Interventional Oncology: Embolisation and Ablation
This domain tests transarterial embolisation, chemoembolisation, radioembolisation, portal vein embolisation and thermal ablation. Items focus on patient selection, staging and safe technique.
Core rules
- Hepatocellular carcinoma: decide treatment in a multidisciplinary meeting. Ablation suits small tumours (usually ≤3 cm) away from bile ducts and bowel. Transarterial chemoembolisation suits intermediate-stage disease with preserved liver function.
- Contraindications to chemoembolisation include decompensated liver disease, bilirubin >3 mg/dL, main portal vein occlusion, extrahepatic spread and uncontrolled infection.
- Ablation: create a margin of at least 5–10 mm; microwave ablation gives larger, more predictable zones than radiofrequency ablation; beware heat-sink near vessels.
- Portal vein embolisation: induce hypertrophy of the future liver remnant before major resection; measure volumes before and after.
Worked example
A 64-year-old with Child–Pugh A cirrhosis has a solitary 3 cm hepatocellular carcinoma and no extrahepatic disease. Reasoning: stage the patient; ablation is suitable if the lesion is accessible and away from the gallbladder, bile ducts and bowel. Plan a 5–10 mm margin. Follow up with contrast imaging at 1 month.
Traps
Treating without staging; ignoring liver function; missing extrahepatic disease; undertaking ablation near the gallbladder; failing to plan follow-up imaging.