Despite the fact that cancer is the second leading cause of death globally, the National Center for Health Statistics in the US declared that cancer death rates have been declining since the 1990s.
However, in contrast to declining death rates for most cancers, primary liver cancer (hepatocellular cancer) death rates increased by 2% per year from 2007 to 2016 becoming the second leading cause of cancer death in the US while being endemic in some countries including France, Italy, and Romania (figure 1). On the other hand, even considering the gradual decrease of death in the most common cancer types such as lung, breast, and colon; the liver still remains to be the most affected organ for metastases. In such cases, the liver itself is often the first and only site for metastases that seem to play a major role in the cause of death. Up to 50-70 % of patients with advanced breast or colorectal cancer develop liver metastases. (Fig.1 Hepatocellular cancer distribution in Europe: GLOBOCAN 2012).
The first line of therapy for primary liver cancers and colorectal metastases to the liver is the surgical resection of the metastases. However, due to the number, size and location of the lesions, as well as the patient’s performance status, only about 20 % of patients are eligible for surgery.
Alternatively, liver cancers may be destroyed by minimally invasive techniques such as ablation or embolization, within the scope of interventional oncology. Interventional oncology is an emerging subspecialty that provides tumor treatments under radiologic image guidance, such as computed tomography, ultrasonography, angiography. As the first-line treatment in many liver cancers, Interventional oncology offers less risk, less pain and less recovery time compared to open surgery. In addition, it can lead to an increase of lifespan, improvement of quality of life and could be curative in selected timely diagnosed cases.
Dr. Inge Aivas, Medical Manager, Anadolu Medical Center, says: “With our best foot forward, we have been fighting cancer for 15 years. We are a team of Romanians helping other Romanians in their most difficult time of need. We understand that a diagnosis of cancer is difficult within itself, let alone traveling to a foreign country for treatment. We are here: native Romanian speakers, understanding of Romanian culture and customs, ready to assist our copatriots 24/7”.
What is ablation in Liver tumors?
Ablation refers to the melting or destruction of tumors using special needles or probes placed into the tumor percutaneously under imaging guidance (figure 2). It can be used to treat tumors in various organs such as the liver, lung, bones etc. Heating (radiofrequency or microwave ablation ), freezing (cryoablation) or chemical agents (alcohol ablation) are used to destroy cancer cells. Both primary and metastatic liver cancers with limited size and numbers (<5 cm up to 5 lesions) can be treated with ablation.
What is embolization in Liver tumors?
Embolization refers to the blocking of vessels using an angiographic technique. Chemo or radioembolization treatment is utilized by interventional radiologists to treat tumors by inserting a catheter through the groin and navigating up to the vessels that feed the tumor in the liver (figure 3).
Chemoembolization, using microspheres or liquid agents loaded with chemotherapy drugs such as doxorubicin and irinotecan, combines the effect of high dose of targeted chemotherapy and ischemia.
During radioembolization, radioactive microspheres, such as Yttrium-90 or Holmium 166, are used to deliver a high dose of radiation inside the tumor, while nearby healthy tissue receives minimal radiation. Both primary and metastatic liver cancers of larger size and greater number can be treated with embolization.
While chemoembolizaton is relatively common, radioembolizaton is a novel procedure, which is not available in most of the eastern European countries.
Dr. Murat Dökdök, Interventional Radiologist at Andolu Medical Center, states: ”Interventional oncology has become the fourth pillar in liver cancer treatment for the last decade. However, to increase reliability and reproducibility of such treatments with a high precision, emerging technologies must be implemented in our routine practice”.
High standards of medicine in Interventional Oncology services
Quality in Interventional Oncology services depends on the required skills and facilities. With proven dedication and commitment to quality and safety, the Anadolu Medical Center Interventional Oncology services have been enrolled as part of IASIOS (International Accreditation System for Interventional Oncology Services) pilot phase, a worldwide initiative. All oncological interventions are performed by interventional radiologists certified by the European Board of Interventional Radiology (EBIR). Sophisticated imaging – with additional use of special software, navigational/robotic systems- plays an essential role during the initial staging (i.e. determining the stage of cancer), pre-operative planning, monitoring of treatment effect and surveillance for recurrence of the disease.
Anadolu Medical Center is a state-of-the-art, multispecialty, acute care hospital in Istanbul. It was established by the Anadolu Foundation in 2005 and has two major characteristics: its non-profit status and its unique affiliation with the globally recognized Johns Hopkins Medicine USA.
The Center’s affiliation with the Johns Hopkins Medicine USA positions the hospital on the level with the best hospitals in the world. This affiliation provides continuous access to the latest innovations, unmatched expertise, and technological advancements. This affiliation allows its staff an opportunity to continuously improve their skills, knowledge, and training to ensure outstanding care and expertise.
Anadolu Medical Center is an institute that was awarded by ESMO (European Society of Medical Oncology) as one of the very few centers in Europe and it is the only hospital in Turkey accredited by OECI (Organization of European Cancer Institutes). The center also has ISO 9001- 2000 (Quality Management System), ISO 14001 (Environment Management System), OHSAS 18001 (Work, Health and Safety) and JCI (Joint Commission International) accreditation and quality certificates, and holds Planetree Gold Certification. The center provides excellence in Oncology (Medical Oncology, Pediatric Oncology, 15 years of experience in Cyberknife Radiosurgery and IMRT, cutting-edge technology in Bone Marrow Transplant Unit reaching 2.000 transplants between 2010- 2019).
What sets apart the Oncology Institute at Anadolu Medical Center is the multidisciplinary and patient-centered care approach. All patients’ managements are discussed at our tumor subtype boards (ex: Thoracic tumor board, Neuro-oncology tumor board, GI tumor board, etc.) to obtain opinions of multiple physicians from various Oncology-related specialties, leading to the most comprehensive, evidence-based and patient appropriate treatment plan for everyone.
The center currently receives patients from more than 65 countries worldwide. The boutique-style services enable patients to feel welcomed in a foreign country and put them at ease throughout the entire process.
Medical Travel Quality Alliance (MTQUA) has ranked Anadolu Medical Center among the Top 10 Global Hospitals in 2019.
Anadolu Romania team includes 15 patient coordinators and translators who are with patients in every step of the way as well as a nurse case manager and Romanian-speaking coordinating physician.