Chemoembolization of the liver is carried out in accordance with the position of the tumor and the age of the patient. Most often, for the purpose of complete anesthesia, it is sufficient to perform local sedoanalgesia. In some situations anesthesia is required. Oncologists reach the hepatic veins through the inguinal ducts, which is facilitated by the use of angiographic equipment. Vessels and neoplasms are filled with special particles containing chemotherapeutic drugs. After such a procedure, pain in the liver is possible.
It takes about two days to completely relieve side symptoms with light medications in a hospital setting. Then patients return to normal life, feel a slight fatigue within a week. In one percent of cases, liver chemoembolization in the presence of cancer may be complicated by bleeding, blood clots, or an infectious abscess. The share of insufficiency of this body accounts for two and a half percent. risk directlydepends on the complexity of therapy.
Basic concepts
Chemoembolization of the liver is a combined treatment for malignant tumors. Such treatment involves local chemotherapy and an embolization procedure. Drugs with antitumor effects are injected directly into the blood vessels that feed the malignancy. In addition, a synthetic substance called an embolizing material is also injected into the vessel that supplies the tumor with blood, which keeps the chemotherapy drug inside the tumor.
Subtleties of diagnosis
All patients will need to have tests assessing liver function. It is mandatory to perform magnetic resonance imaging with intravenous administration of a contrast agent, in addition, computed tomography will be required. In most situations, metastases are detected by performing a radiological examination in combination with a biopsy. As part of the diagnosis of primary liver tumors and vascular masses in patients with high AFP levels, a biopsy may not be necessary.
Indications
Chemoembolization of the liver is prescribed in a number of the following situations:
- Treatment of inoperable tumors.
- Reducing the concentration of chemotherapy drugs in he althy tissue.
- Maintaining a high concentration of drugs in the tumor structure.
- Restructuring of various vascular formations.
Prospects for the development of the procedure depend on studies that provide an objective assessment of the possibilities of its combination withradiation therapy. It is very difficult to compare different methods of treating hepatic tumors, since there are few exact data. When choosing a therapy, one must rely on the high qualifications of specialists. And most importantly, it is necessary to be able to use such a modern method as liver chemoembolization. In Russia, it is not yet very common.
How should you prepare?
A few days before the transarterial chemoembolization of liver tumors, the patient is consulted by a specialist related to interventional radiology, who will be treated. As a rule, a number of blood tests are carried out immediately before the procedure, allowing to evaluate the functions of the liver and kidneys, along with the work of the clotting system.
It is very important to tell the doctor about all medicines taken by the patient, including those of plant origin, as well as the presence of allergies, especially to local anesthetics, and in addition to all kinds of drugs for anesthesia or iodine-containing contrast material. A short time before the procedure, it is necessary to stop using Aspirin or other drugs that thin the blood, as well as non-steroidal anti-inflammatory drugs. In addition, it is necessary to inform the doctor about recent pathologies or other dangerous conditions.
Women should inform their doctor and radiologist about the possibility of pregnancy. As a rule, an examination using x-rays during pregnancy is not carried out in order toavoid possible negative effects on the fetus. If there is a need for an X-ray examination, all measures must be taken to minimize the effect of such radiation on a developing baby.
The doctor should provide the patient with detailed instructions on how to prepare for chemoembolization of a tumor in the liver, including any required changes in the usual drug regimen. In the event that it is planned to use sedatives during therapy, then 8 hours before the procedure, it is recommended to stop eating and drinking. In addition, a relative or friend should be invited to the hospital to help the patient get home after therapy. Chemoembolization is carried out in a hospital, which will require short-term hospitalization for several days (usually no more than 3 days). During treatment, you will need to wear a special hospital gown.
Oil chemoembolization of the liver is a procedure that involves the introduction into the lumen of the vessel that feeds the tumor, an oil x-ray substance (lipiodol and etiodol are most often used) with further ligation of the vessel. This technique is the least effective, since there is a high probability of the appearance of a new focus. In addition, oil embolization does not make it possible to clog the vessel for a long time, which often causes cases of incomplete tumor death.
What is the procedure based on?
