Flashcards in EXAM #2: INTERVENTIONAL RADIOLOGY Deck (44)
What is radiofrequency ablation?
Sound waves to increase heat and kill tumors
What is microwave ablation?
Use of microwaves to kill tumors
What is cryoablation?
Freezing of tumors to kill them
What is the most likely diagnosis for a 70 year-old with a renal mass?
Renal cell carcinoma
What do you need to do after identifying a renal mass on CT?
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
What are the advantages of cyroablation?
Ability to monitor ablation zone (vs. thermal ablation)
What are the disadvantages of cryoablation?
What is cryoshock?
Systemic inflammatory response leading to:
- Respiratory compromise,
- Mutliorgan failure
What is the Jules Thompson principle?
Use of Helium and Argon to cause freezing
What is the most common type of renal cell carcinoma (RCC)?
Clear cell variant (83-88%)
How common is renal cell carcinoma overall (RCC)?
Only seen in 2% of all adult cancers
When is RCC typically discovered?
Incidentally during imaging for other indications
What is stage 1A RCC?
Tumor less than 4cm confined to kidney
What is the treatment of choice for stage 1A RCC?
Laproscopic partial nephrectomy
*****Note that this is shifting to cryoablation*****
What is the secondary treatment of choice for 1A RCC in poor surgical candidates?
CT or US guided cryoablation
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
What is a hepatoma?
Malignant tumor that is derived from hepatocytes
*****Also called hepatocellular carcinoma*****
What patient population is highly susceptible to develop a hepatoma?
What is unique about a hepatoma from a diagnostic standpoint?
Doesn't require biopsy, can be diagnosed with imaging only
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
What is the treatment of choice for hepatoma?
Local regional therapy
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
Where is HBV most common?
Where is HBC most common?
What is the prognosis for HCC without treatment?
Less than 10% 5-year survival rate
What are the local regional therapies available for HCC treatment?
3) Transarterial therapy- chemoembolization
5) Drug eluting bead embolization
What is Transarterial Chemoembolization (TACE)?
Delivery of concentrated chemotherapy in lipid medium combined with arterial embolization
Describe the "dual blood supply" of the liver.
1) Portal venous blood supply --major
2) Hepatic arterial supply --minor