– Vertebral Body Compression Fractures
– Vertebral Body Tumors
Head and Neck Tumors
Juvenile Nasopharyngeal Tumor
Bones are the third most common location where cancer cells spread and metastasize.3 Each year, about 100,000 cases of bone metastasis are reported in the United States.2 Bone metastases occur when cancer cells gain access to the bloodstream, reach the bone marrow, begin to multiply, and then grow new blood vessels to obtain oxygen and food—which in turn causes the cancer cells to grow more and spread.
Some bone metastases become painful because the tumor eats away at the bone, creating holes that make the bone thin and weak. As the bones are replaced with tumors, nerve endings in and around the bone send pain signals to the brain. If left untreated, bone metastases can eventually cause the bone to fracture—seriously affecting a patient’s quality of life.2 This is particularly true for long bones of the extremities where a fracture may render a limb nonfunctional. These patients may require surgical intervention to restore the function of their limbs. More commonly, metastases involve the ribs, pelvis, and spine.
For the most part, the goal of treating bone tumors is not curative, but rather palliative by reducing pain, preventing additional bone destruction, and improving function.
In treating cancer patients with painful bone metastases, interventional radiologists may use a form of treatment called kyphoplasty or vertebroplasty.
The spine is one of the most common sites of metastasis. Vertebral bodies involved by the tumor may become painful and may eventually fracture. Surgical intervention with reconstruction of the spinal column is indicated only if the tumor causes compression of the spinal cord or instability of the spine. Vertebroplasty is an outpatient procedure performed using conscious sedation. An interventional radiologist inserts a needle through a small incision in the back, directing it under fluoroscopy (continuous, moving X-ray imaging) into the fractured vertebra. The physician then injects medical-grade bone cement into the vertebra. The cement hardens within about 15 minutes and stabilizes the fracture. This treatment improves pain, prevents further collapse of the vertebra, and restores mobility. Vertebroplasty dramatically improves back pain within hours of the procedure, provides long-term pain relief and has a low complication rate, as demonstrated in multiple studies.5-11
Fractures of the bones of the spine (vertebrae) can occur as a result of trauma, osteoporosis (loss of calcium resulting in decreased bone strength), or as a result of a tumor within the bone. Approximately 700,000 vertebral, or spinal bone, fractures occur each year, usually in women over the age of 60.
Osteoporosis is basically defined as porous bones. The human bone is made of a thick outer shell and a strong inner honeycomb mesh. Osteoporosis occurs when the holes in the honeycomb mesh become larger making the bone fragile and susceptible to breaking easily. When this happens, the bone collapses upon itself. The most common sites of these breaks are at the hip, spine, and wrist. (Thinning of the bone can be detected by measuring bone density using a dual energy x-ray absorptiometry (DXA) scan. Low bone density does not cause any symptoms.)
Osteoporosis itself does not cause back pain. However, osteoporosis can weaken the vertebral body (spine) so that it can no longer withstand normal stress or a minor trauma (e.g. a fall), all of which can result in a fracture. In fact, a fracture is typically the first outward sign of the disease.
Tumors in the spine are not uncommon conditions and can bring about fractures as a result of a severe weakening of the bone.
Ultimately, spinal fractures often result in moderate to severe pain that greatly impacts the patient’s ability to function day to day.
The spine is a flexible column formed by a series of bones called vertebrae, each stacked one upon another to support the head and trunk. The spine is made up of 33 vertebrae: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused into one), and 4 coccygeal (fused into one). The vertebrae most commonly affected by compression fractures are one or more of the thoracic or lumbar vertebrae.
The intervertebral discs are located between the vertebrae from the second cervical vertebrae to the sacrum. They vary in size, thickness, and shape at different levels of the spine. The purpose of the intervertebral discs is to cushion movement.
The spinal cord is a slender nerve column that is protected within the spine. It passes downward and terminates near the last thoracic and the first lumbar vertebrae. The spinal cord consists of 31 segments, each of which gives rise to a pair of spinal nerves. These nerves branch out to various body parts to connect them with the central nervous system.
Vertebral body compression fractures may be treated with medications, surgically or with minimally invasive procedures known as vertebroplasty and kyphoplasty.
