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.
What happens to the patient after this procedure
is done?
The patient generally stays in the hospital overnight for observation. A
sandbag is placed over the groin to compress the area where the catheter was
inserted into the femoral artery. The nurses periodically check for signs of
bleeding from the femoral artery puncture. They also check for the pulse in the
foot on the side of the catheter insertion to be sure that the femoral artery is
not blocked as a result of the procedure. (Blockage would be signaled by the
absence of a pulse.)
Generally, the liver tests increase (get worse) during the two to three days
after the procedure. This worsening of the liver tests is actually due to death
of the tumor (and some non-tumor) cells. The patient may experience some
post-procedure abdominal pain and low-grade fever. However, severe abdominal
pain and vomiting suggest that a more serious complication has developed.
Imaging studies of the liver are repeated in six to 12 weeks to assess the size of
the tumor in response to the treatment.
Chemoembolization of the Liver (Trans-Arterial Chemoembolization or TACE)
How does chemoembolization differ from arterial
chemotherapy infusion?
Both techniques takes advantage of the fact that liver cancer (hepatocellular
carcinoma, HCC) is a very vascular (contains many blood vessels) tumor and gets
its blood supply exclusively from the branches of the hepatic artery.
Chemoembolization (TACE) is similar to intra-arterial infusion of chemotherapy.
But in TACE, there is the additional step of blocking (embolizing) the small
blood vessels with different types of compounds, such as gelfoam or even small
metal coils.
How does chemoembolization compare with arterial chemotherapy
infusion?
Thus, TACE has the advantages of exposing the tumor to high concentrations of
chemotherapy and confining the agents locally since they are not carried away by
the blood stream. At the same time, this technique deprives the tumor of its
needed blood supply, which can result in the damage or death of the tumor
cells.
The type and frequency of complications of TACE and
intra-arterial chemotherapy are similar. The potential disadvantage of TACE is
that blocking the feeding vessels to the tumor(s) may make future attempts at
intra-arterial infusions impossible. Moreover, so far, there are no head-to-head studies directly
comparing the effectiveness of intra-arterial infusion versus chemoembolization.
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.
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