A couple of months ago, UF Health/Shand’s tumor board reviewed my case and recommended that I move forward with radioembolization to the liver or what is also known as Y90. Radioembolization is a combination of radiation therapy and a procedure called embolization where blood flow is blocked off within blood vessels. Millions of tiny beads called microshperes are placed inside the blood vessels that feed the tumors in order to block the supply of blood to the cancer cells. These beads are filled with radioactive isotope yttrium Y-90 where its common “Y90” name comes from. The spheres become lodged in the tumors and deliver a high dose of radiation to the tumor and not to the surrounding normal tissues. This procedure is typically offered to people like me, whose tumors cannot be surgically removed but they use to use it as a “last resort” option whereas they are now starting to use it more proactively. As my doctor explained it, we had the perfect window of opportunity to do this procedure. The cancer load in my body was at its weakest so he basically said let’s beat that cancer down while it is already down and weak! The interventional radiologist who is doing the procedure was very optimistic about the results and told me that I could get this procedure done 3 times in my lifetime.
Before the real procedure, a mock trial needs to be performed to make sure that one is a candidate to get the real beads. It involves making sure that the liver and kidney functions were within an acceptable range. Then under conscious sedation, a catheter is introduced into the femoral artery (in the groin) and is guided through x-ray. The doctor guides the catheter to the liver where an angiogram is performed to map the blood vessels feeding the tumors. Then “coils” are inserted to block off blood flow to neighboring organs to make sure that the beads would not leak into them and create havoc (ulcers). Then a substance that mimics what the radiation beads would do is injected, some sort of fake radiation, and then they send you to nuclear medicine to take pictures. During the mock trial, I was under conscious sedation for about 2.5 hours and was asked to hold my breath several times as they were doing their thing. I vaguely remember being conscious enough to keep asking them many questions (I guess that’s in my nature lol!) until they probably had enough and decided to make me sleep deeper. Typically, after the procedure, they can “seal” the artery and you need to lay flat on your back between 2 and 4 hours to make sure that the artery doesn’t start bleeding. In my case, they were not able to seal it (apparently I don’t have enough fat “down there”!) so they just let me lay flat on my back for 6 hours! Good thing they had drugged me up good! One really interesting thing that we found out as a result of this procedure, is that the blood vessels in my liver were quite damaged from the chemotherapy. I had only been off the chemo for two weeks and my doctor was confident that they would get better, but he was still surprised to see how much damage had been done. I say this is good knowledge because I have always been told that I should be on “chemo for life”. Perhaps there is something to be learned here, where chemo breaks would give my body a chance to recover before we hit it again with more chemo.
A few days after the mock trial, I received a call to schedule the “real” procedure. I was so excited that I had passed and was indeed a candidate. We were to return to Shands the following week where they would repeat the steps from the mock but this time, they would inject the radioactive microspheres. I walked in feeling pretty confident and ready to get it done with some nervous anticipation of the side effects. The procedure was supposed to be 1.5 to 2 hours but ended up being 4.5 hours! When they went in, they saw that new blood vessels had decided to form to compensate for the ones that were coiled and so they had to close those off before they injected me with the beads. Normally people go home after the procedure but after my 6 hours of lying flat, I was vomiting uncontrollably and they figured out that I had a small blockage in my bowels and admitted me for a couple of days. The worst part of it all was by far getting the NG (nasogastric) tube, I now tell my doctors that I am allergic to these tubes but no one listens to me, they laugh it off, they obviously have never had one.
I then spent the following month recovering. I must admit the procedure and the beads really kicked my butt! I was very tired for a long time and still have heartburn. I was scheduled this week to come back for the left side of my liver. I was a bit apprehensive but my doctors tried to reassure me with the fact that the right side (which had been treated first) represents 70% of my liver and therefore they would only be treating the remaining 30% so the procedure and recovery should be smoother. After checking my liver functions and getting an MRI, I had the green light to move forward. I then had to get through the 2 procedures, the mock trial and the “real” procedure. This time, I didn’t walk in as confident as I did the first time. I was dreading the procedure or more specifically, the recovery. The morning of my appointment, on my way to interventional radiology, we serendipitously ran into my beloved GI oncologist. He gave me a hug and told me he had seen my MRI from the day before – I was in shock as I didn’t even have an appointment with him! He gave us his impressions, told me that I was exactly where it was expected for me to be and even said that he had ordered more blood work. I am so impressed by this doctor, whom I have seen only 3 times but I feel that he has my back 100%. I had a big smile on my face after talking with him, my husband was jealous and told me there was nothing he could have done or said to bring a smile to my face like that lol! So in I went for my procedure prep, it was weird that all the nurses remembered me and many stopped to say “hi” and ask me how the kids were! They started the procedure as usual but sadly the doctor was not able to move the catheter through the hepatic artery in my liver. They had to stop the procedure short. I remember my doctor coming to me to explain the situation and me trying to focus on what he was saying but still being under sedation I didn’t really get what he was saying. Since they had opened up my femoral artery, I still had to lay flat for 6 hours! They called my husband who had gone to get lunch and when he came back, he found me in tears. I knew they couldn’t do the procedure but couldn’t explain what had happened. The doctor came back in and explained how the artery had closed off as and his best guess was that it had probably been damaged during the last procedure. He proceeded to tell us that he had never seen this before and consulted with his colleagues and no one seemed to have a good answer. He sent me for a CT scan, consulted with my GI oncologist, and came back with the following plan:
- Get an endoscopy to get a good look at the stomach. They suspect gastritis from some beads leaking in there from the first procedure. Make sure there is no abscess.
- If there is no abscess, start aspirin daily to thin the blood and see if the hepatic artery opens up
- Get another CT scan in 2 months (by then it will be 3 months since I got the beads). Look at how well the right side of the liver responded and try to get an idea of how the artery looks.
- If I had a good response from the beads and the artery looks in good shape then re-try Y90.
- If not – I don’t know yet!
We talked about something super experimental. My doctor did the Y90 procedure using the portal vein in the liver. He is apparently the only one who has done this in the US but had really good results. One would need a special IRB permission to do this but my oncologist put the breaks on that as he would want to try proven methods first…
I am waiting to hear from my GI oncologist to see if there is anything he would like me to do in the mean time (like restarting chemo) – so things are once again “up in the air” and I will just need to roll with the next punch!
I have been meaning to update this blog, lots happened since my last post and I plan on doing so soon!
Thanks for all your support!
Until next time…