Performed approximately 75,000 times a year in the United States, vertebroplasty is designed to reinforce the fractured bone, thus eliminating the debilitating pain suffered by patients with compression fractures. Originally developed in the mid-1980’s in Europe, this procedure was eventually brought to the United States in the early 1990’s by two interventional neuroradiologists, Lee Jensen, M.D. and Jacque Dion, M.D.
Vertebroplasty is performed by first inserting a special needle into the affected vertebrae under fluoroscopic (x-ray) guidance. When the needle tip is in position, a cement mixture is injected into the affected vertebral body. When sufficient amounts of the cement are injected into the damaged bone, the needle is removed and gentle pressure is applied over the puncture site. No stitches are required and the patient is left only with a band-aid. The patient may then go home an hour or 2 after completion of the procedure. Almost all patients experience complete and immediate relief of the severe pain caused by the compression fracture.
Kyphoplasty is a technique originated in the late 1990’s and established in 2001. Also a minimally invasive procedure, kyphoplasty is conducted by inserting a balloon into the crushed vertebra via needle under X-ray guidance, expanding the balloon to create a cavity or void space within the bone tissue, and then withdrawing the balloon and inserting in its place a cement-like substance which ultimately serves to stabilize the vertebra.
Most patients undergo both of these procedures on an outpatient basis and are allowed to leave the hospital within a few hours of the procedure. Activities at home may be limited at first and slowly increased as tolerated. Strenuous activity such as heavy lifting should be avoided for up to one week; e.g., nothing heavier than a pocketbook or a small bag of groceries.
If the pain is not alleviated by either of these procedures, the patient should be re-evaluated for other possible causes by his/her referring physician. In some cases, similar pain can occur in a different location which may indicate that the patient has developed another fracture.
Depending on the specifics of the patient’s condition, he/she may be referred to a physical therapist or other rehabilitation services as needed.
Spinal tumors are abnormal growths of tissue found inside the spinal column. Primary tumors originate in the spine and are caused by uncontrollable growth among cells that reside in the spinal column or neural tissues. Considered rare, primary tumors of the spine can be benign or malignant and their cause is unknown. Secondary tumors are ones which spread to the spine from some other part of the body. Most often, the primary cause of these tumors is breast, lung, and kidney cancers.
Vertebral tumors which arise or spread to the spine present some of the most difficult challenges for patients and physicians as they can cause several types of problems. First, the tumor may weaken the bone, causing it to fracture and collapse. As a result, the patient suffers severe pain from excess pressure on nerves or the spinal cord. Additionally, the tumor can expand outside the bone, also causing pressure on nerves or the spinal cord. And finally, some tumors can cause the bone to expand, similarly placing pressure on surrounding tissues.
The primary symptom of a spinal tumor, and the one that brings most patients to the doctor’s office, is non-mechanical back pain. Non-mechanical back pain is constant and does not improve with rest or lying down. Mechanical back pain, on the other hand, is most often caused by muscle strains or disc injury and usually worsens with activities such as sitting, bending, and walking. It does improve with rest or lying down.
Other symptoms of spinal tumors may include sciatica, numbness, partial paralysis, spinal deformity, difficulty with bladder control, and fever. These symptoms generally develop slowly and worsen over time unless they are treated.
Depending on the type of tumor and the symptoms it is causing, different treatments can be used to treat vertebral body tumors. If there is collapse of the bone, a procedure called vertebroplasty may be performed by inserting a needle through the skin into the bone using x-ray guidance and injecting cement to strengthen the bone. If the tumor causes pressure on nerves or the spinal cord, surgery may be considered. In the event that the tumor has a large blood supply, which can complicate surgery, endovascular techniques may be employed by inserting a catheter into the blood vessels supplying the tumor and injecting materials to block off the blood supply to the mass. This procedure, called embolization, is usually performed within a few days of the impending surgery. If surgery is not recommended or possible, embolization may be performed to shrink the tumor.
In some cases, a needle can be placed directly into the tumor using x-ray guidance and material can be injected to kill the tumor. Some tumors are best treated with radiation therapy.
In the United States, a woman is diagnosed with breast cancer every three minutes and one woman will die from the disease every 13 minutes.1 For these women, as well the thousands of men diagnosed each year,1 breast cancer treatments can be highly effective, but often require invasive treatment options such as surgery and chemotherapy. Recent advancements in technology and imaging now offer patients more tools to fight breast cancer—minimally invasive treatments known as thermal ablation and laser therapy.
