Flashcards in EXAM #2: INTERVENTIONAL RADIOLOGY Deck (44):
1
What is radiofrequency ablation?
Sound waves to increase heat and kill tumors
2
What is microwave ablation?
Use of microwaves to kill tumors
3
What is cryoablation?
Freezing of tumors to kill them
4
What is the most likely diagnosis for a 70 year-old with a renal mass?
Renal cell carcinoma
5
What do you need to do after identifying a renal mass on CT?
Biopsy
6
Describe how cryoablation works.
- Delivery of cold to the tumor
- Formation of intracellular ice and osmotic COAGULATIVE necrosis
1) Freeze= cell shrink/ dehydration w/ pore formation
2) Thaw= rush of water back into cell via pores-->cells burst
3) Delayed= immune response (macrophages) to damaged tissue
7
What are the advantages of cyroablation?
Ability to monitor ablation zone (vs. thermal ablation)
8
What are the disadvantages of cryoablation?
Cryoshock
9
What is cryoshock?
Systemic inflammatory response leading to:
- Hyotension
- Respiratory compromise,
- DIC
- Mutliorgan failure
10
What is the Jules Thompson principle?
Use of Helium and Argon to cause freezing
11
What is the most common type of renal cell carcinoma (RCC)?
Clear cell variant (83-88%)
12
How common is renal cell carcinoma overall (RCC)?
Only seen in 2% of all adult cancers
13
When is RCC typically discovered?
Incidentally during imaging for other indications
14
What is stage 1A RCC?
Tumor less than 4cm confined to kidney
15
What is the treatment of choice for stage 1A RCC?
Laproscopic partial nephrectomy
*****Note that this is shifting to cryoablation*****
16
What is the secondary treatment of choice for 1A RCC in poor surgical candidates?
CT or US guided cryoablation
17
What are the advantages of cryoablation?
1) Outpatient procedure
2) Doesn't require general anesthesia
3) Preserves renal function/ nephron sparing
4) Few complications
5) Can be repeated for residual tumor
18
What is a hepatoma?
Malignant tumor that is derived from hepatocytes
*****Also called hepatocellular carcinoma*****
19
What patient population is highly susceptible to develop a hepatoma?
Alcoholics/ cirrhosis
20
What is unique about a hepatoma from a diagnostic standpoint?
Doesn't require biopsy, can be diagnosed with imaging only
21
What does ECOG stand for? What is an ECOG score?
Eastern Cooperative Oncology Group
- This is a score of how well a patient functions
- 0 is the highest i.e. normal, 5 is dead
- Only intervene in patients with a score of 0,1, or 2
22
What is the treatment of choice for hepatoma?
Local regional therapy
23
What are the risk factors for hepatocellular carcinoma i.e. hepatoma?
1) Hepatitis (B or C)
2) Alcoholic liver disease/ non-alcoholic fatty liver disease (NAFLD)
3) Metabolic Syndrome
4) Aflatoxin exposure
24
Where is HBV most common?
SE Asia
25
Where is HBC most common?
US
26
What is the prognosis for HCC without treatment?
Less than 10% 5-year survival rate
27
What are the local regional therapies available for HCC treatment?
1) Radio-frequency
2) Microwave
3) Transarterial therapy- chemoembolization
4) Radioembolization
5) Drug eluting bead embolization
28
What is Transarterial Chemoembolization (TACE)?
Delivery of concentrated chemotherapy in lipid medium combined with arterial embolization
29
Describe the "dual blood supply" of the liver.
1) Portal venous blood supply --major
2) Hepatic arterial supply --minor
30
How is the dual blood supply manipulated in TACE of a HCC?
Nearly all HCCs derive vascular supply from the the hepatic artery
31
When is TACE indicated for HCC?
Patients that aren't candidates for
- Transplant
- Resection
- Local ablation i.e. tumors greater than 3 cm
32
What are the side effects of TACE?
Postembolization Syndrome
33
What is postembolization syndrome?
- Nausea and vomiting
- Abdominal pain
- Fever
- Anorexia
- Fatigue
All seen secondary to embolization; thought to be secondary to immune response to ablation.
34
What is Drug-Eluting Bead Embolization?
Small beads loaded with chemotheraputic drug for delivery to HCC via the hepatic artery
35
What drug is most commonly used in Drug Eluting Bead Embolization?
Doxorubicin
36
What molecules are being agitated in radio-frequency and microwave ablation respectively?
Radiofrequency= ionic
Microwave= water
37
For HCC less than 3cm, what is the preferred treatment?
Radiofrequency or microwave ablation
38
What size of an ablative zone must be achieved with a HCC of 3cm?
4-5cm i.e. you want a normal margin or negative margin of at least 10mm
39
What is radioembolization?
Use of intra-arterially delivered microspheres emitting high dose radation
40
What is radioembolization or Y90 utilized for?
- Unresectable liver tumors
- Metastatic colorectal tumors
- Neuroendocrine tumors
41
Why is radioembolization a good option for unresectable liver tumors?
Microspheres emitting radiation preferentially lodge in noevasculature of the tumor
42
What is the advantage of radioembolization over TACE?
Can be performed on HCC with portal vein invasion, which in a contraindication for TACE
43
What is a malignant pleural effusion? What is the prognosis?
This is a pleural effusion related to a malignancy
- Lung
- Breast
- Ovarian
Prognosis is 4 months
44