A National Cancer Institute-designated Comprehensive Cancer Center

Make an appointment: 800-826-HOPE

Interventional Radiology

Interventional Radiology
Welcome to the Department of Interventional Radiology website.

Interventional Radiology
As part of a multidisciplinary team approach in the treatment of cancer and cancer related disorders, interventional oncology is the fourth arm of cancer therapies, including medical oncology, surgical oncology and radiation oncology. Using image-guided, minimally-invasive surgery in combination with the most advanced diagnostic and molecular imaging techniques, interventional radiologists specialize in both minimal and non-invasive therapies, resulting in shorter recovery times and decreased post-procedural complications which, in turn, means shorter hospital stays and more outpatient procedures.
 
Specialty Treatment Programs
  • Deep vein thrombosis
  • Focal ablation therapy
  • Loco-regional therapy
  • Portal vein embolization
 
Our team and mission
City of Hope's interventional radiology team is comprised of a dedicated group of health-care professionals who are committed to providing exceptional patient care, clinical and translational research, and educational programs for our patients and the community abroad. Using the most advanced image-guided techniques, we provide a wide array of minimally-invasive procedures and surgeries to treat many types of benign and malignant conditions, including diseases of the blood vessels and many different types of cancers.
 
As part of a treatment team, we often work in collaboration with other clinical services and physicians, such as medical oncologists, surgical oncologists and radiation oncologists, to provide the most comprehensive care for each of our cancer patients. In a truly multidisciplinary team approach, our interventional radiologists, nurses and staff play pivotal roles in the overall care of each patient seen and treated here at City of Hope and are dedicated to helping our patients fight and overcome cancer.

If you would like to hear more, or would like to see one of our physicians in consultation, please contact us to schedule an appointment.
 
 

Deep Vein Thrombosis and Pulmonary Emboli

Certain cancer patients may develop blood clots in their arms or legs due to the biology of their tumors, or due to other risk factors. These blood clots are called "deep vein thrombus" or "DVTs" and sometimes can dislodge and travel into the venous circulation of the lungs, which can lead to a life-threatening condition called pulmonary embolus. Oftentimes these conditions can be treated with blood thinning medication alone. However, for some individuals, this may not be an option, or more aggressive treatment of their clots may be required.
 
Sometimes a simple procedure can be performed to place a filter device in one of the large veins that acts as a "net" to catch any large clots that may break off and migrate to the lungs.
 
Other times, more direct therapy, such as, "clot-busting" must be performed by the interventionalist.
 
Post-Thrombotic Syndrome
In addition to causing pulmonary emboli, deep venous thrombosis is a very serious condition that can cause permanent irreversible damage to veins of the leg and their valves, known as post-thrombotic syndrome. In the United States alone, approximately 600,000 new cases of acute DVTs are diagnosed each year, and 1 in every 100 people who develops a DVT may eventually succumb to this disorder or its complications. Post-thrombotic syndrome results in abnormal pooling of blood in the leg, chronic leg pain, fatigue, swelling, and, in extreme cases, severe skin ulcers.
 
Risk Factors for DVTs
• Previous DVT or family history
• Immobility, such as bed rest or sitting for long periods of time
• Recent surgery
• Advanced age
• Hormone replacement therapy or oral contraceptives (OCP)
• Pregnancy or post-partum
• Cancer
• Coagulation abnormalities
• Obesity
 
Some Symptoms
• Discoloration of the legs
• Calf or leg pain or tenderness with leg swelling
• Prominent surface veins
• Leg fatigue
• Post thrombotic syndrome
• Life-threatening pulmonary emboli
 
Treatments
Catheter-directed thrombolysis is performed under direct imaging guidance by an interventional radiologist. This procedure, performed in a hospital’s interventional radiology suite, is designed to rapidly break up the clot, restore blood flow within the vein, and potentially preserves valve function to minimize the risk of post-thrombotic syndrome or even pulmonary emboli. Treatment duration may range from one to a few days.
 