Thermal ablation treatment is building on the two-decade trend toward less radical approaches and utilizing local treatments for breast cancer. Due to the cosmetic result of more invasive therapies, treatments that would preserve the greatest amount of normal tissue (breast conservation) have great appeal.5, 7 Although the devices used in radiofrequency ablation, cryoablation and laser therapy are FDA approved, more research and long-term data are needed to determine the role these procedures will have in the fight against breast cancer.
Surgery offers the best chance for a cure. Until long-term data are available, interventional treatments are reserved for women who cannot have surgery.
When breast tissue divides and grows at an abnormal rate, a mass of extra tissue can develop into a tumor. To continue growing, a tumor generates its own blood supply to provide oxygen and nutrients. Although the cancerous cells can grow in size in the breast, they can also travel throughout a person’s blood stream and become embedded in other organs, a process known as metastasis. Typically, 20 percent of breast cancer develops in the lobules where milk is produced, while 80 percent originates in the mammary ducts that carry milk from the lobules to the nipple.2
As vascular experts, interventional radiologists are uniquely skilled in using the vascular system to deliver targeted treatments via catheter throughout the body. In treating cancer patients, interventional radiologists can attack the cancer tumor from inside the body without medicating or affecting other parts of the body. For breast cancer, interventional radiologists use thermal ablation, as well as some laser therapy, to kill the cancer cells. Although the devices used are FDA approved, research to evaluate the long-term effects of these treatments is still ongoing.
Interventional radiologists can also assist with the diagnosis by performing a needle-core biopsy of an abnormal lump. Using imaging for guidance, an interventional radiologist can insert a small needle into the mass and remove a tissue sample, which is given to a pathologist to determine what the cause of the abnormal tissue—cancer, benign tissue, infection, or scar.
Needle biopsy is typically an outpatient procedure with very infrequent complications; less than 1 percent of patients develop bleeding or infection. In about 90 percent of patients, needle biopsy provides enough tissue for the pathologist to determine the cause of the abnormality.
Patients with invasive breast cancer are at risk for liver cancer. The liver serves as a way-station for cancer cells that circulate through the bloodstream. These cells may grow and form tumors in the liver. It is estimated that as many as 70 percent of all people with uncontrolled cancer will eventually develop secondary liver tumors, or metastases (tumors formed by primary cancer cells that have spread from other cancer sites). Interventional radiologists offer nonsurgical treatments for liver cancer, including embolization to cut off the blood supply to the tumor, radioembolization that delivers radiation directly inside the tumor, and chemoembolization, which delivers the cancer drug directly into the tumor and then cuts off the blood supply.
Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus.
The esophagus is the hollow, muscular tube that moves food and liquid from the throat to the stomach. The wall of the esophagus is made up of several layers of tissue, including mucous membrane, muscle, and connective tissue. Esophageal cancer starts at the inside lining of the esophagus and spreads outward through the other layers as it grows.
The stomach and esophagus are part of the upper digestive system. The two most common forms of esophageal cancer are named for the type of cells that become malignant (cancerous):
Smoking, heavy alcohol use and Barrett esophagus can increase the risk of developing esophageal cancer.
The most common signs of esophageal cancer are painful or difficulty swallowing and weight loss. These and other symptoms may be caused by esophageal cancer or by other conditions. A doctor should be consulted if any of the following problems occur:
Tests that examine the esophagus are used to detect (find) and diagnose esophageal cancer. The following tests and procedures may be used:
Doctors often recommend placing a gastrostomy tube in the stomach for a variety of conditions in which a patient is unable to take sufficient food by mouth. In the procedure, the feeding tube is inserted through a small nick in the skin and into the stomach under X-ray guidance.
