Interventional Oncology

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. I am Deborah Howell and today's guest is Dr. David Tahour, board-certified vascular and interventional radiologist at MemorialCare Medical Group. Using image guidance, CT, X-ray, ultrasound, MRI, and PET, he performs minimally invasive procedures to diagnose and treat diseases in nearly every single organ system. Welcome, Dr. Tahour.

David Tahour, MD: Good morning, Deborah, and thank you for having me.

Deborah Howell (Host): Oh, it's our pleasure. Can you tell us what interventional oncology is?

David Tahour, MD: Sure. Interventional oncology is a field of medicine, or a subset of interventional radiology, that utilizes imaging such as MRI, CAT scan, ultrasound, and X-ray to perform minimally invasive procedures on patients for the diagnosis and treatment of cancer. Using the high-tech imaging that we have today, we can visualize abnormalities almost anywhere inside the body. Then, with advances in engineering, such as small needles and catheters, we can guide these devices to pinpoint structures inside the body. And once there, we can do many things, such as take a sample of tissue, also known as a biopsy. We can destroy tissue, or we can deliver treatments such as chemotherapy and radiation to that exact site. And all of this is really possible without having to make an incision in the body.

Deborah Howell (Host): Wow, that's incredible. So how does interventional oncology complement current cancer treatment methods?

David Tahour, MD: Well, in regards to diagnosis, we play a pivotal role in obtaining tissue via biopsy to first help determine whether a person has cancer or not. Once a diagnosis of cancer is made, then using a comprehensive approach with other specialties such as medical oncology, radiation oncology, and surgeons, it's determined what the next best treatment option is.

Deborah Howell (Host): Okay. And what type of patients are candidates for interventional oncology?

David Tahour, MD: In general, interventional oncology techniques are reserved for patients whose cancer cannot be surgically removed or is not effectively treated with systemic chemotherapy. Our procedures are also frequently used in combination with other therapies provided by other members of the cancer team.

Deborah Howell (Host): I see. Now, I know this next question, it might be kind of a long series of things, but maybe you can tell us about some of the procedures involved with interventional oncology.

David Tahour, MD: Sure. So, one of the more popular procedures that we perform is local-regional therapies for liver cancers. These can be either primary liver cancers, meaning they originated in the liver, or they can be metastatic liver cancers, meaning they spread from other parts of the body such as the lung or colon. Using small catheters, we navigate through the arteries of the body right to the liver tumor that we see. Once there, we can deliver many different types of therapies. For example, we can deliver small beads that occlude the blood supply to the cancer and starve it of oxygen and nutrients, killing the cancer through ischemia. We can also deliver particles which contain drugs and slowly leak out chemotherapy to the liver. Or we can deliver particles which are radioactive and radiate the cancer from within. And this is really beneficial because if you radiate the cancer from within, unlike traditional external radiation, you're not only protecting the surrounding tissues and organs, but we're allowed up to five times a higher dose to be delivered to the cancer.

Deborah Howell (Host): Wow.

David Tahour, MD: Yeah. And currently we're one of very few institutions in Southern California which offers this therapy known as radioembolization. And all these therapies are able to deliver the treatment just to the liver, minimizing the toxicity throughout the rest of the body.

Deborah Howell (Host): That's incredible.

David Tahour, MD: Yeah. Another therapy we perform within interventional oncology is called tumor ablation. When there's a small cancer seen in a person's body, one way to treat it is with surgery and resect it. Yet another new treatment is called tumor ablation. And in tumor ablation, using sophisticated imaging, we first see the cancer in the person's body. And then using this imaging, we guide very small needles, making sure to avoid important structures like nerves, arteries, and other organs, we guide this needle to the center of the tumor, and using either heat or cold energy, we destroy that tissue. Tumor ablation right now is used in many organs such as the liver, lung, kidneys, and bones. And unlike radiation therapy, it's usually a one-time procedure and doesn't have to, you know, the patient doesn't have to come in for numerous visits. However, another advantage over radiation is that it can be repeated if the patient ever needs to have it done again.

Deborah Howell (Host): Well, that's wonderful news on all fronts.

David Tahour, MD: Yeah.

Deborah Howell (Host): Are there side effects that arise with interventional oncology procedures, and if so, how are they managed?

David Tahour, MD: Well, the side effects are typically minimal and much less compared with systemic therapies. That's one of the beauties of the technology. Since we deliver the treatment to the exact site of the disease, we drastically reduce the chances of side effects such as hair loss, nausea, or weakening of the immune system. Also, because our procedures are minimally invasive and do not require large incisions, there's not much recovery time. Patients typically go home either the same day of treatment or the next day and are back to work soon thereafter.

Deborah Howell (Host): Oh, that's tremendous. How widespread is the use of interventional oncology in the US?

David Tahour, MD: It's a fairly new field, I would say about 15 years old. It's currently being performed at larger institutions which are capable of compiling a strong multidisciplinary approach for the cancer care of the patients. We're fortunate at Long Beach Memorial, we have great physicians and ancillary staff, we have interdisciplinary conferences, and we also have the Todd Cancer Institute which plays a big role.

Deborah Howell (Host): Now, are physicians specially trained in interventional oncology?

David Tahour, MD: Well, to become an interventional oncologist, after medical school - four years of medical school - it requires one year of internship, followed by four years of diagnostic radiology residency, and then a one-year fellowship in interventional radiology. And then depending on the institution where the fellowship is performed, people have different exposure to the volume and complexity of interventional oncology cases. I myself was very fortunate to have trained at Memorial Sloan Kettering Cancer Center in New York, where a lot of the doctors are pioneers in the field of interventional oncology.

Deborah Howell (Host): Right. Now, is interventional oncology used sometimes in combination with traditional cancer treatments?

David Tahour, MD: Absolutely, absolutely. Sometimes if someone... there's times where someone needs surgery and tumor ablation. Where first the surgeon will go in and resect a large portion of the cancer, and then if the cancer comes back, but just to a focal site, we'll go ahead and we'll either ablate it or we can embolize it. We also have other procedures which are more palliative, such as putting nephrostomy tubes and biliary tubes for people who have obstruction due to cancer. Or if someone has, or keeps reaccumulating fluid around their lungs, we can place special tunneled pleural catheters. And these procedures are really aimed at making a patient feel more comfortable in the setting of a terminal disease and just making them more comfortable.

Deborah Howell (Host): Sure. Quality of life measures.

David Tahour, MD: Quality of life. So it's sort of diagnosis, treatment, and then if we get to that point, palliation procedures as well.

Deborah Howell (Host): Okay. I have so many more questions, but we are out of time. This absolutely flew, it was fascinating. Thank you so much for being on the program, Dr. Tahour.

David Tahour, MD: My pleasure, thank you for having me.

Deborah Howell (Host): Really informative. To listen to the podcast or for more information, please visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness, brought to you by MemorialCare Health System. Have a fantastic day.