Is Vascular Embolization Safe for an 80-Year-Old with an 8cm Liver Tumor?

Is an 80-year-old patient with an 8 cm liver tumor really not suitable for transarterial embolization?

Hello, doctor.
First, I would like to say thank you.
My grandfather experienced a sudden weight loss of over 10 kilograms last month and was diagnosed with an 8-centimeter malignant tumor in his liver after being examined at the hospital.
While preparing for further tests, he suddenly collapsed and lost consciousness at home.
He was taken to Taoyuan Veterans Hospital for emergency treatment and then transferred to Taipei Veterans General Hospital.
The doctors initially implanted a cardiac pacemaker.
Later, I heard from family elders that the hospital suggested performing a transarterial embolization, but Chang Gung Memorial Hospital indicated that due to my grandfather's advanced age, it would be better to let him enjoy the remaining days of his life, as they were concerned he might not be able to endure the pain of subsequent chemotherapy.
I would like to ask, is it not sufficient to only perform the transarterial embolization? Would avoiding chemotherapy not potentially extend his life more than doing nothing at all? Or is there a significant risk associated with the transarterial embolization as well?

penny, 30~39 year old female. Ask Date: 2007/10/16

Dr. Chen Sirong reply Oncology

1.
Chemotherapy may not be suitable for an 80-year-old.

2.
Embolization can be performed alone.

3.
Since you are already at Veterans General Hospital, you can follow the recommendations of the doctors there regarding embolization.

4.
The physician will reassess the patient's physical condition before proceeding with the embolization.

Thank you for your letter.
Wishing you peace and happiness.

Sincerely,
Dr.
Chen Sih-Rong,
Director of the Oncology Department, Taoyuan General Hospital, Department of Health.

Reply Date: 2007/10/16

More Info

When considering vascular embolization for an 80-year-old patient with an 8 cm liver tumor, several factors must be taken into account, including the patient's overall health, the nature of the tumor, and the potential risks and benefits of the procedure.

Vascular embolization is a minimally invasive procedure that involves blocking the blood supply to a tumor, which can help to shrink it or reduce its blood flow. This can be particularly beneficial for patients with liver tumors, as it may alleviate symptoms and potentially prolong survival. However, the decision to proceed with this treatment in an elderly patient requires careful consideration of their medical history and current health status.

In your grandfather's case, the fact that he experienced significant weight loss and a sudden episode of syncope (fainting) raises concerns about his overall health and the potential for complications. The placement of a pacemaker indicates that there may be underlying cardiac issues that could complicate any invasive procedure. Age alone is a significant factor in determining the safety of surgical interventions, as older patients often have comorbidities that can increase the risk of complications.

The recommendation from the medical team at Taipei Veterans General Hospital to consider vascular embolization suggests that they believe the potential benefits may outweigh the risks. However, the caution expressed by the team at Chang Gung Memorial Hospital reflects a common concern in geriatric medicine: the balance between extending life and maintaining quality of life. In many cases, aggressive treatments like chemotherapy or invasive procedures may lead to significant discomfort and a decline in quality of life, particularly in elderly patients who may not tolerate such interventions well.

Regarding your question about whether vascular embolization alone could be sufficient without chemotherapy, it is essential to understand that while embolization can reduce the size of the tumor or control its growth, it may not be curative. The effectiveness of embolization can vary depending on the tumor type and its stage. In some cases, it may be used as a palliative measure to manage symptoms rather than as a definitive treatment.

The risks associated with vascular embolization include bleeding, infection, and damage to surrounding tissues. In elderly patients, these risks may be heightened due to factors such as frailty, the presence of other medical conditions, and the potential for slower recovery times. Therefore, the medical team would likely conduct a thorough assessment of your grandfather's overall health, including cardiac function, liver function, and any other comorbidities, before making a final recommendation.

In conclusion, while vascular embolization can be a viable option for managing liver tumors, it is crucial to weigh the potential benefits against the risks, especially in an elderly patient with significant health concerns. Engaging in open discussions with the healthcare team about your grandfather's prognosis, treatment goals, and preferences will be vital in making an informed decision that aligns with his values and wishes. Ultimately, the focus should be on ensuring the best possible quality of life for your grandfather, whether that involves active treatment or supportive care.

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