Kidney cancer is the eighth most common cancer in men and the tenth in women.1 The most common type of kidney cancer is renal cell carcinoma that forms in the lining of the renal tubules in the kidney that filter the blood and produce urine.2 Approximately 85 percent of kidney tumors are renal cell carcinomas.1 When kidney cancer spreads outside the organ, it can often be found in nearby lymph nodes, lungs, bones or liver, as well as the other kidney.2
Surgical removal of tumors confined to the kidney offers the best chance for a cure. Unfortunately, some patients may not tolerate surgery due to underlying medical conditions. In this group of patients, minimally invasive image-guided therapies performed by interventional radiologists offer a less invasive option. These treatments also offer valuable benefits to those patients with advanced or metastatic renal cell carcinoma. Chemotherapy drugs and radiation are generally ineffective at curing kidney cancer.3
More than 32,000 Americans each year are diagnosed with kidney cancer—many of them don’t have symptoms.2 Typically, those with kidney cancer are past the age of 40 and twice as often are men.2 Other risk factors include:
The incidence of kidney cancer is on the rise. Fortunately, the availability of modern imaging technology has led to more frequent detection of small, asymptomatic tumors that otherwise would be undetected. Often, small tumors do not cause symptoms and are discovered on CTs, MRIs or ultrasounds that are performed for some other reason, such as standard imaging studies (CT or ultrasound) performed during many emergency room visits. These small tumors are often the best candidates for nonsurgical treatment options.
In addition to a basic physical exam, urine test and blood tests, several other techniques can be used to diagnose kidney cancer. CT scan, MRI or ultrasound can be performed to see inside the body and identify a tumor. An image-guided needle biopsy can be done to remove tissue samples and look for cancer cells. At the time of diagnosis, 25 to 30 percent of patients have metastases.1
Advanced renal cell carcinoma tumors are often quite large and invade adjacent structures and veins. They may even extend through the veins into one of the heart chambers. Some patients with advanced tumors may not be surgical candidates. Arterial embolization is an invaluable treatment option for such patients.
During embolization, an interventional radiologist inserts a small tube (catheter) into an artery in the groin and directs it to the renal artery that supplies blood to the kidney and the tumor. The doctor injects small solid particles or special liquid agents into the artery to block the flow of blood into the kidney. The blockage prevents the tumor from getting oxygen and other substances it needs to grow, causing it to shrink.2
In some patients, arterial embolization may shrink the tumor substantially, rendering the patient a suitable surgical candidate. In others, arterial embolization effectively eliminates tumor-related symptoms and improves patients’ quality of life.
Arterial embolization has also been used to facilitate surgical resection of large tumors. Blocking the blood supply to the tumor decreases the risk of bleeding and minimizes the amount of blood transfusion during surgery. Similarly, arterial embolization can facilitate ablation of larger tumors. Reduction of blood supply to the tumor renders ablation procedures (RFA or cryoablation) safer and more effective.
Radical Nephrectomy: Kidney cancer may be treated with radical nephrectomy, in which the entire kidney, along with the adrenal gland and some tissue around the kidney, is surgically removed. Some lymph nodes in the area also may be removed.1
Simple Nephrectomy: Some patients with early kidney cancer may have a simple nephrectomy which involves removing only the kidney.2
Partial Nephrectomy: A surgeon removes the section of the kidney with the tumor. This procedure may be used when the patient has only one kidney or the cancer affects both kidneys, and only in patients with small kidney tumors.2
Chemotherapy is a systemic therapy in which anticancer drugs enter the bloodstream and travel throughout the body. Anticancer drugs have shown limited effectiveness against kidney cancer.2
Surgical removal of liver tumors offers the best chance for a cure. Unfortunately, liver tumors are often inoperable because the tumor may be too large, or has grown into major blood vessels or other vital structures. Sometimes, many small tumors are spread throughout the liver, making surgery too risky or impractical. Surgical removal is not possible for more than two-thirds of primary liver cancer patients and 90 percent of patients with secondary liver cancer.
Historically, chemotherapy drugs have been generally ineffective at curing liver cancer.
Tumors need a blood supply, which they actively generate, to feed themselves and grow. As vascular experts, interventional radiologists are uniquely skilled in using the vascular system to deliver targeted treatments via catheter throughout the body. In treating cancer patients, interventional radiologists can attack the cancer tumor from inside the body without medicating or affecting other parts of the body by using embolization and radiofrequency heat.
Embolization is a well-established interventional radiology technique that is used to treat trauma victims with massive bleeding, to control hemorrhage after childbirth, to decrease blood loss prior to surgery, and to treat tumors. In treating cancer patients, interventional radiologists use embolization to cut off the blood supply to the tumor (embolization), deliver radiation to a tumor (radioembolization), or combine this technique with chemotherapy to deliver the cancer drug directly to the tumor (chemoembolization).
