The role of interventional radiology in the palliation of cancer (#71)
Interventional radiological procedures make a significant contribution to the palliation of patients with cancer, dealing with discomfort and improving the quality of life.
Percutaneous nephrostomy and ureteric stenting can maintain renal function in patients with obstruction of the urinary tract. Percutaneous biliary drainage and stenting enable the relief of jaundice and the elimination of the unpleasant physical and psychological consequences of the retention of bile. Self-expanding metallic biliary endoprostheses have revolutionised this field, as they have made it possible to achieve effective internal drainage without the risks and discomfort associated with the insertion of fixed-size conventional biliary stents. Metallic stents have also made a major contribution to the palliation of patients with oesophageal, duodenal, colorectal and bronchial malignant obstruction. Rigid plastic oesophageal tubes were not particularly effective in achieving adequate nutrition because of their relatively small lumen, which permitted only a liquid or semi-liquid diet, whereas metallic self-expanding oesophageal stents make it possible for patients to eat almost normally. Tracheobronchial stents can relieve distressing stridor and frequent episodes of pneumonia in patients with malignant bronchial obstruction. Vertebroplasty can help to relieve bone pain and stabilize the spine in patients with skeletal metastases.
The optimum use of palliative interventional radiological procedures requires an informed discussion between the referring physician, the interventional radiologist and the patient. When such procedures are performed simply in response to written requests, as for diagnostic investigations, important information that can influence the precise technique used, or even lead to a decision not to proceed with the procedure, may be overlooked. Personal communication between those involved in the care of the patient, ideally at a meeting of a multidisciplinary team, ensures optimum care and avoidance of potentially irreversible errors.