Its antitumor effect is explained by two factors. First of all, it is the delivery of very high doses.a chemotherapy drug directly to the tumor itself without the negative effect of this drug on the human body as a whole. In addition, there is a cessation of blood flow in the tumor itself, which deprives it of nutrients and oxygen, which are necessary for cell growth. In addition, a delay of the anticancer drug is achieved inside the neoplasm.
The liver is a unique organ because it receives its blood supply from two sources: the portal vein and the hepatic artery. Normally, about 75% of blood enters the liver through the portal vein, while only 25% of the total blood flow is provided by the hepatic artery. True, a tumor that grows in the tissues of the liver receives almost all the nutrition it needs through the hepatic artery.
It is in connection with this that a chemotherapy drug injected directly into the hepatic artery immediately enters the tumor and has practically no effect on the he althy tissue of the organ. Once occlusion of such an artery is achieved, the tumor no longer receives a blood supply, while blood flow is maintained in the liver by the portal vein. In addition, chemoembolization of liver metastases ensures the maintenance of high concentrations of the chemotherapy drug in the tumor tissue for a sufficiently long time.
Algorithm for carrying out
Minimally invasive, image-guided procedures such as chemoembolization should be performed by a specialist trained in interventional radiology. Treatment is carried out in the operating room. Before therapythe doctor performs a special X-ray examination to help see the blood vessels that feed the tumor.
The patient is prescribed a drug called Allopurinol, which protects the kidneys from the negative effects of the chemical and the decay products that form when the tumor dies. Antibiotics are used to prevent infections. Pain syndrome with nausea is controlled by special medications.
The doctor helps the patient to be placed on a special operating table. In order to control the heartbeat, pressure and pulse, during the procedure, devices are used that connect to the patient's body. The nurse puts in a system for intravenous infusion, with its help the patient is administered sedatives. In other cases, general anesthesia may be performed. The doctor makes a pinpoint incision of the skin or a small puncture.
Under control, a thin catheter is inserted through the skin into the femoral artery and advanced through it into the liver. After that, a contrast material is injected intravenously and an initial series of x-rays is taken. Following the precise placement of the catheter in the vascular branches that feed the tumor, a mixture of the anticancer drug and the embolizing agent is injected through it. An additional series of images makes it possible to make sure that the tumor was treated with a mixture of drug components carefully.
After the procedure is completed, the catheter is removed, bleeding is stopped, and a pressure bandage is applied to the wound. There is no need for sutures. After the procedure, the patient will need to stay in bed under the supervision of a doctor for 6-8 hours. The duration of the procedure is usually about 90 minutes.
Diet after liver chemoembolization
After undergoing such treatment, the patient will need to follow a special diet to restore the liver. We are talking about the food that is easily digested and contains only the necessary vitamins and minerals. The diet must necessarily exclude all kinds of harmful elements. What do you need to eat to restore the liver? Attention should be paid to the following products.
Cottage cheese is a complete source of protein. Therefore, doctors recommend that patients with liver disease use it in the amount of 200 grams. Low-fat cottage cheese is rich in choline for cell repair, it breaks down fats. In addition, lactic acid in cottage cheese prevents the formation of putrefactive products in the intestines, which leads to unloading of the liver. Such microorganisms partially help break down proteins with milk lactose.
What other foods help the liver recover?
Beetroot is a source of betaine and a very he althy food for liver recovery. This is a lipotropic component that helps cells use fat and improve lipid metabolism in the body. In addition, beets contain fiber that binds toxins and removes them from the intestines.
Pumpkin, just like pumpkin seed oil, is a product that helps the liver recover. Contains fiber, which accelerates the removal of associatedliver toxic substances and hormones.
In the diet after liver chemoembolization, be sure to include fresh cabbage, which is a source of vitamin U, that is, lipoic acid. Such a compound, together with choline and betaine, can improve fat metabolism in cells, helping to heal ulcers in the stomach. Cabbage is especially useful for fatty degeneration. In case of fiber intolerance, only cabbage juice can be consumed.
Flaxseed, just like olive oil, has a choleretic effect, improving digestion, preventing putrefactive processes. These products contain unsaturated fatty acids that help disturbed fat metabolism. These oils should be included in the diet while following the diet.
