ROLE OF INTERVENTIONAL RADIOLOGY IN CANCER
Interventional radiology has a great supportive role in diagnosis and management of malignancy. It adds new dimension to the facilities that can be offered to the patient in an institution.
Diagnosis- various deep-seated biopsies can be done under US and CT guidance. These would other wise need laprotomy. This small procedure can reduce morbidity and facilitate speedy treatment.
Various malignancies where interventional procedures can play a role are following:
1. Liver malignancies-primary and secondaries.
2. Malignant Biliary obstruction
3. Renal malignancies
4. Cervical and other pelvic malignancies.
5. Ca lung
6. GI bleeds.
7. Epistaxis- Secondary, Nasopharyngeal angiofibroma.
8. SVC Thrombosis- thrombolytic therapy.



Liver malignancies-primary small HCC (hepatocellular carcinoma) when detected can be treated with PEIT (percutaneous ethanol injection treatment) or Radiofrequency ablation(RFA) or TACE (transarterial chemoembolisation).
In large inoperable HCC TACE can be done. This procedure involves embolisation of the selective feeding artery. The chemotherapeutic agent is epirubicin and the dose is calculated on body surface area. The epirubicin is mixed in 5-15ml of lipidol. The mixture is well shaken and injected into the feeding artery. The chemotherapeutic agent-lipidol mixture gets concentrated in the tumor tissue and washed off from the normal liver. At end of the injection, the artery is occluded with gelfoam.
Liver malignancies-Secondaries. – If there are few secondaries in the liver and primary lesion has been resected, then lesions less than 30mm can be treated with percutaneous ethanol injection treatment or high frequency thermal treatment.


Malignant Biliary obstruction
Inoperable patients of malignant biliary obstruction need palliation to reduce itching and jaundice to improve the quality of life and well-being. Procedures that can be performed are external drainage, external internal drainage, and biliary stenting. Metallic stents are preferred over plastic stents due to low profile and long patency of 6mths to one year. In case the lesion cannot be crossed then external biliary drainage is done.
Renal malignancy- Inoperable renal malignancies can have life-threatening hematuria. For this renal artery embolisation can be done. .
Alcohol ablation of the kidney can be performed using absolute alcohol. This procedure gives severe pain in there loin due to infarction. Also patient can suffer from nausea, vomiting, fever and leucocytosis. This needs symptomatic treatment for few days.
GI malignancies- The lesion that are causing excessive GI bleeding and the lesion is not amenable to immediate surgical treatment then embolisation of the visceral arteries can be done.

Cervical and other pelvic malignancies. Patients with carcinoma cervix can suffer from uncontrolled bleeding per vagina spontaneously or following radiotherapy. Here the uterine artery can be embolised. Similarly bladder malignancies with hematuria can be treated with embolisation of vesical arteries. In pelvis arteries of both sides are embolised, as rich anastomosis exists between two sides.
Lung malignancies patients with primary lung malignancies can suffer from massive hemoptysis. Embolisation of bronchial arteries can control such episodes.Radiofrequency ablation can also be offered in selected cases.
SVC(superior vena cava) syndrome. - Patients with carcinoma bronchus can invade mediastinum and obstruct SVC resulting in uncomfortable clinical features of SVC syndrome. Metallic stents can be placed to relieve such symptoms.
Also patients can develop SVC thrombosis. Here thrombolytic therapy can be done. This involves infusion of urokinase in the thrombus at the rate of 50,000-100,000 units/hour.

Head and neck malignancies- secondaries in nose or Nasopharyngeal angiofibroma, which is a highly vascular tumor, can be embolised. This results less bleeding at the time of surgery and also complete removal of the tumor is possible.

There are large numbers of interventional procedures that can be helpful in diagnosis, treatment and palliation. These procedures save patients from a life threatening hemorrhage in malignancies. It helps in improving the level of medicare provided to the cancer patients in a given institution.