Additionally, interventional radiologists can use imaging to guide them directly to the tumor through the skin to administer radiofrequency heat to “cook” and kill the cancer cells (radiofrequency ablation).
Chemoembolization is a minimally invasive treatment for liver cancer that can be used when there is too much tumor to treat with radiofrequency ablation (RFA), when the tumor is in a location that cannot be treated with RFA, or in combination with RFA or other treatments.
Chemoembolization delivers a high dose of cancer-killing drug (chemotherapy) directly to the organ while depriving the tumor of its blood supply by blocking, or embolizing, the arteries feeding the tumor. Using imaging for guidance, the interventional radiologist threads a tiny catheter up the femoral artery in the groin into the blood vessels supplying the liver tumor. The embolic agents keep the chemotherapy drug in the tumor by blocking the flow to other areas of the body. This allows for a higher dose of chemotherapy drug to be used, because less of the drug is able to circulate to the healthy cells in the body. Chemoembolization usually involves a hospital stay of two to four days. Patients typically have lower than normal energy levels for about a month afterwards.
Chemoembolization is a palliative, not a curative, treatment. It can be extremely effective in treating primary liver cancers, especially when combined with other therapies. Chemoembolization has shown promising early results with some types of metastatic tumors. Although the individual materials used in this treatment are FDA approved, the treatment itself is not approved for intra-arterial therapy of liver tumors.
This treatment incorporates the radioactive isotope Yttrium-90 into the embolic spheres to deliver radiation directly to the tumor. Each sphere is about the size of five red blood cells in width. These beads are injected through a catheter from the groin into the liver artery supplying the tumor. The beads become lodged within the tumor vessels where they exert their local radiation that causes cell death. This technique allows for a higher, local dose of radiation to be used, without subjecting healthy tissue in the body to the radiation. The Yttrium-90 radiates from within and, since it is administered in the hepatic artery, it can be viewed as “internal” radiation.
Radioembolization is a palliative, not a curative, treatment—but patients benefit by extending their lives and improving their quality of life. It is a relatively new therapy that has been effective in treating primary and metastatic liver cancers. It is performed as an outpatient treatment. There are fewer side effects from this treatment compared to standard cancer treatments, with the main one being fatigue for seven to 10 days.
For more information on this procedure please click here to read a patient pamphlet.
For inoperable liver tumors, radiofrequency ablation (RFA) offers a nonsurgical, localized treatment that kills the tumor cells with heat, while sparing the healthy liver tissue. Thus, this treatment is much easier on the patient than systemic therapy. Radiofrequency energy can be given without affecting the patient’s overall health and most people can resume their usual activities in a few days.
In this procedure, the interventional radiologist guides a small needle through the skin into the tumor. From the tip of the needle, radiofrequency energy (similar to microwaves) is transmitted to the tip of the needle, where it produces heat in the tissues. The dead tumor tissue shrinks and slowly forms a scar. The FDA has approved RFA for the treatment of liver tumors.
In a small number of cases, RFA can extend patients’ lives, but it is generally palliative. Depending on the size of the tumor, RFA can shrink or kill the tumor, extending the patient’s survival time and greatly improving their quality of life while living with cancer.
Because it is a local treatment that does not harm healthy tissue, the treatment can be repeated as often as needed to keep patients comfortable. It is a very safe procedure, with complication rates on the order of two to three percent, and has been available since the late 1990s.
By decreasing the size of a large mass, or treating new tumors in the liver as they arise, the pain and other debilitating symptoms caused by the tumors are relieved. While the tumors themselves may not be painful, when they press against nerves or interfere with vital organs, they can cause pain. RFA is effective for small to medium-sized tumors and emerging new technologies should allow the treatment of larger cancers in the future.
Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die and new cells take their place. Sometimes this orderly process goes awry—that is, new cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue, or tumor. Cancerous tumors are abnormal and divide without control or order.
The lung is the most common site for primary cancer worldwide, and smoking tobacco is the leading risk factor.1,5 The lung is also a common site of metastases for various malignancies.1 Metastases occur when a single tumor cell or clump of cells gain access to the bloodstream or lymphatic system, travel to a new organ such as the lung, begin to multiply, and then regrow their vascular structure to obtain food.