Enteric Access (Gastrostomy Tube)
Patients with Head and Neck cancer and certain individuals who are unable to tolerate oral intake of nutrition, may require additional direct enteric supplementation via a feeding tube. Doctors may sometimes recommend placement of a gastrostomy (G-tube) tube in the stomach if the patient is unable to take sufficient food by mouth. In this procedure, the feeding tube is inserted through a small nick in the skin and placed into the stomach under image-guidance.
 
More Information

Focal Tumor Interventions Non-surgical Resection

What is Focal Ablation Therapy?
Focal ablation therapy is a minimally invasive treatment for cancer or other symptomatic soft tissue or bone lesions. It is an image-guided technique that utilizes small, percutaneously placed electrodes (needles) or probes to destroy cancer cells using chemical (ethanol), thermal-based (radiofrequency ablation, cryosurgery), or non-thermal (irreversible electroporation) techniques.
 
Radiofrequency Ablation and Cryoablative Surgery
In both radiofrequency ablation (heat) and cryosurgery (cold), imaging techniques such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) are used to help guide needle-like electrodes into a cancerous tumor or symptomatic lesion. Precisely localized heat or cold is then applied at the desired location and margins, which destroys the abnormal cells, all without the need for invasive surgery. Advantages of this form of therapy include decreased pain, less complications, faster recovery times and may potentially be done on a same-day outpatient basis.
 
What are some common areas of treatment?
Focal ablation is used to treat many different cancers, including:
• Liver - primary liver tumors, colon or other cancers that spread to the liver (ie. breast, pancreas, neuroendocrine, melanoma)
• Lung - primary and metastatic lesions
• Kidney - primary tumors
• Bone - cancers for pain palliation, osteoid osteomas
 
How Do I Prepare for the Procedure?
You should report to your doctor all medications that you are taking and if you have any allergies, especially to certain medications or intravenous contrast dye (x-ray dye).
You may be advised to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or any blood thinners you may be on for a specified period of time before your procedure.
Prior to your procedure, you may require a blood test to determine how well your liver and kidneys are functioning and whether your blood clots normally. An EKG may also be ordered.
Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.
You may be instructed not to eat or drink anything after midnight before your procedure.
Your doctor will tell you which medications you may take in the morning.
You should plan to have a relative or friend drive you home after your procedure.
 
Where will the procedure be performed?
In most cases, procedures will performed in a CT procedural suite by a professionally trained minimally-invasive specialist. Most procedures will be performed under general anesthesia. However, some patients may qualify for deep sedation only.
 
What happens after the procedure?
Patients will continue to follow-up with their referring physician, as well as, the performing interventionalist post-procedure. During routine clinic visits, blood tumor markers and other surveillance imaging will be reviewed, based upon standard protocol. Stringent follow-up is vital as residual or recurrent tumors may be detected when they are small and may be treated early with repeat focal ablation.

Bone Tumor Ablation and Cementoplasty
Certain individuals with bone tumors/metastases outside of the spine may also benefit from combination tumor ablation and cementoplasty in order to debulk the bone-eroding and painful tumor, while stabilizing the adjacent bone with cement injection. This process is performed in a similar fashion as with Vertebroplasty and Kyphoplasty and may offer palliative relief to qualified individuals.

More Information
Interventional Radiology Treatments for Liver Cancer
Chemoembolization
 

Intra-arterial Tumor Treatment - Locoregional Therapy

What is "locoregional" therapy?
Minimally-invasive, intravascular, catheter-based therapies at targeting the individual blood vessels that directly supply tumor, using localized high-dose chemotherapy, blood-supply constricting embolic particles, and/or radioactive particles. There are many forms of locoregional, transcatheter-based therapies, with newer, increasingly effective treatment devices and regimens being developed. These therapies are considered “bridging therapy”, but are also at times employed as definitive treatment in certain situations.

Chemoembolization (TACE, Precision-TACE)
Chemoembolization is a form of locoregional therapy that specifically targets tumors by simultaneously delivering high dose local cancer killing agents, while also, blocking the blood vessels that supply the tumor (embolization). The end effect is higher local doses of the tumoricidal agent, without the typical side-effects of traditional systemic chemotherapy. Additionally, by closing the blood vessels that supply the tumor, cancer cells that may survive the chemotherapy starve resulting in eventually tumor regression.
 
