1. Transarterial Chemoembolization (TACE)

TACE is a minimally invasive procedure where chemotherapy drugs are mixed with embolic agents and injected directly into the blood vessels feeding the tumor through a catheter.

How TACE works:

• A thin catheter is inserted through the groin artery
• It is guided to the artery supplying the tumor under fluoroscopy
• Chemotherapy mixed with embolic material is injected
• This kills cancer cells directly and cuts off tumor blood supply
• Healthy liver tissue is largely spared

TACE is used for:

• Hepatocellular carcinoma (HCC)
• Liver metastases from various cancers
• Neuroendocrine liver metastases
• Downstaging tumors for liver transplant
• Palliative control of large or multiple liver tumors

Advantages of TACE:

• High concentration of chemotherapy at tumor site
• Reduced systemic side effects compared to IV chemotherapy
• Tumor blood supply is simultaneously cut off
• Can be repeated if required
• Effective palliation of symptoms
• Can be combined with ablation or systemic therapy

2. Transarterial Radioembolization (TARE / Y-90)

TARE involves delivering millions of tiny radioactive microspheres (Yttrium-90) directly into the blood vessels of the tumor through a catheter. These microspheres lodge inside the tumor and deliver targeted internal radiation.

How TARE works:

• A catheter is passed into the hepatic artery
• Radioactive Y-90 beads are injected selectively into the tumor’s blood supply
• The beads emit radiation locally, destroying tumor cells
• Radiation exposure to the rest of the body is minimal

TARE is used for:

• Hepatocellular carcinoma
• Liver metastases (colorectal, neuroendocrine, breast)
• Large or multifocal liver tumors
• Portal vein invasion by tumor
• Patients not suitable for TACE or surgery

Advantages of TARE:

• Targeted internal radiation
• Minimal systemic radiation exposure
• Effective for large tumor burden
• Can be performed even with portal vein involvement
• Outpatient or short hospital stay procedure

3. Radiofrequency Ablation (RFA)

Radiofrequency ablation uses high-frequency electrical energy delivered through a needle electrode placed inside the tumor to generate heat, which destroys cancer cells.

How RFA works:

• Under CT or ultrasound guidance, a needle electrode is inserted directly into the tumor
• Radiofrequency energy creates heat of 60–100°C
• Tumor cells are destroyed while surrounding tissue is preserved

RFA is used for:

• Small liver tumors (HCC and metastases)
• Kidney tumors
• Lung tumors
• Bone lesions for pain relief
• Thyroid and adrenal nodules

Advantages of RFA:

• No surgical incision
• Outpatient or short hospital stay
• Minimal pain and recovery time
• Can be repeated if needed
• Suitable for elderly or medically unfit patients

4. Microwave Ablation (MWA)

Microwave ablation is an advanced form of thermal ablation that uses microwave energy to destroy tumors. It is faster and can treat larger tumors compared to RFA.

Advantages of MWA over RFA:

• Faster ablation time
• Higher temperatures achieved
• Effective for larger tumors
• Less affected by nearby blood vessels (heat sink effect)
• More predictable ablation zone

MWA is used for:

• Liver, kidney, and lung tumors
• Tumors near blood vessels
• Larger lesions not suitable for RFA

5. Cryoablation

Cryoablation uses extreme cold (liquid nitrogen or argon gas) delivered through a probe to freeze and destroy tumor tissue.

Advantages of cryoablation:

• Visible ice ball on imaging — precise monitoring
• Less painful than heat-based ablation
• Suitable for tumors near sensitive structures
• Effective for kidney, prostate, and bone tumors

6. Irreversible Electroporation (IRE / NanoKnife)

IRE uses electrical pulses to create permanent pores in cancer cell membranes, leading to cell death without heat. It is particularly useful for tumors located near critical structures like bile ducts or major blood vessels.

Suitable for:

• Pancreatic tumors
• Tumors near bile ducts or major vessels
• Locally advanced tumors not suitable for thermal ablation

7. Percutaneous Tumor Biopsy

Image-guided biopsy is a minimally invasive way to obtain tissue samples from tumors for accurate diagnosis, staging, and treatment planning.

Advantages of image-guided biopsy:

• Precise targeting of the tumor under CT or ultrasound
• Avoids open surgical biopsy
• Quick procedure with minimal discomfort
• Early diagnosis enables timely treatment
• Can be performed for liver, lung, kidney, bone, and other tumors

8. Pre-Surgical Tumor Embolization

Before removing highly vascular tumors surgically, embolization is performed to reduce blood supply, minimize intraoperative bleeding, and make the surgery safer.

Commonly performed for:

• Renal tumors
• Bone tumors
• Head and neck tumors (meningioma, paraganglioma, juvenile nasopharyngeal angiofibroma)
• Pelvic tumors

9. Vertebroplasty and Cementoplasty

When cancer spreads to the spine or other bones, it can cause severe pain, weakness, and risk of fracture. Bone cement is injected into the affected bone under imaging guidance to stabilize it and relieve pain.

Benefits:

• Rapid and effective pain relief
• Stabilizes weakened bone
• Prevents pathological fracture
• Minimally invasive with short recovery

10. Celiac Plexus Block and Neurolysis

Cancer of the pancreas and upper abdominal organs can cause severe, difficult-to-control pain. Celiac plexus block involves injecting alcohol or local anesthetic around the celiac nerve plexus under imaging guidance to interrupt pain signals.

Benefits:

• Significant reduction in cancer pain
• Reduces dependence on opioid pain medications
• Minimally invasive
• Can be repeated if needed
• Improves quality of life

11. Biliary Drainage and Stenting for Cancer

Cancer of the bile duct, pancreas, or liver can block bile flow, causing jaundice. PTBD or biliary stenting restores bile drainage and relieves jaundice.

Used in:

• Cholangiocarcinoma
• Pancreatic cancer
• Liver metastases causing biliary compression
• Pre-surgical biliary decompression

12. Embolization for Tumor Bleeding

Tumors can bleed internally, sometimes severely. Embolization blocks the bleeding blood vessel and controls hemorrhage effectively without surgery.

Used for:

• Kidney tumor bleeding
• Liver tumor hemorrhage
• Pelvic tumor bleeding
• Post-biopsy or post-surgical bleeding

13. Port-a-Cath and Chemotherapy Port Insertion

For patients requiring long-term intravenous chemotherapy, a port-a-cath (implantable venous port) is placed under the skin for easy, repeated venous access.

Benefits:

• Avoids repeated needle pricks
• Safe and comfortable chemotherapy administration
• Reduced risk of vein damage
• Can stay in place throughout chemotherapy course

14. IVC Filter for Cancer Patients

Cancer patients are at high risk of DVT and pulmonary embolism. IVC filter placement protects against life-threatening pulmonary embolism in high-risk patients.