Interventional radiologists can also assist with the diagnosis by performing an image-guided needle biopsy of an abnormal tissue mass. Using CT, ultrasound, MR or X-ray imaging for guidance, an interventional radiologist can insert a small needle into the mass and remove a tissue sample, which is given to a pathologist to determine what is the cause of the abnormal tissue—cancer, benign tissue, infection, or scar.
Needle biopsy is typically an outpatient procedure with infrequent complications; for example, less than one percent of patients develop bleeding or infection. In about 90 percent of patients, needle biopsy provides enough tissue for the pathologist to determine the cause of the abnormality.
Head and neck cancer is the name given to a variety of malignant tumors that occur in the head and neck region. They may develop in the mouth, throat, sinuses, nasal cavity, larynx or salivary glands. Some experts also include skin cancers such as melanomas (in the throat or nose) under the broad heading of head and neck cancers.
Excluding superficial skin cancers, but including cancer of the larynx and thyroid, it is conservatively estimated that about 60,000 people are diagnosed with head and neck cancer annually; about 5% of all cancers diagnosed in the United States. There are approximately half a million survivors of oral, head, and neck cancer living in the United States today.
The most common type of malignant tumor in the head and neck region is squamous cell cancer, also known as squamous cell carcinoma. This is due to the fact that the lining of much of the mouth, nose and throat is made up of a type of cell known as squamous cell. When these cells give rise to malignancy, the tumor is called squamous cell carcinoma (abbreviated SCCA). This tumor is most often associated with heavy smoking and/or heavy consumption of alcohol.
Early symptoms of head and neck cancer include a sore in the throat that does not heal especially with pain radiating to the ear, a growth in the mouth, a lump in the neck, a cough or hoarseness, a sore throat that does not improve, coughing up blood or bleeding into the throat and nosebleeds. These cancers initially spread into the lymph nodes in the neck. A lump in the neck (enlarged lymph node) that does not go away may be the first indication of a head and neck cancer.
Risk factors of head and neck cancer include smoking or chewing tobacco and alcohol use. Leukoplakia (white spots or patches in the mouth) also may be considered a risk factor, as this condition becomes cancerous in approximately one-third of patients.
Juvenile nasopharyngeal angiofibromas (JNAs) are tumors that arise at the back of the nose and account for .05% of all head and neck tumors. Typically benign, these tumors are almost always seen in adolescent boys, with the highest incidence rate between seven and 19 years of age. JNAs are rare in patients older than 25 years of age.
Given this condition’s predisposition to boys, it is thought that hormones may play a role in its development. Some specialists suggest these tumors are sensitive to hormone levels and stimulated to growth by the onset of puberty.
The most common symptom of a juvenile nasopharyngeal angiofibroma is nasal obstruction (occurring in 39 to 90 percent of all cases). These tumors also cause recurrent nosebleeds in 45 to 60 percent of cases. Other symptoms may include sinusitis, otitis (ear infection), loss of sense of smell, facial swelling, headache and double vision.
The definitive treatment for juvenile nasopharyngeal tumors is surgical removal. This can be difficult depending on the size of the tumor and where it has spread. Additionally, these tumors usually have a large blood supply, which further complicates surgery. In order to decrease the amount of bleeding during surgery, endovascular treatment can be performed prior to surgery by inserting a catheter into the blood vessels supplying the tumor and injecting materials to block off the blood supply to the tumor. This procedure, called embolization, is usually done within a few days in advance of the impending surgery.
Tumors of the head and neck (such as tongue or throat cancer) can cause bleeding into the throat or nosebleeds. Not infrequently, this bleeding can be difficult to control by surgery. When this is the case, endovascular methods can be used to treat these tumors and their bleeding by inserting a catheter into the blood vessels supplying the tumor and injecting materials to block off the blood supply to the tumor. This procedure, called embolization, can also be performed before a scheduled surgery if the surgeon is concerned that the large blood supply to the tumor will make surgery more difficult.
Additionally, certain tumors can be treated by placing a catheter into the artery supplying the tumor and injecting chemotherapy drugs directly into the mass, rather than dispensing the drugs intravenously. This treatment option depends on the kind of tumor, its size, and its location.