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.
Dr. Schoenfield served as associate professor of medicine and consultant in gastroenterology on the faculty of the Mayo Clinic for seven years. He became a professor of medicine in residence at UCLA from 1972 to 1999 (now emeritus). He was the director of gastroenterology at Cedars-Sinai Medical Center in Los Angeles for 25 years, where he received the chief resident's teaching award, the president's award, and the pioneer of medicine award.
How is percutaneous alcohol injection done
and how does it work?
In this technique, pure alcohol is injected into liver cancers to kill the
cancer cells. The alcohol is injected through the skin (percutaneously) into the
tumor using a very thin needle with the help of ultrasound or CT visual
guidance. Alcohol induces tumor destruction by drawing water out of tumor cells
(dehydrating them) and thereby altering (denaturing) the structure of cellular
proteins.It may take up to five or six sessions of injections to
completely destroy the cancer.
Which patients are treated with percutaneous alcohol
injection?
The ideal patient for alcohol injection has fewer than three Hepatocellular
Carcinoma (HCC) tumors, each of which is:
well defined (distinct margins)
less than 3cm in diameter
surrounded by a shell consisting of scar tissue
(fibrous encapsulation)
not near the surface of the liver
Additionally, patients with HCC undergoing alcohol injection should have no
signs of chronic liver failure, such as ascites or jaundice. (Patients with
liver failure would not be able to tolerate the alcohol injections.)
What are the side effects of percutaneous
alcohol injection?
The most common side effect of alcohol injection is leakage of alcohol onto
the surface of the liver and into the abdominal cavity, thereby causing pain and
fever. It is important that the location of the tumor relative to the adjacent
blood vessels and bile ducts is clearly identified. The reason for needing to
locate these structures is to avoid injuring them during the procedure and
causing bleeding, bile duct inflammation, or bile leakage.
REFERENCES: Garden OJ, Rees M, Poston GJ, Mirza D, Saunders M, Ledermann J, Primrose JN, Parks RW.
Guidelines for resection of colorectal cancer liver metastases.
Gut. 2006 Aug;55 Suppl 3:iii1-8.
Brown DB, Geschwind JF, Soulen MC, Millward SF, Sacks D.
Society of Interventional Radiology position statement on chemoembolization of hepatic malignancies.
J Vasc Interv Radiol. 2006 Feb;17(2 Pt 1):217-23.
Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases.
Management of hepatocellular carcinoma.
Hepatology. 2005 Nov;42(5):1208-36.
Medically Reviewed by Paul Oneill, MD,
Board Certified Oncology
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.
While the patient's history and physical examination are the building blocks
of making a medical diagnosis, the ability to peer inside the body can be a
powerful tool. Ultrasound is an imaging technique that provides that
ability to medical practitioners.
What is an ultrasound?
Ultrasound produces sound waves that are beamed into the body causing return
echoes that are recorded to "visualize" structures beneath the skin. The ability
to measure different echoes reflected from a variety of tissues allows a shadow
picture to be constructed. The technology is especially accurate at seeing the
interface between solid and fluid filled spaces. These are actually the same
principles that allow SONAR on boats to see the bottom of the ocean.
What is ultrasonography?
Ultrasonography is body imaging using ultrasound in medical diagnosis. A
skilled ultrasound technician is able to...
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