenance of high concentrations of chemotherapy in the tissue formation for a sufficiently long time.
Algorithm
Minimally invasive procedures performed under visualization control such as chemoembolization should be carried out by a specialist who is versed in interventional radiology. Treatment is carried out in the operating room. Before therapy, the doctor performs a special x-ray examination, which helps to see the blood vessels that feed the tumor.
The patient is prescribed a drug called Allopurinol, which protects the kidneys from the negative effects of the chemical and decay products that are formed when the tumor dies. In order to prevent the occurrence of infections, antibiotics are used. Pain syndrome with nausea is controlled by special medications.
The doctor helps the patient to sit on a special operating table. In order to control heart rate, pressure and pulse, during the procedure, devices are used that connect to the patient's body. The nurse puts the system for intravenous infusion, with its help the patient is injected with sedatives. In other cases, general anesthesia is possible. The doctor makes a point incision of the skin or a small puncture.
Under control, a thin catheter that enters the femoral artery is inserted through the skin and advanced through it into the liver. After that, contrast material is injected intravenously and an initial series of X-ray images is taken. Following the precise placement of the catheter in the vascular branches that feed the tumor, a mixture of an antitumor drug and embolizing substance is injected through it. An additional series of images makes it possible to verify that the tumor has been carefully treated with a mixture of medicinal components.
After the procedure is completed, the catheter is removed, the bleeding is stopped, and a pressure dressing is applied to the wound. No suturing is required. After the procedure, the patient will need to be in bed under the supervision of a doctor for 6-8 hours. The duration of the procedure is usually about 90 minutes.
Diet after chemoembolization of the liver
After undergoing such treatment, the patient will need to follow a special diet to restore the liver. We are talking about that food that is easily absorbed and contains only the necessary vitamins with minerals. Diet must necessarily exclude all kinds of harmful elements. What do you need to eat to restore the liver? Attention should be paid to the following products.
Cottage cheese is a source of complete protein. Therefore, doctors recommend patients with liver disease to use it in the amount of 200 grams. Low-fat cottage cheese is rich in choline to restore cells, they break down fats. In addition, lactic acid in the curd prevents the formation of putrefactive products in the intestine, which leads to unloading of the liver. Such microorganisms partially help break down proteins with milk lactose.
What other foods help the liver recover?
Beetroot is a source of betaine and a very useful food for liver repair. It is a lipotropic component that helps cells use fat and improve lipid metabolism in the body. In addition, beets have fiber that binds toxins and removes them from the intestines.
Pumpkin, just like pumpkin seed oil, is a product that helps the liver recover. Contains fiber, which speeds up the elimination of toxic substances and hormones bound by the liver.
After chemoembolization of the liver, it is imperative that you include fresh cabbage, which is a source of vitamin U, that is, lipoic acid, in the diet. This combination, along with choline and betaine, can improve fat metabolism in cells, helping to heal stomach ulcers. Cabbage is especially useful for fatty degeneration. In case of intolerance to fiber, you can use only cabbage juice.
Flaxseed, just like olive oil, has a choleretic effect, improving digestion, inhibiting putrefactive processes. Such foods contain unsaturated fatty acids that help impaired fat metabolism. In the diet, following a diet should include just such oils.
Apples contain pectin, which binds toxic components in the intestines. The diet may also include baked apples.
Berries also act as a source of pectin. Blueberries with cranberries and other berries contain benzoic acid, which has an antiseptic effect in the intestines, preventing all sorts of putrefactive processes.
Vegetables are a source of fiber, which can bilirubin - sulfated hormones in the liver accelerate its excretion.
With a deficiency of dietary fiber, harmful microscopic organisms decompose compounds that were in a safe form. As a result, such substances can again be absorbed into the bloodstream, enter the portal vein of the organ, providing it with additional work and enhancing general intoxication.
Enteral nutrition is equally important. Ready-made mixtures in an assimilable form are often prescribed to patients who are in a state of exhaustion after chemotherapy or surgery to remove the tumor. The diet can be based on mixtures like Nutrison, Nutridrinka and more.
Temperature after chemoembolization of the liver
Within one week after such treatment, patients may experience a slight increase in temperature along with weakness and a decrease in appetite. This condition often persists for up to two weeks, and sometimes even longer.
In general, this side effect of chemoembolization of the liver is a sign of normal recovery processes. It is necessary to contact the treating doctor in case of changes in the intensity or nature of pain, at high temperature or against the background of any unusual symptoms.
Severe pain
According to patients' reviews of liver chemoembolization, most of them after the described treatment develop a series of side effects called postembolization syndrome. It usually includes intense pain along with nausea, vomiting, and fever. The most common side effect is usually pain, which is associated with the cessation of blood flow within the tumor. Severe pain after chemoembolization of the liver can be controlled by using painkillers in tablets or injections.
Recovery and what should be expected?
Within one month after this procedure, patients should be regularly examined by a doctor to assess the course of the entire recovery period. The examination, as a rule, includes the delivery of blood tests, computed tomography or MRI, which makes it possible to assess changes in size and the general behavior of the tumor, which was affected the day before.
In the case of bilateral localization of the tumor in the liver, therapy usually consists of two stages. In this case, a month after the first procedure, during which one of the formations is exposed to the drugs, the second stage of chemoembolization is carried out.
Computed tomography or MRI after therapy is mandatory every 3 months, which makes it possible to judge the rate of decrease in tumor volumes and the appearance of new pathogenic foci. Repeated chemoembolization due to the occurrence of a new formation or relapse should be required no earlier than after 10-14 months. Such a procedure can generally be repeated several times over a number of years: as long as technically possible. The frequency of treatment also depends on the general condition of the patient. Patient reviews on liver chemoembolization are presented at the end of the article.
If legs swell
Patients often ask why swollen legs after chemoembolization of the liver? In this case, one of the conditions is the following: you need to eat less salt, a maximum of 3 grams per day. To use with this side effect is recommended no more than 1.5 liters of water per day, including soups. Dried apricots are considered useful along with apricots, cucumbers and pumpkin.
With liver chemoembolization, according to patients, the frequency of this side effect is very high.
Natural diuretics (diuretics) include products in the form of milk, cottage cheese, honey, juice of viburnum, lemon, apples, tea (especially green varieties). It is important to additionally take vitamins of the groups “B”, “A”, “P”, which strengthen vessels and capillaries. They are contained quite a lot in citrus fruits, in sea buckthorn, carrots, black currants, apples and other fruits and vegetables.
It helps with swollen feet massage, ointments, for example, "Wasonite", "Detralex" and others. A contrast shower does not hurt. In that case, if a person has to sit a lot, you should try to often touch with your toes, making circular movements with your feet, standing on tiptoe for a couple of seconds (15-20 times). In the evenings, for 10 minutes you should go to bed and throw your legs on the wall, and then vigorously rub them from the feet directly to the knees.
Below we consider reviews of liver chemoembolization from patients.
Reviews
Such a procedure as chemoembolization, had to go through many. People write that doctors usually prescribe it in cases where a liver tumor is considered inoperable.
It is reported that most often the application of this technique is effective and the blood flow to the neoplasm is actually able to stop. But it also happens that to achieve the desired result, specialists are forced to re-carry out such treatment.
In reviews of liver chemoembolization, patients often complain that after going through they had to face severe pain and fever. But this symptomatology is temporary and is considered a standard adverse reaction.