Radiotherapy (Y-90)
Internal radiation therapy is another form of locoregional therapy that utilizes targeted delivery of small, radioactive particles into certain liver tumors, resulting in death of the rapidly dividing tumor cells, while preserving the relatively sturdy normal liver cells.
 
What are some common areas of treatment?
Currently, locoregional therapy is primarily being used in the setting of liver cancers, both primary and metastatic tumors.
 
What happens after the procedure?
Patients will continue to follow-up with their referring physician, as well as, the performing interventionalist post-procedure. During routine clinic visits, blood tumor markers and other surveillance imaging will be reviewed, based upon standard protocol.
 

Interventional Radiology Team

Pain Palliation

Many patients with cancer often experience chronic, debilitating pain, whether due to the main tumor itself, or from a painful metastasis involving other soft tissue organs or bone. Pain can manifest as focal bone and back pain, soft tissue pain, or as diffuse "belly" pain in patients with spread of their tumors within the abdomen. Due to the excruciating nature of their pain, many patients often require large amounts of pain medication just to remain functional. However, these medications, especially narcotics, may lead to many other problems, such as constipation, nausea, and in some situations, addiction. Certain patients may, however, qualify for specific pain reduction procedures provided by a minimally-invasive specialist.
Below are some of the procedures that we offer, both for cancer related, and other benign, sources of acute and chronic pain.
• Celiac Neurolytic Blockade (for intractable belly pain)
• Bone Pain Palliation (for bone metastases and other lesions)
• Spinal Nerve Block
 
For more information, please contact us.

Pediatric Interventions

As with adults with cancer, children may also require similar interventions as the ones described in the other sections. Often these must be performed under general anesthesia due to the young age of the patients; however, similar minimally invasive procedures are available by the interventional oncologist.
 
 

Portal Vein Embolization

In certain patients with primary or metastatic liver cancer, liver transplantation may not be an option, and surgical resection and/or tumor ablation may be the only solutions. However, removing too much liver tissue may result in life-threatening liver failure. Therefore, a procedure can be performed prior to liver resection or ablation in order to promote liver regeneration and growth in non-diseased liver segments. This is accomplished by "starving" and shrinking the diseased segment of liver, while sparing viable liver and improving the success of surgery and patient recovery. This can be performed both as inpatient and outpatient procedures by the interventional oncologist.

Tumor Biopsy

Once a mass has been discovered, it will often require a tissue sample/biopsy in order for the pathologist to determine the diagnosis. This can be a challenging time for patients as undergoing biopsies can be difficult to bear for patients and loved ones.

Therefore, the City of Hope interventional oncology team offers minimally invasive, percutaneous or transvenous biopsies that can be conducted as outpatient procedures in the evaluation of liver, kidney, thyroid, bone, lung, and other soft tissue masses.

Depending on the type and location of the mass being tested, the doctor will either perform Fine Needle Aspiration (FNA) or a Core Needle Biopsy (CNB), which will immediately be sent to the cytopathologist or surgical pathologist for special staining and results.

Tumor Fiducials

Some patients may qualify for external beam irradiation of their tumors. However, in order to accurately target the lesion, pre-procedural "marking' of the tumor margins is necessary for the radiation oncologist to adequately plan the treatment. This pre-procedural marking is done by placement of targetable clips or coils within the tumor using imaging guidance by the interventional radiologist.

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients.  City of Hope was founded by individuals’ philanthropic efforts 100 years ago. Their efforts – and those of our supporters today -- have built the foundation for the care we provide and the research we conduct. It enables City of Hope to strive for new breakthroughs and better therapies – helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact our  Donor Relations Department at 800-667-5310 or developmentrelations@coh.org. Or, to make a gift that supports all the research at City of Hope,  donate online now . We thank you for your support.
 
