Interventional Treatment for Cancerous Lesions in Bone
When cancer cells reach the bloodstream, get into the bone marrow and begin to multiply, the cells create metastases on the bone. These tumors can become painful as they eat away at the bone, which creates weaknesses in the bone, and nerve endings in or near the tumor send pain signals to the brain. Untreated bone metastases can cause painful bone fractures.
Prevalence
Bones are the third most common location where cancer cells metastasize (metastasis is when cancer cells from one area of the body spread to another). Bone cancer, or cancer that originates in the bones, is uncommon. It generally appears in long bones, such as the ones in your arms and legs, but it can manifest in any bone.
Risk Factors
- Radiation therapy for cancer
- Cancer elsewhere in the body
- Some inherited genetic syndromes
Symptoms
- Bone pain affects 70% of patients with bone metastases
- Bone fracture
- Spinal cord compression
Diagnosis
Physicians use a variety of tests to aid in the diagnosis of cancer, including physical examination, blood tests, and imaging (CT, MRI, ultrasound, and x-ray), but final diagnosis cannot be determined until a biopsy is performed. A biopsy provides a sample of tissue for a pathologist to examine, which will help determine the type of cancer and its growth rate. Upon gathering this information, physicians can determine the best treatment for the patient.
Needle Biopsy
This biopsy technique, also called an image-guided biopsy, utilizes imaging, such as fluoroscopy, CT, ultrasound, or MRI, to guide the procedure. This imaging allows the Interventional Radiologist to guide the needle to the tissue to obtain an accurate biopsy sample.
Needle biopsy is usually an outpatient procedure and patients return to normal activities after the procedure. This technique very rarely produces complications and has several advantages:
- Image-guidance allows the physician to see and avoid blood vessels and vital organs while obtaining the biopsy sample.
- Recovery time is short and patients usually return to normal activities immediately.
- Pain and scarring is greatly reduced and there is no need for stitches.
Treatment
Bone cancer treatment usually does not aim to be curative, but is meant to reduce pain, improve function, and prevent further bone damage. Interventional Radiologists use radiofrequency ablation (RFA) to kill nerve endings near the metastasis, which results in desensitizing the bone and a reduction in pain. A procedure called a vertebroplasty is also used to treat spinal metastases and fractures.
Radiofrequency Ablation
Radiofrequency Ablation (RFA) is a preferred nonsurgical procedure because it is delivers targeted, localized treatment, which uses heat to kill the targeted tissue while leaving healthy tissue intact. This procedure does not have any systematic side effects and does not affect the overall health of the patient. Most patients return to normal activities within a few days of the procedure.
To perform the procedure, the Interventional Radiologist guides a small needle into the tumor using medical imaging. Through the needle, radiofrequency energy is transmitted into the targeted tissue to kill the tumor by heating it, causing the dead tumor tissue to shrink.
How to Prepare for Radiofrequency Ablation
Prior to your procedure, you will receive specific instructions for how to properly prepare for your procedure. The following information is a general guideline for what you might expect, but always follow the instructions given to you by your physician.
- Be sure to tell your doctor about all medications you are taking and any allergies you may have.
- You may be advised to stop taking blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) for a specified period of time prior to your treatment.
- If you will be given sedation, you may be asked to fast (not eating or drinking anything) for several hours prior to your procedure.
- Blood tests may be ordered to determine how well your liver and kidneys are functioning and to see how your blood clots.
- Female patients should always inform their physician if they are or if there is a possibility that they are pregnant.
- Shower or bathe the night before your procedure.
- Remove jewelry, nail polish/artificial nails and hairpins, but please wear the following items to the procedure if you use them:
- Eye Glasses
- Dentures
- Hearing Aid(s)
- You should plan to have a relative or friend drive you home following your procedure.
What to Expect During & After Radiofrequency Ablation
- You will be positioned on the examining table and be connected to monitors that track your heart rate, blood pressure and pulse during the procedure, and a nurse or technologist may insert an intravenous (IV) line into a vein in your hand to deliver sedation medication.
- The physician will discuss the procedure with you and answer questions you may have. You will also read and sign a consent form.
- The area where the electrodes are to be inserted will be sterilized and draped with a surgical drape before the physician numbs the area with a local anesthetic.
- A very small nick in the skin is made where the physician inserts a needle electrode and uses medical imaging to guide it to the tumor site.
- Radiofrequency energy is applied to the tumor. The electrode may need to be repositioned for large tumors.
- After the treatment, the needle electrode is removed and pressure is applied to stop any bleeding. The small opening is covered with a dressing (no stitches are needed).
- Any discomfort, pain or nausea you experience will be controlled by medication.
- The entire procedure usually takes one to three hours to complete.
- Following the procedure, you will spend about six hours in a recovery room to allow the puncture site to heal before you are allowed to move. You will not be allowed out of bed and will need to use a bedpan or urinal.
- In recovery, a nurse will regularly check your blood pressure, foot pulses, and the puncture site. You will be allowed to eat and drink unless you are going into surgery.
- Very few patients still have pain a week following treatment.
- Your physician’s staff will schedule a follow up CT, PET or MRI and a clinic appointment. The physician will review the imaging and discuss the results of the procedure with you at this appointment.
Benefits
- May be performed under conscious sedation or general anesthesia
- Only a small nick in the skin is made, which does not require sutures
- Can be repeated if necessary
- May be combined with other treatments
- It has no effect on blood pressure
- Can relieve pain for many cancer patients
- It is a very safe procedure with low complication rates
Vertebroplasty
Vertebral metastases can be very painful and even result in fractures. Treatment by an Interventional Radiologist with an outpatient procedure called a vertebroplasty can be very effective in relieving pain and preventing future damage.
