【The story of coordinator】「Starving cancer to death」Accompanying a patient who underwent Transcatheter Arterial Embolization

The patient wanted to fulfill his duty for as long as possible. So, he decided to come to Japan

The patient was a urologist living in Eastern Europe. He had colorectal cancer that had metastasized to the liver. Using his network of doctors, he found by himself a transcatheter arterial embolization specialist at a national university hospital in the Tokyo area of Japan, and contacted EAJ with a strong desire to receive personal treatment from this doctor.

EAJ immediately contacted the doctor on the patient’s behalf and sent him the patient’s examination images and other information, and he agreed to treat the patient. At the time, however, many foreigners had left Japan immediately after the Great East Japan Earthquake, and some areas were still experiencing power outages, and inquiries about coming to Japan for medical care had plummeted. “Are you sure you can come?” EAJ confirmed to the patient. “I am a doctor and I understand that there is little chance of a complete cure. But, I want to fulfill my duty as a doctor for as long as possible. So even if it is a little inconvenient, I want to receive treatment in Japan because I have no other choice,” he said with a strong desire to receive treatment in Japan.

Cancer is a disease in which one’s cells grow in an uncontrolled and unlimited manner due to some genetic abnormality. Because of the uncontrolled increase, the body’s normal tissues and organs are compressed, and body functions are impaired. Thus, when body organs, especially nerve cells, are compressed or damaged by proliferating cancer cells, severe pain occurs and quality of life (QOL) is significantly reduced. Even in the stage where cancer is not curable, damage and compression of these organs and nerves can be minimized as much as possible, and pain control and symptom control can be achieved. To this end, embolization is applied to cancer patient. Embolization is a technique that helps to change the destination (direction) of cancer cell growth and to control the location and speed of growth.

After completing examinations, etc., the patient finally enters the operating room on the day of surgery, where preoperative measures and general anesthesia are explained. Surgery is a delicate and detailed work that can take up to four hours in the long run, but it is an important job that can affect human lives. Some doctors perform a routine before each surgery to enhance concentration of mind. The routine of this doctor was to hear his favorite music. When the music began to play, the doctor entered the operating room fully prepared and focused.

What is transcatheter arterial embolization?

First, a long, thin tube is inserted through a blood vessel in the groin at the base of the leg. The torso is photographed by CT, and while looking at it, the tube reaches the liver area at great speed first. This is where arterial embolization begins. Tumors take nutrients from blood vessels to grow tissue. Embolization is a treatment in which a sponge-like filling is placed in the artery leading to the tumor to block blood flow, preventing tumor from taking in nutrient to stop the growth of tumor or to make tumor shrink. When attacking a castle in an old war, the warrior at the time used the tactics of surrounding the castle and waiting for the people in the castle to slowly perish from hunger after cutting supply routes of food and other supplies to the castle. We call this way of tactics as starving defender to death by besieging. It is the same tactics as this. This time, the anticancer drug is soaked into a sponge-like substance to further attack the cancer. It is like throwing flame into the diseased part in conjunction with tactics called as starving defender to death by besieging.

The term “arterial embolization” gave me the impression that there were several large blood vessels called arteries, and that once the arteries are stuffed with fillings, the procedure is over. In reality, however, it was far from what I expected. It was a repetitive and tedious process of examining each and every very small blood vessel, called a capillary, to see if it was connected to the tumor while looking at a CT scan, and then placing fillings in all the small blood vessels that were connected. Though the surgical procedural device is equipped with software that converts CT images to 3D for easier viewing, Skilled technicians are progressively placing fillings, using CT images that just looks like black and white planar for untrained eyes instead of very three-dimensional. Thus, in about four hours, all possible blood vessels were stuffed and the procedure was over.

Arterial embolization as palliative care

It does not mean that once all the fillings are done, it is the end of the process. When blood vessels lose their pathways, they create new branches and vessels that lead to the object. This is called angiogenesis, and after a few months, bypass vessels will form to bypass the stuff-filled area. The patient visited to Japan a total of four times over a period of time to receive the same surgeries to place fillings to newly created bypass vessels. After the treatment, the ex-patient informed me that he was feeling great and was able to continue working every day as a doctor. He also gave a speech as a person who has experienced Japanese medical care when we held a symposium on medical cooperation between that country and Japan, hoping to share Japanese medical technology with his home country. Although he ran out of energy in the end, he was happy that he was able to extend his working hours with good health while keeping his cancer under control as he had originally hoped. Arterial embolization is also an effective treatment for these palliative purposes.

（This is a re-edited version of the coordinator’s story as of April 2011）