Interventional Oncology: The Fourth Pillar Of Modern Cancer Care

Interventional oncology is a minimally invasive treatment that directly targets cancer tumours using advanced image-guided technology. An interventional oncologist is a trained radiologist with special skills in doing these modern, effective, safe, and advanced treatments that cancer patients need.

Interventional oncology is a subspecialty of interventional radiology, focussed on targeting difficult-to-treat cancers. These specialists collaborate closely with cancer specialists in surgery, medical oncology, and radiation therapy, which are the traditional arms or pillars of cancer care.

The most common cancers that are treated through interventional oncology are- liver cancer (hepatocellular carcinoma- HCC) and bile duct cancer (cholangiocarcinoma). They also treat secondary liver cancer (cancers that spread to the liver) mainly from colon cancer, neuroendocrine cancer, and any other localised liver metastases. Other common cancers that are treated are- kidney cancer and lung cancer.

The most common procedures that are performed using advanced technology include:

• Tissue biopsy: This is done to diagnose and manage post-operative complications, which is mainly infection, secondary to any surgery causing fluid collection in the body. An interventional radiologist uses Ultrasound, CT scan, CT PET or rarely MRI scan for these complex procedures.

• Radiofrequency and Microwave ablation: These procedures are designed to kill cancer without the need of a surgery. Luckily, these procedures are as good as surgery and prevent all possible complications or side effects associated with surgery. So, patients who are scared of surgery or not fit for surgery can safely undergo these procedures to cure their cancer.

These can be done without general anaesthesia and require significantly shorter time as compared to a traditional surgery.

• Embolisation and Chemoembolisation: Cancer is targeted using X-ray machine and it’s controlled and cured in some cases. Even if a cancer is not initially cured by surgery, an interventional radiologist can cut off the blood supply to the cancer and then make it safer for the patient and surgeon to operate.

• Radioembolisation with Yttrium-90 (SIRT): These are new treatment options performed by the interventional radiologist in specialist centres, whereby a very high dose of radiation is given to kill the cancer and this is done keeping in mind the patient’s quality of life. Some of these patients can then go on to have surgery to cure their cancer, particularly in cancers of the liver.

• Palliative care, such as pain management: Pain in cancer is a big problem and here an interventional radiologist can help the patient in various ways to completely get rid of cancer-related pain. These are simple day care procedures, done under local anaesthesia alone and this can completely transform the day-to-day life of patients who are diagnosed with advanced-stage cancers, where there is very little hope of a cure.

Generally, for a long-term treatment of cancer patients, there isn’t a need of intravenous access and these when repeated, can be very problematic for many patients. In such cases, an interventional radiologist can place PICC line, tunnelled lines, chemo ports, under ultrasound and X-ray guidance. This approach has often succeeded in difficult cases.

Going forward, I think this is where interventional oncology is headed: treatment based on individual tumour biology. Well-established interventional oncology practices are based on the fact that each treatment should be patient-specific. Our future appears to be going one step further, devising therapies that are not only specific to patient, but also specific to the patient’s individual tumour or cancer.

Long live interventional oncology- an important subspecialty of interventional radiology.