Transcription:
Cancer Treatments

Caitlin Whyte (Host): Deciding how to treat your cancer can be a daunting and difficult task, but our doctors are here to help break down your options and find the best care team for you. Today, we are joined by Dr. Mollie Meek to talk about our options when it comes to cancer treatments. She is an Interventional Radiologist at UAMS.

This is UAMS Health Talk, the podcast by the University of Arkansas for Medical Sciences. I'm Caitlin Whyte. So Dr. Meek, we're talking about cancer treatments today. To start us off, can you tell us about the main categories that cancer treatments fall into or the different types?

Mary 'Mollie' Meek, MD (Guest): So in interventional radiology, we do minimally invasive procedures. So we either do procedures from like inside your blood vessels or procedures with tiny little needle pokes. And I would say the two main categories of cancer treatments that we do are either via needle access, so we put a needle into a tumor and we burn it or freeze it. Or we go into the blood vessels that feed the tumor and we put in chemotherapy to poison it. Or we can administer some really high radiation doses via the arteries. So, you're not getting radiation elsewhere in your body. So, I would say probably endovascular and then percutaneous ablation would probably be the two big categories.

Host: Now let's dive into each of those some more. We'll start with endovascular. Tell us a bit more about how it works and when that would be considered the route for treatment.

Dr. Meek: So your liver is a great example of this. There are two main blood supplies into the liver. One is your portal vein, and one is your hepatic artery. So, the artery, the hepatic artery connects to the big blood vessel in the middle of your body called the aorta. And then that connects to the little blood vessel that goes down your leg. So, I can put a little tiny tube in the blood vessel in your leg and drive it all the way up into a little teeny, tiny blood vessel in your liver that say feeds a tumor like a colon cancer met, or a primary liver tumor, like a hepatocellular carcinoma or an HCC.

And you can deliver, you can take your catheter all the way out to where these tumors are actually living in the liver. And then you can inject some kind of medicine. You can do chemotherapy, you can do radiation. Those are the two main things you can even just put bland beads in there to cut off the blood supply. You don't even have to poison them. Really. You can just cut off their oxygen.

Host: Oh, wow. Gotcha. Okay. And how about our other option? The chemo and radiation route again, just a little bit more about how it works and when it would be considered for treatment.

Dr. Meek: Yeah. So for metastatic colon cancer, we're still trying to figure out when the best time for patients to come for liver arterial treatment is. Right now, we think that it's probably after they have failed their first round of chemo. So, if you had your colon cancer removed and you had mets and you got a round of chemotherapy and then your cancer comes back, then that's a great time to be looking for alternative treatments. Now that's different than hepatocellular carcinoma or HCC, and that's a kind of tumor that starts in the liver. And that's where it originates from. Those patients are generally referred or should be referred as soon as you identify one of those tumors and in particular, because the best treatment for HCC in the end is going to be a liver transplant, most of the time, there's lots of ways that we can treat patients and keep the tumors sort of slow growing and down until we can get a patient to a liver transplant.

Host: Now looking at both these types, are there any kinds of pros and cons to each approach when it comes to side effects or recovery time or, you know, just weighing our options?

Dr. Meek: Sure. So some, the HCC cancer does really great with the radiation treatment and some other tumors are particularly radiation sensitive. So renal cell carcinoma is a kidney cancer. And sometimes it can spread to the liver and those kinds of cancers are very responsive to radiation. So, sometimes those cancers are best treated with what is called Y90 or a radiation treatment from inside the artery. Other cancers, like colon cancer, for example, may do better with a certain chemotherapy mix that gets injected into the artery. And then some cancers that are very slow growing and generally benign, like a carcinoid tumor; those you can treat really well with, like I said earlier with no poison or no radiation, you just go in and sort of close up the artery and kill the blood supply to the tumor with bland part, they can be a little beads. They can be pieces of plastic that look kind of like tiny snowflakes. There's a variety of ways to do it.

Host: Now, if I'm a patient or I'm a family member of a patient, and we're starting out this process of examining our different treatment options, I mean, where do we begin? Of course we start with our doctor, but if we're just doing some side research, looking for places to go, what should we be taking into account when looking into various treatment options?

Dr. Meek: So you want to find a place that sees a fair number of patients that are similar to you or your family member. So you want to look for a place that takes care of a lot of cancer patients. And then especially if you're talking about liver transplant or liver surgery; you want to make sure that you go to a place that has a transplant program, or has a, has an experienced liver surgeon. You can find interventional radiologists on the Society of Interventional Radiology website. There's a lot of information for patients and families.

It's sirweb.org. You can find tons of information there and you can find links to providers, but you really want to find somebody who does a lot of whatever it is that you need done. So for instance, we do needle ablations of lung cancers. So, if you get a small lung cancer, but your lungs are too sick to have the best treatment, which would be to have it surgically cut out, then we can take a needle and stick it into your little tumor in your lung, in the CT scanner, and basically burn it and kill the tumor.

But you want to go somewhere where there are lung cancer surgeons and where there's a multidisciplinary team that talks about you specifically and what your problem is and what your best treatment is with lots of options.

Host: So, what does the timeline look like for each of these routes or in other words, how long does this kind of take between starting the process itself, having the treatment and then completion or re-evaluation afterwards?

Dr. Meek: So for ablation therapies, meaning we put a needle into something and we freeze a tumor, or we cook a tumor, usually that involves some imaging ahead of time, a CT scanner and MRI. Sometimes a PET scan and then you come to the clinic and you visit with the physician. And then fairly quickly after that, we would schedule the procedure. The procedures generally don't take too long, maybe two hours or so. And then lots of times these procedures are done outpatient. So you wake up from the procedure, you hang out in the recovery room for an hour or two, and then you get to get home. And then we see you back in clinic, you know, within a few weeks. And then your first imaging followup is somewhere three months, six months, depending on what kind of cancer it is and what treatments you had. And then we just follow you with imaging and clinic visits and see if there's something else that needs to be done and make sure that you're meeting all the other markers and things for your disease process.

Host: Wonderful. And Doctor, as we wrap up here, you know, it's a pretty big topic, cancer treatments, but what would you like people, patients, family members to know when it comes to weighing our options?

Dr. Meek: I would say you want to go to a place that is busy and sees a lot of patients. Even though it may be inconvenient, right? It's hard, especially in a state like Arkansas, where it's rural and patients have to travel a long way and it's expensive to do that, but you will really, you will really get a better treatment plan when all the doctors, you know, the, the chemotherapy doctors, the radiation doctors, the surgeons, the interventional radiologists, when they all sit down together and look at your case and say, this is what we think needs to happen, and in this order. And then the other thing I would say is, you know, don't be afraid to get second opinions, you know, and, and I would ask, ask early because sometimes if you wait too long and you're too sick, then it really limits your treatment options.

Host: Yeah, it sounds like definitely just putting in that time, whether it's travel, effort, I mean, it's mentally exhausting, but finding the team that works for you and your needs.

Dr. Meek: Yeah. And definitely find somebody that you trust, you know, people that you like to work with. Cause this is cancer treatment is not just generally is not a one and done sort of thing. It's like we treat your cancer and then we follow you and follow you and follow you and make sure it doesn't come back, you know?

Host: Yes absolutely. Well Doctor, thank you so much for being with us today and for all the care that you put into your work. You could find more on our website at uams.edu. And thank you for listening today. This has been UAMS Health Talk, the podcast by the University of Arkansas for Medical Sciences. I'm Caitlin Whyte. Stay well.