Dr. Fong is the Medical Director of the USC Liver Transplant Program and Associate Professor of Medicine at the USC Keck School of Medicine. He obtained his medical degree from the University of Southern California and completed his residency in Internal Medicine at Los Angeles County-USC Medical Center. He is board certified in Internal Medicine and the subspecialty of Gastroenterology.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Arterial chemotherapy infusion of the liver and chemoembolization of the
liver (transarterial chemoembolization or TACE) are similar procedures that are
used for the treatment of liver cancers. In both procedures, chemotherapy is
injected into the hepatic (liver) artery that supplies the liver tumor. The
difference between the two procedures is that in chemoembolization, additional
material is injected to block (embolize) the small branches of the hepatic
artery.
Arterial Chemotherapy Infusion of the Liver
Why is the chemotherapy
injected into the hepatic artery?
The normal liver gets its blood supply from two sources: the portal vein
(about 70%) and the hepatic artery (30%). Primary liver cancer, also known as
hepatoma or hepatocellular carcinoma (HCC) gets its blood exclusively from the
hepatic artery. Making use of this fact, investigators have delivered
chemotherapy agents selectively through the hepatic artery directly to the HCC
tumor. The theoretical advantage is that higher concentrations of the agents can
be delivered to the tumors without subjecting the patients to the systemic
toxicity of the agents.
What are the side effects and benefits of
arterial chemotherapy infusion?
In reality, however, much of the chemotherapeutic agents
does end up in the rest of the body. Therefore, selective intra-arterial chemotherapy
can cause the
usual systemic (body-wide) side effects. In addition, this treatment can result
in some regional side effects, such as inflammation of the gallbladder
(cholecystitis), intestinal and stomach ulcers, and inflammation of the pancreas
(pancreatitis). HCC patients with
advanced cirrhosis may develop liver failure after this treatment. Well then,
what is the benefit of intra-arterial chemotherapy? The bottom line is that
fewer than 50% of HCC patients will experience a reduction in tumor size.
Just how is arterial chemotherapy infusion
done?
An interventional radiologist (one who does therapeutic procedures) usually
carries out this procedure. The radiologist must work closely with an oncologist
(cancer specialist), who determines the amount of chemotherapy that the patient
receives at each session. Some patients may undergo repeat sessions at six- to 12-week intervals. This procedure is done with the help of fluoroscopy (type of
x-ray) imaging. A catheter (long, narrow tube) is inserted into the femoral
artery in the groin and is threaded into the aorta (the main artery of the
body). From the aorta, the catheter is advanced into the hepatic artery. Once
the branches of the hepatic artery that feed the liver cancer are identified,
the chemotherapy is infused. The whole procedure takes one to two hours, and
then the catheter is removed.
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Biologic rhythms, or biorhythms, are how our bodies respond to the regular phases of the sun, moon, and seasons. A medical chronobiologist studies how the "body clock" or biorhythms affect diseases and how the body clock responds to treatment of diseases and conditions at different times of the day.
"Just a spoonful of sugar... " goes the song. But what happens to that sugar once you swallow it? In fact, how is it that you are able to swallow it at all? Your digestive system performs amazing feats every day, whether you eat a double cheeseburger or a stalk of celery. Read on to learn what exactly happens to food as it makes its way through your digestive system.
What Is Digestion?
Digestion is the complex process of turning the food you eat into the energy you need to survive. The digestion process also involves creating waste to be eliminated.
The digestive tract (or gut) is a long twisting tube that starts at the mouth and ends at the anus. It is made up of a series of muscles that coordinate the movement of food and other cells that produce enzymes and hormones to aid in the breakdown of food. Along the way are three other organs that are needed for digestion: the liver, gallbladder, and the ...
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