Value of interventional treatments in cancer

The classical treatment methods in oncology are surgery, radiotherapy and chemotherapy. Interventional oncology is a branch of interventional radiology that has been involved in cancer treatment for the last 20 years. Interventional oncology has made some important changes in the diagnosis and treatment of cancer in recent years:

1. The biopsy method in cancer has changed radically: In the past, patients had to be operated and a piece of their tumors should be removed to diagnose cancer; In other words, even for the diagnosis, patients were operated and sometimes the patient's main treatments such as chemotherapy could not be started due to side effects of surgery. This situation first changed in the breast, thyroid and liver tumors and the diagnosis of these tumors was made with ultrasound-guided needle biopsies. Later, such biopsies were started to be made also in organs such as lung, kidney, pancreas, bone and spleen. Today, with the help of imaging methods such as ultrasound, tomography and MRI, tissue biopsy can be performed with special needles from almost every region of the body. In this way, patients avoid unnecessary surgeries,  diagnosis can be made early and correctly and the necessary treatments can be started as soon as possible.

2. Image-guided minimally invasive treatments for cancer have begun: The possibility to perform needle biopsy from a tumor using devices such as ultrasound and tomography has also made it possible to treat tumors with special needles using the same imaging devices. In this method, which is called percutaneous ablation, special needles are  placed directly into the tumor from the skin and the tumor is destroyed by heating, freezing or giving high doses of electric current. In many studies in the literature, these interventions have been shown to destroy the tumor completely, just like a surgical operation. Unlike surgery, percutaneous ablation can be performed through a needle hole under local anesthesia, and the patient can usually return home on the same or following day. If there is a recurrence of the tumor, percutaneous ablation may be repeated as many times as needed. 

3. Angiography has become a lethal weapon in cancer treatment (Arterial interventions):  In these interventions, firstly, an angiography is made to detect the arteries that feed the tumor, and then, through very tiny catheters placed into these arteries, some drugs or particles are given that kill tumor cells. These treatments are more effective than classical methods because they are applied directly to the tumors, not to the whole body. For example, when chemotherapy is given through the arm vein, the drug is distributed evenly in the body, diluted with the blood  and then reach the tumor. In contrast, when chemotherapy is given directly into the tumor-feeding vessels (intraarterial chemotherapy), its concentration in the tumor tissue is 10-20 times higher and thus, it becomes more effective compared to the standart chemotherapy.  Or, when the chemotherapy drug is loaded into very small particles and given to these vessels, the tumor vessels are blocked and the chemotherapy drug is released from these particles and directly affects the tumor for weeks (chemoembolization). Similarly, radioactive material can be loaded into such particles and delivered to the tumor through the feeding vessels (radioembolization) providing a more targeted and higher dose radiotherapy with much less side effects.

In conclusion, interventional oncology offers many innovations to cancer patients both in diagnosis and treatment. The aim of this website is to share these methods with the patients and to inform them objectively in the light of the scientific data and personal experiences that have marked the last 20 years in the field of cancer. Interventional cancer therapies may be used in some cases where classical therapies are ineffective, but in many cases they can also be applied together with chemotherapy and/or radiotherapy. For this reason, we recommend that our patients share this information with their physicians before making a treatment decision. 

Interventional oncology in cancer management

Prof Saim Yilmaz, MD

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