 
 
Patient Care Overview
City of Hope sees patients at all points in their care, from diagnosis, to treatment, through survivorship.
For the 10th year in a row, City of Hope is named as one of the top cancer hospitals in the country by U.S.News & World Report.
Cancers We Treat
Become a Patient
City of Hope is committed to making the process of becoming a patient here as easy as possible. Call 800-826-HOPE (4673) or complete the Schedule a Callback form.
Led by multidisciplinary teams of volunteers and professionals, the Sheri & Les Biller Patient and Family Resource Center offers an integrated array of cancer support services.
City of Hope Locations

NEWS & UPDATES
  • For breast cancer survivors, a common worry is a recurrence of their cancer. Currently, these patients are screened with regular mammograms, but there’s no way to tell who is more likely to have a recurrence and who is fully cleared of her cancer. A new blood test – reported in Cancer Research, a journal of the...
  • Metastasis — the spreading of cancer cells from a primary tumor site to other parts of the body — generally leads to poorer outcomes for patients, so oncologists and researchers are constantly seeking new ways to detect and thwart this malicious process. Now City of Hope researchers may have identified a substa...
  • Deodorant, plastic bottles, grilled foods, artificial sweeteners, soy products … Do any of these products really cause cancer? With so many cancer myths and urban legends out there, why not ask the experts? They can debunk cancer myths while sharing cancer facts that matter, such as risk factors, preventi...
  • Cancer risk varies by ethnicity, as does the risk of cancer-related death. But the size of those differences can be surprising, highlighting the health disparities that exist among various ethnic groups in the United States. Both cancer incidence and death rates for men are highest among African-Americans, acco...
  • George Winston, known worldwide for his impressionistic, genre-defying music, considers music to be his first language, and admits he often stumbles over words – especially when he attempts languages other than English. There’s one German phrase he’s determined to perfect, however: danke schön. Winston thinks h...
  • Few decisions are more important than those involving health care, and few decisions can have such lasting impact, not only on oneself but on relatives and loved ones. Those choices, especially, should be made in advance – carefully, deliberately, free of pain and stress, and with much weighing of values and pr...
  • Using a card game to make decisions about health care, especially as those decisions relate to the end of life, would seem to be a poor idea. It isn’t. The GoWish Game makes those overwhelming, but all-important decisions not just easy, but natural. On each card of the 36-card deck is listed what seriously ill,...
  • Young adults and adolescents with cancer face unique challenges both during their treatment and afterward. Not only are therapies for children and older adults not always appropriate for them, they also must come to terms with the disease and treatment’s impact on their relationships, finances, school or ...
  • Breast cancer is the most common cancer, other than skin cancer, among women in the United States. It’s also the second-leading cause of cancer death, behind lung cancer. In the past several years, various task force recommendations and studies have questioned the benefits of broad screening guidelines fo...
  • Paternal age and the health effects it has on potential offspring have been the focus of many studies, but few have examined the effect parental age has on the risk of adult-onset hormone-related cancers (breast cancer, ovarian cancer and endometrial cancer). A team of City of Hope researchers, lead by Yani Lu,...
  • Hormone therapy, which is prescribed to women for relief of menopausal symptoms such hot flashes, night sweats and vaginal dryness, has recently seen a decline in popularity (and use) due to its link to an increased risk of breast and endometrial cancer. But City of Hope researchers have found that menopausal h...
  • Myeloproliferative neoplasms can’t be narrowed down to a single cancer, but they can be described by a defining characteristic: too many blood cells. The diseases bring with them a host of frustrating, potentially life-altering symptoms, and management of the diseases and their symptoms is crucial. An upcoming ...
  • More than 18,000 researchers, clinicians, advocates and other professionals will convene at the 105th American Association for Cancer Research (AACR) annual meeting taking place in San Diego from April 5 to 9. With more than 6,000 findings being presented over this five-day period, the amount of information can...
  • Cancer of the prostate is the No. 2 cancer killer of men, behind lung cancer, accounting for more than 29,000 deaths annually in this country. But because prostate cancer advances slowly, good prostate health and early detection can make all the difference. Many prostate cancer tumors don’t require immedi...
  • Despite advances made in detecting and treating nonsmall cell lung cancer, its prognosis remains grim. Even patients whose cancers are caught at their earliest stage have only a 50 percent chance of five-year survival. This poor prognosis is due in part to the cancer’s ability to resist treatment, renderi...