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About Breast Cancer
When breast tissue divides and grows at an abnormal rate, a mass of extra tissue can develop into a tumor. To continue growing, a tumor generates its own blood supply to provide oxygen and nutrients. Although the cancerous cells can grow in size in the breast, they can also travel throughout a person's blood stream and become embedded in other organs, a process known as metastasis. Typically, 20 percent of breast cancer develops in the lobules where milk is produced, while 80 percent originates in the mammary ducts that carry milk from the lobules to the nipple.
As vascular experts, interventional radiologists are uniquely skilled in using the vascular system to deliver targeted treatments via catheter throughout the body. In treating cancer patients, interventional radiologists can attack the cancer tumor from inside the body without medicating or affecting other parts of the body. For breast cancer, interventional radiologists use thermal ablation, as well as some laser therapy, to kill the cancer cells. Although the devices used are FDA approved, research to evaluate the long-term effects of these treatments is ongoing.
Patients with invasive breast cancer are at risk for liver cancer. The liver serves as a way-station for cancer cells that circulate through the bloodstream. These cells may grow and form tumors in the liver. It is estimated that as many as 70 percent of all people with uncontrolled cancer will eventually develop secondary liver tumors, or metastases (tumors formed by primary cancer cells that have spread from other cancer sites). Interventional radiologists offer nonsurgical treatments for liver cancer, including embolization to cut off the blood supply to the tumor, radioembolization that delivers radiation directly inside the tumor, and chemoembolization, which delivers the cancer drug directly into the tumor and then cuts off the blood supply.
Breast Cancer Diagnosis
There are a number of tests that can help in the diagnosis of cancer, including blood tests, physical examination and a variety of imaging techniques including X-rays (e.g., chest X-rays and mammograms); computed tomography (CT); magnetic resonance (MR) and ultrasound. Usually, however, the final diagnosis cannot be made until a biopsy is performed. In a biopsy, a sample of tissue from the tumor or other abnormality is obtained and examined by a pathologist. By examining the biopsy sample, pathologists and other experts also can determine what kind of cancer is present and whether it is likely to be fast or slow growing. This information is important in deciding the best type of treatment. Open surgery is sometimes performed to obtain a tissue sample for biopsy. But in most cases, tissue samples can be obtained without open surgery with interventional radiology techniques.
Needle biopsy, also called image-guided biopsy, is usually performed using a moving X-ray technique (fluoroscopy) computed tomography (CT), ultrasound or magnetic resonance (MR) to guide the procedure. In many cases, needle biopsies are performed with the aid of equipment that creates a computer-generated image and allows radiologists to see an area inside the body from various angles. This "stereotactic" equipment helps them pinpoint the exact location of the abnormal tissue.
Needle biopsy is typically an outpatient procedure with very infrequent complications; less than 1 percent of patients develop bleeding or infection. In about 90 percent of patients, needle biopsy provides enough tissue for the pathologist to determine the cause of the abnormality.
Advantages of needle biopsy include:
An X-ray of a needle inserted into the lung to obtain a sample for biopsy.
Large core needle biopsy. In this technique, a special needle is used that enables the radiologist to obtain a larger biopsy sample. This technique is often used to obtain tissue samples from lumps or other abnormalities in the breast that are detected by physical examination or on mammograms or other imaging scans. Because approximately 80 percent of all breast abnormalities turn out not to be cancer, this technique is often preferred by women and their physicians because it:
A similar technique called fine needle aspiration can be used to withdraw cells from a suspected cancer. It also can diagnose fluids that have collected in the body. Sometimes, these fluid collections also may be drained through a catheter, such as when pockets of infection are diagnosed.
Many interventional radiology procedures for the diagnosis and treatment of cancer can be performed on an outpatient basis or during a short hospital stay. In many cases, the procedures:
Thermal Ablation Treatments
For cancerous tumors, radiofrequency ablation (RFA) offers a nonsurgical, localized treatment that kills the tumor cells with heat, while sparing the healthy breast tissue. Because of the localized nature of this treatment, RFA does not have any systemic side effects. Radiofrequency ablation can be performed without affecting the patient's overall health and most people can resume their usual activities in a few days.
In this procedure, interventional radiologists use imaging to guide a small needle through the skin into the tumor. From the tip of the needle, radiofrequency energy is transmitted into the target tissue, where it produces heat and kills the tumor. Most patients experienced mild to moderate discomfort during the 15 minute RFA time. Following the RFA, the dead tumor tissue shrinks and slowly forms an internal scar. Because there is no surgical incision, RFA barely affects the appearance of the breast.
Depending on the size of the tumor, RFA can shrink or kill the tumor, extending the patient's survival time and greatly improving their quality of life while living with cancer. RFA can extend patients' lives or in a small number of cases cure patients.Efficacy
Because it is a local treatment that does not harm healthy tissue, the treatment can be repeated as often as needed to keep patients comfortable. RFA is a very safe procedure, with few complications. It is effective for small to medium-sized tumors, and emerging new technologies should allow the treatment of larger cancers in the future. One study showed 100 percent tumor cell death using RFA, with no complications after the procedure. 10 RFA is often reimbursed by insurance carriers.
Currently, the protocol is to "ablate and resect," in other words, to kill the tumor with heat and then remove the dead cells to ensure all the cancer cells were destroyed. As research progresses, the treatment pattern will become "ablate and follow"-simply treat the patient with RFA and track their progress over the following years.
For some women, surgery is not an option, due to other health concerns. For these patients, RFA is an excellent treatment option. In one study of postmenopausal women 60 years of age and older, 95 percent of women would be willing to have RFA again and 95 percent would be willing to have RFA without definitive surgery if it was known that RFA could kill their entire tumor.
Although the use of RFA in other organs, especially in the liver, has shown promising results for killing cancer cells, the technique is not a mainstream treatment option for breast cancer patients. Current research is underway to further explore this treatment and the long-term effects on the disease and