Buddy is a 17-year-old male neutered Schipperke who was diagnosed with Hepatocellular carcinoma (liver cancer) in July of 2017. He had recently started refusing treats and was losing weight. These symptoms would markedly improve with supportive care, but then return when the treatments wore off. Abdominal radiographs (x-rays) and an abdominal ultrasound were performed on July 1st, 2017 at his primary care veterinary clinic, revealing a mass in the right liver. Cytology of the liver mass was consistent with Hepatocellular carcinoma.
Buddy was then presented to AMCS for a CT scan of the abdomen, which showed a mass in the right lateral, right medial and caudate lobes of the liver. The right medial and right lateral liver lobe mass appeared to abut, and the total volume was ~9 x 7 cm. A small mass in the caudate lobe measured approximately 2.0 cm.
Buddy presented to the AMCS Oncology department for a recheck examination on 7-13-17 after starting prednisone and continuing Cerenia for presumed Irritable Bowel Disease (IBD). Buddy also had a collapsing trachea and following anesthesia from the CT scan a week prior, had harsh coughing for several days. This was now improved. The possibility of chemoembolization for Buddy’s hepatic masses was discussed once his symptoms were under control, which was more than likely due to his intestinal disease and less so directly related to the liver masses. Since starting prednisone and continuing Cerenia Buddy’s GI signs had been resolved.
On 7-25-2017 Buddy was then presented to the AMCS Internal Medicine service for cholecystectomy (removal of the gallbladder) and liver biopsy with ASCS in preparation for possible chemoembolization of his hepatic masses. Surgery revealed the right-sided liver mass that occupied the majority of the abdomen. Surgical resection of the mass was not possible. Cholecystectomy was performed without incident, and Buddy did well after discharge. Chemoembolization of the liver mass was scheduled for 9-5-2017.
On 9-5-2017 the Chemoembolization procedure was performed via the femoral artery using a combination of wires and catheters under fluoroscopy (medical imaging that shows a continuous X-ray image on a monitor) to micro-select the tumor directly, deliver chemotherapy and occlude all blood-flow in the tumor with embolization beads. Buddy recovered well overnight and was discharged to home the following day without complications.
On 9-12-2017 Buddy was presented to the Internal Medicine department for a recheck examination and to collect blood for a CBC (complete blood count) to monitor his response to the chemotherapeutic drug Adriamycin that was administered during his chemoembolization procedure. An elevated platelet count was noted, but antiplatelet therapy could not be started until 2 weeks post-procedure to ensure complete healing of the femoral artery.
Buddy was presented to the Internal Medicine department again on 9-21-2017 for a recheck examination and for follow-up evaluation for a partial saddle thrombus (a blood clot that cuts off blood flow to the hind limbs) that he was seen at VSC for on 9-14-2017. Since his last appointment, Buddy had been steadily improving daily and had full function of both hind limbs. An ultrasound was performed on Buddy’s blood vessels to look for blood flow and found the clot to be almost completely gone, with excellent blood flow into the right leg, and good blood flow into the left leg. Buddy continues to do well at home. He will be monitored with ultrasound but does not require any additional chemotherapy.
About Interventional Radiology: Interventional Radiology (IR) involves the use of contemporary imaging modalities (CT scans, fluoroscopy, ultrasonography) to gain access to different structures of the pet’s body for diagnostic and therapeutic purposes. IR can be applied to any body system in patients of all sizes. Some techniques, such as chemoembolization of tumors or palliative stenting for malignant obstructions, offer treatment options for pets with various conditions that may not be amenable to standard therapies. IR procedures are generally associated with better patient outcomes, minimal anesthesia time and reduced hospital stays.