Imagine a microcatheter as skinny as a needle. Now imagine threading that through an artery the diameter of a spaghetti noodle.
That’s the precision required for a procedure interventional radiologists at San Joaquin Community Hospital performed on a 70-year-old man last week called radioembolization. It’s an intervention treatment for liver cancer that stops or slows the growth of a tumor, buying patients more time to wait on transplant lists, and in some cases, making them candidates for surgery to have the tumor removed entirely.
The procedure has been performed in Los Angeles, San Francisco and other large U.S. cities, but when doctors at San Joaquin Community Hospital finished last week, it marked a milestone for Kern County, hospital officials said.
“Many people die while waiting for a transplant, waiting for an organ. What we can do is keep the cancer at bay or shrink it, and that gives them a bridge. It gives them several more years to hopefully get that organ,” said Dr. Levi Dansby, an interventional radiologist who developed the program at SJCH with Dr. Russell Paul.
The procedure goes like this: radiologists enter through a needle puncture near the groin, then insert a microcatheter into an artery carrying blood to the liver. They monitor their path through fluoroscopy, which is like a real-time X-ray that helps doctors chart their movements. Once the catheter gets as close to the tumor as possible, they inject a dose of Yttrium-90 radiation beads into the targeted area, which shrinks – and in some cases, kills – the tumor.
It’s an outpatient procedure that has most patients going home after about two hours of recovery, Dansby said.
Such a precise method is critical for battling liver cancer, Dansby said. Doctors can’t emit radiation externally because the high dose required to minimize a tumor could damage healthy parts of the organ. The radioembolization treatment is so targeted that it spares healthy parts of the liver.
In cases where liver cancer is identified and diagnosed when the tumor is confined to that organ, 29 percent of patients survive five years, according to the California Department of Public Health’s California Cancer Registry. But once the tumor spreads to other organs, the survival rate over five years dives to about 4 percent.
Which is why SJCH brought the program to Kern County. Before, patients needing such a treatment would have had to travel to L.A. or beyond.
Some patients can’t afford to take their family with them to an out-of-county hospital, Paul said.
“That’s very problematic because going through something as unfortunate as liver cancer requires a support system,” Paul said.
The travel – which includes added costs of transportation, day care, loss of work for the day, and potentially a hotel stay – could also pose such a financial barrier that some patients choose to forego the procedure altogether, Dansby and Paul said.
That leaves them running the risk of the tumor growing and rupturing, Paul added.
“Then they end up in our [emergency room] bleeding to death, and you turn an elective procedure into an emergent procedure and there’s a good chance they end up dying,” Dansby said.
In Kern County, liver cancer infected 8.2 per 100,000 people in 2013. Those rates are compounded by high rates of Hepatitis C and alcoholism leading to cirrhosis of the liver, which can lead to cancer.
“For the size of the town, we have plenty of disease to treat,” Dansby said.
Liver cancer can also be brought on by obesity, Dansby said. Fatty depositions cause inflammation in the organ, which causes scarring, or cirrhosis. When the liver attempts to repair itself, tumors can grow, Dansby said.
“We’ve seen patients who have no Hepatitis C, never drank alcohol who had what they call NASH, or nonalcoholic steatohepatitis,” Dansby said.
More than 60 percent of Kern County’s residents are considered overweight, and 30 percent are characterized as obese, according to the Kern County Department of Public Health.
SJCH has been developing the interventional oncology program to treat tumors with minimally invasive means for about four years.
“We’ve been pushing for this quite some time,” Dansby said.