For this procedure a needle is inserted through a small incision and the physician uses medical imaging to guide the needle to the fracture in the vertebra. Medical-grade bone cement is injected into the fracture, which hardens in 15 minutes to stabilize the fracture. Within hours of the procedure, patients experience a dramatic improvement in back pain. Vertebroplasty is effective in preventing future damage, restores mobility, and it has a very low complication rate.
How to Prepare for Vertebroplasty
Prior to your procedure, you will receive specific instructions for how to properly prepare for your procedure. The following information is a general guideline for what you might expect, but always follow the instructions given to you by your physician.
- Be sure to tell your doctor about all medications you are taking and any allergies you may have.
- You may be advised to stop taking blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) for a specified period of time prior to your treatment.
- If you will be given sedation, you may be asked to fast (not eating or drinking anything) for several hours prior to your procedure.
- Blood tests may be ordered to determine how well your liver and kidneys are functioning and to see how your blood clots.
- Female patients should always inform their physician if they are or if there is a possibility that they are pregnant.
- Shower or bathe the night before your procedure.
- Remove jewelry, nail polish/artificial nails and hairpins, but please wear the following items to the procedure if you use them:
- Eye Glasses
- Dentures
- Hearing Aid(s)
- You should plan to have a relative or friend drive you home following your procedure.
What to Expect During & After Vertebroplasty
- You will be positioned on the examining table and be connected to monitors that track your heart rate, blood pressure and pulse during the procedure, and a nurse or technologist may insert an intravenous (IV) line into a vein in your hand to deliver sedation medication.
- The physician will discuss the procedure with you and answer questions you may have. You will also read and sign a consent form.
- The area where the needle is to be inserted will be sterilized and draped with a surgical drape before the physician numbs the area with a local anesthetic.
- A very small nick in the skin is made where the physician inserts a needle, called a trocar, and uses medical imaging to guide it to the fracture site.
- An orthopedic cement is injected into the fracture site and will harden in about 15 minutes, and a CT scan will check the distribution of the cement.
- After the treatment, the needle is removed and pressure is applied to stop any bleeding. The small opening is covered with a dressing (no stitches are needed).
- Any discomfort, pain or nausea you experience will be controlled by medication.
- The entire procedure usually takes one hour to complete.
- Following the procedure, you will spend about one hour in a recovery room.
- Your physician’s staff will schedule a follow up CT, PET or MRI and a clinic appointment. The physician will review the imaging and discuss the results of the procedure with you at this appointment.
Benefits
- Vertebroplasty typically increases patient functionability and reduces the pain caused by vertebral compression fracture.
- Only a small nick in the skin is made, which does not require sutures.
- It is a very safe procedure with low complication rates.
Transcatheter Embolization
Transcatheter Embolization is a technique used to control cancer pain, in order to improve quality of life and ability to function for the patient. Bone metastases are particularly painful and this pain can often be treated by an Interventional Radiologist.
To perform this procedure, the physician injects tiny particles (about the size of a grain of sand) into the artery that supplies blood to the tumor using a catheter guided by medical imaging. These particles clot and block blood flow to the tumor, which reduces pain and helps prevent bone fracture by killing the tumor by depriving the tumor of the oxygen and nutrients it need to grow.
How to Prepare for Transcatheter Embolization
Prior to your procedure, you will receive specific instructions for how to properly prepare for your procedure. The following information is a general guideline for what you might expect, but always follow the instructions given to you by your physician.
- Be sure to tell your doctor about all medications you are taking and any allergies you may have.
- You may be advised to stop taking blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) for a specified period of time prior to your treatment.
- If you will be given sedation, you may be asked to fast (not eating or drinking anything) for several hours prior to your procedure.
- Blood tests may be ordered to determine how well your liver and kidneys are functioning and to see how your blood clots.
- Female patients should always inform their physician if they are or if there is a possibility that they are pregnant.
- Shower or bathe the night before your procedure.
- Remove jewelry, nail polish/artificial nails and hairpins, but please wear the following items to the procedure if you use them:
- Eye Glasses
- Dentures
- Hearing Aid(s)
- You should plan to have a relative or friend drive you home following your procedure.
What to Expect During & After Transcatheter Embolization
- You will be positioned on the examining table and be connected to monitors that track your heart rate, blood pressure and pulse during the procedure, and a nurse or technologist may insert an intravenous (IV) line into a vein in your hand to deliver sedation medication.
- The physician will discuss the procedure with you and answer questions you may have. You will also read and sign a consent form.
- The area where the catheter is to be inserted will be sterilized and draped with a surgical drape before the physician numbs the area with a local anesthetic.
- A very small nick in the skin is made where the physician inserts a catheter and uses medical imaging to guide it to the tumor site.
- When the catheter is properly placed, the physician injects the embolizing agent. Medical imaging is taken to ensure that the blood flood is blocked.
- After the treatment, the needle electrode is removed and pressure is applied to stop any bleeding. The small opening is covered with a dressing (no stitches are needed).
- Any discomfort, pain or nausea you experience will be controlled by medication.
- The entire procedure usually takes from 30 minutes to several hours to complete, depending on the complexity of the procedure.
- Following the procedure, you will spend about six hours in a recovery room to allow the puncture site to heal before you are allowed to move. You will not be allowed out of bed and will need to use a bedpan or urinal.
- In recovery, a nurse will regularly check your blood pressure, foot pulses, and the puncture site. You will be allowed to eat and drink unless you are going into surgery.
- Very few patients still have pain a week following treatment.
- Your physician’s staff will schedule a follow up CT, PET or MRI and a clinic appointment. The physician will review the imaging and discuss the results of the procedure with you at this appointment.
Benefits
- Only a small nick in the skin is made, which does not require sutures.
- It is a very safe procedure with low complication rates.