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    (with an angiogram) Liver Cancer Treatment

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    What is TheraSphere Treatment and an Angiogram?

    Liver tumor with radioactive glass beads--Image used by permission of Nordion
    TheraSphere is a liver cancer treatment that uses millions of small beads. Each glass bead has radioactive Yttrium-90 inside. The Interventional Radiologist (IR doctor) will inject TheraSphere into the main artery of your liver through a small tube (catheter). The tiny radioactive glass beads are delivered directly into the liver tumor through the blood vessels. The radiation destroys the tumor cells from within the tumor, with little injury to the healthy liver tissue. The Yttrium-90 in TheraSphere turns into Zirconium-90. Zirconium-90 is harmless in the small amounts that stay in the body. This means that most of the radioactivity of Yttrium-90 is gone in about 10-12 days following treatment.

    The TheraSphere treatment is done in two parts (requires two days). The first day is the planning day. The IR doctor will do a special x-ray study called an angiogram, also known as an arteriogram, that will “map” your vessels. It allows the doctor to clearly see your arteries and correctly inject TheraSphere into the main artery of your liver. The doctor will also decide on the dose needed of Yttrium-90. The second part will be the actual TheraSphere treatment and it is scheduled 2 to 6 weeks after your planning day. This window of time is needed to prepare your dose of TheraSphere.

    Special Note: Blood-thinning drugs (Anticoagulants) must be stopped at least 3-4 days before your TheraSphere treatment. Examples are Vitamin E and Coumadin (Warfarin). In addition, diabetes drugs such a Glucophage (Metformin) or Glucovance (Glyburide and Metformin) must be stopped for 48hours AFTER the treatment. Please be sure to contact your doctor before your TheraSphere treatment if you take any of these drugs.

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    TheraSphere Treatment Schedule Summary

    The following is a summary of a typical treatment plan:

    • Pre-planning angiogram

    • TheraSphere treatment 2-6 weeks after pre-planning angiogram

    • 2 week phone call follow-up

    • Repeat CT/MRI, PET scan if needed, and lab tests 4 weeks after treatment

    • Return office visit with your doctor 1 month after your treatment

    • Possible 2nd TheraSphere treatment if needed; if a second treatment is needed, the same schedule will be repeated

    • If your disease is stable, you will have repeat scans as part of your oncologists/hepatologists follow-up.

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    What Can I Expect While at California Pacific Medical Center?

    • Pre-registration is a two-step process that you must complete before having a surgery, test, or procedure at California Pacific Medical Center.
      1. Health History. Please call (415) 600-2500 within 1- 2 weeks before your procedure to speak with a Pre-admission Testing nurse who will take your health history, answer your questions, and explain what testing is necessary before your surgery, test, or procedure.

        Based on your health status, the nurse may send you to complete any required testing before you come to the hospital. The nurse will tell you where you can go for your test(s).
      2. Pre-Registration. The nurse will connect you to the Patient Access Center to complete the pre-registration process. Please be sure to have your insurance card information ready when you begin.
    • Do not eat or drink anything within 6 hours of your procedure, unless otherwise directed by your doctor. However, you may continue to take your routine medications, such as heart and blood pressure medications, with only a sip of water.

    • On the day of your TheraSphere treatment, come to the Ambulatory Care Unit, located at 2351 Clay Street, 6th floor, at least 4 hours before your scheduled treatment.

    • Parking is available at 2405 Clay Street (cross street is Webster Street).

    • Bring a list of all drugs you are taking and your insurance information.

    • You may have blood tests taken if needed.

    • An IV (intravenous line) will be placed in your arm in the Ambulatory Care Unit before your treatment. The IV is needed to give you drugs during your treatment to help you relax and make sure you are comfortable.

    • In Interventional Radiology, the IR doctor will explain the procedure to you and ask you to sign the consent form stating that you understand the procedure you are having. This is a good time for you to ask questions and share any concerns you may have.

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    During Your TheraSphere Treatment

    • During the treatment, you will be placed on monitors that measure your blood pressure, pulse, breathing and oxygen level.

    • Next, the doctor will: 1) inject a small amount of local anesthetic around the groin (femoral) artery, 2) insert a small plastic tube (catheter) into this area, and 3) position the tip of the tube in the main artery of the liver. A liquid (called contrast) is injected through the tube which makes the liver vessels visible. After the injection, you may feel a warm flush as the liquid travels through your system. This feeling quickly passes! Please be sure to let the staff know if you have ever had an allergic reaction to the x-ray liquid (contrast) in the past.

    • Then the IR doctor will take x-ray pictures that will record your vessels and blood supply to the tumor(s) in your liver. During this time, the doctor will give you instructions on how to breathe and when to hold your breath. It is very important to hold still while the x-ray pictures are being taken.

    • On the day of your TheraSphere treatment, the IR doctor will inject the beads through the small tube (catheter) into your liver vessels.

    • The IR doctor will talk to you right after the completion of your treatment to give you any updates or answer any questions. The final results of your treatment will be given to you by your primary doctor.

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    After Your TheraSphere Treatment

    Once the treatment is completed, the IR doctor removes the catheter and applies pressure to the catheter entry site for 5 to 20 minutes to prevent bleeding. You will either return to the ACU on a gurney or be admitted into the hospital. Your nurse will then:

    • Ask you to lie still without bending the leg that the tube (catheter) was placed in or raising your head for 2 – 6 hours after the treatment (it is OK to bend your other leg for comfort). This is to prevent any bleeding from the groin (femoral) artery where the tube was placed.

    • Watch your pulse, blood pressure, oxygen levels and check your puncture site for any bleeding or bruising. You may eat if you want, but remember to keep your head flat.

    • Continue to give you IV fluids for a couple of hours.
    Before you go home, you will receive specific instructions about your care at home from your doctor or the nursing staff. Do not forget your prescriptions for steroids and antibiotics from your liver doctor (hepatologist) before you leave the hospital.

    YOU MAY NOT DRIVE OR TAKE A CAB HOME ALONE. You may take a cab ONLY if you are accompanied by a responsible adult.

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    What to Expect at Home

    • It is very important to drink fluids at home in order to flush the contrast liquid from your body

    • Remember to take it easy over the 72 hours following your treatment. No heavy lifting or exertion.

    • Be sure to take your drugs as prescribed by your hepatologist (liver doctor).

    • Your liver doctor will order blood tests once a week for four weeks after treatment - be sure to have these tests completed.

    • Call your liver doctor immediately with any concerns.

    • Go to your nearest Emergency Room if you have bleeding, severe pain or signs of an infection such as a high fever.

    • The Interventional Radiology staff will phone you a few days after your treatment to check in on you.

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    More Ways to Learn

    Created by Interventional Radiology; Anna M. Choi, RN, BSN, CCRN

    Produced by the staff and physicians at California Pacific Medical Center in association with the Center for Patient and Community Education. Last updated: 03/15.

    Note: This information is not meant to replace any information or personal medical advice which you get directly from your doctor(s). If you have any questions about this information, such as the risks or benefits of the treatment listed, please ask your doctor(s).

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