Apples contain pectin, which binds toxic components in the intestines. The diet may also include baked apples.
Berries are also a source of pectin. Blueberries with cranberries and other berries contain benzoic acid, which has an antiseptic effect in the intestines, preventing all kinds of putrefactive processes.
Vegetables are a source of fiber, which can bind bilirubin - hormones sulfated by the liver speed up its excretion.
When dietary fiber is deficient, harmful microscopic organisms decompose compounds that were in a safe form. As a result, such substances can again be absorbed into the bloodstream, enter the portal vein of the organ, providing it with additional work and increasing general intoxication.
Enteral nutrition is just as important. Ready-made mixtures in an assimilable form are often prescribed to patients who are in a state of exhaustion after chemotherapy or surgery to remove a tumor. The diet can be based on mixtures like Nutrizone, Nutridrink, etc.
Temperature after liver chemoembolization
For one week after this treatment, patients may experience a slight increase in temperature along with weakness and loss of appetite. This condition often lasts up to two weeks, and sometimes even longer.
In general, this side effect of liver chemoembolization is a sign of normal recovery processes. You should contact your doctor if there is a change in the intensity or nature of the pain, if you have a high temperature, or if you experience any unusual symptoms.
Severe pain
According to patients' feedback on liver chemoembolization, most of them develop a number of side effects after the described treatment, which are called post-embolization syndrome. It typically includes intense pain along with nausea, vomiting, and fever. The most common side effect is usually pain, which is associated with the cessation of blood flow within the tumor. Severe pain after hepatic chemoembolization can be controlled with pain medication tablets or injections.
Recovery and what to expect?
Within one month after this procedure, patients should be regularly examined by a doctorto assess the course of the entire recovery period. The examination usually includes blood tests, a CT scan, or an MRI to assess changes in the size and general behavior of the tumor that was treated the day before.
In the case of bilateral localization of the tumor in the liver, therapy usually consists of two stages. At the same time, a month after the first procedure, during which one of the formations is affected by the drugs, the second stage of chemoembolization is carried out.
Computed tomography or MRI after therapy is mandatory every 3 months, which makes it possible to judge the rate of tumor reduction and the emergence of new pathogenic foci. Repeated chemoembolization due to the occurrence of a new formation or recurrence should be required no earlier than after 10-14 months. Such a procedure can generally be repeated several times over a number of years: as long as it is technically possible. The frequency of treatment also largely depends on the general condition of the patient. Patient feedback on liver chemoembolization is presented at the end of the article.
If your feet swell
Patients often ask why do legs swell after liver chemoembolization? In this case, one of the conditions is the following: you need to eat less s alt, a maximum of 3 grams per day. With this side effect, it is recommended to consume no more than 1.5 liters of water per day, including soups. Dried apricots, along with apricots, cucumbers and pumpkins, are considered useful.
With chemoembolization of the liver, according to patients, the frequency of such a side effect is very high.
Natural diuretics (diuretics) include products in the form of milk, cottage cheese, honey, viburnum juice, lemon, apples, tea (especially green varieties). It is important to additionally take vitamins of groups "B", "A", "P", which strengthen blood vessels and capillaries. They are found quite a lot in citrus fruits, sea buckthorn, carrots, blackcurrants, apples and other fruits and vegetables.
Helps with swollen legs massage, ointments, for example, "Vazonite", "Detralex" and others. Do not interfere with the contrast shower. In the event that a person has to sit a lot, one should try to often touch the toes, making circular movements with the feet, standing on tiptoe for a couple of seconds (15-20 times). In the evenings, lie down for 10 minutes and throw your legs up on the wall, and then vigorously rub them from the feet directly to the knees.
Below, consider reviews of liver chemoembolization from patients.
Reviews
Many people have undergone such a procedure as chemoembolization. People write that doctors usually prescribe it in cases where a liver tumor is considered inoperable.
It is reported that most often the use of this technique is effective and the blood flow to the neoplasm can actually be stopped. But it also happens that in order to achieve the desired result, specialists are forced to repeat such treatment.
In reviews of liver chemoembolizationPatients often complain that after undergoing surgery they had to deal with severe pain and fever. But these symptoms are temporary and are considered a standard side effect.
