Hepatocellular Carcinoma (HCC) is the most common form of primary liver cancer, often developing in individuals with chronic liver diseases. Transarterial Chemoembolization (TACE) is a minimally invasive procedure that offers a targeted treatment option for certain patients. Performed by an interventional radiologist, TACE attacks the cancer directly within the liver. This localized approach is a standard treatment for intermediate-stage HCC.
How TACE Fights Liver Cancer
TACE has a two-pronged attack on liver tumors, combining targeted drug delivery with a method to cut off the tumor’s blood supply. This is possible because most liver tumors get blood from the hepatic artery, while healthy liver tissue is supplied by the portal vein. This difference allows for a focused assault on cancerous cells while sparing most healthy tissue.
The first part, chemoembolization, involves delivering chemotherapy drugs directly to the tumor. An interventional radiologist guides a catheter through the arteries to the specific hepatic artery branch feeding the tumor. Drugs like doxorubicin or cisplatin are infused, delivering a high-concentration dose directly to the cancer cells.
The second part is embolization, which blocks the tumor’s blood supply. After delivering the chemotherapy, the radiologist injects tiny particles into the artery. These embolic agents lodge in the small vessels feeding the tumor, cutting off blood and oxygen flow. This starves the tumor and prevents it from growing.
The TACE Procedure Step-by-Step
Before the Procedure
Preparation begins with a thorough evaluation, including blood tests to assess liver and kidney function and overall health. Patients are instructed to fast for several hours before the scheduled treatment.
During the Procedure
On the day of the treatment, the patient is brought to the interventional radiology suite. They receive conscious sedation, a type of anesthetic that induces a state of relaxation and drowsiness, but not complete unconsciousness. The interventional radiologist begins by numbing a small area, usually in the groin or wrist, and making a tiny incision to access a major artery, such as the femoral or radial artery.
Using real-time X-ray imaging, known as fluoroscopy, the radiologist guides a catheter through the arterial system and into the hepatic artery that supplies blood to the liver. A contrast medium is injected, which makes the blood vessels visible on the X-ray, allowing the radiologist to create a map of the arteries feeding the tumor. Once the target vessel is identified, the chemotherapy and embolic agents are delivered. The procedure typically takes one to two hours.
Immediately After the Procedure
After the treatment, the catheter is withdrawn, and firm pressure is applied to the insertion site to prevent bleeding before a small dressing is applied. The patient is moved to a recovery area for several hours of observation. During this time, nurses monitor vital signs and manage any immediate discomfort.
Who Is a Candidate for TACE?
The decision to proceed with TACE is made by a multidisciplinary team of specialists who evaluate several factors. TACE is most frequently recommended for patients with intermediate-stage HCC. This includes individuals with tumors confined to the liver that are not suitable for surgical removal due to their size, number, or location. The treatment may also be used as a “bridge” therapy to control cancer growth for patients awaiting a liver transplant.
A patient’s overall liver function is a primary consideration. Doctors use a scoring system, such as the Child-Pugh score, to assess the health of the liver. TACE is generally reserved for those with well-preserved liver function, as the procedure can put temporary strain on the organ. The patient’s general health and ability to tolerate the procedure, often referred to as their performance status, is another important factor in the decision-making process.
The treatment is not recommended if the cancer has spread beyond the liver or has invaded major blood vessels like the portal vein. Patients with diffuse tumors spread extensively throughout the liver may be directed toward systemic drug therapies instead.
Recovery and Common Side Effects
After returning home, most patients experience Post-Embolization Syndrome (PES), an expected response to the treatment. Symptoms include abdominal pain, fever, and nausea or vomiting, which occur as the body reacts to the treated tumor tissue. Managing PES often involves rest, fluids, and medications for pain and nausea prescribed by the medical team.
These symptoms typically begin within a day or two of the procedure and can last for several days to a week. Warning signs that require medical attention include severe, uncontrolled pain, a high fever that doesn’t respond to medication, or any signs of infection. Following the specific discharge instructions provided by the hospital is key to a smooth recovery.
Beyond PES, other side effects are possible. These can include fatigue, temporary changes in liver enzyme levels shown on blood tests, or complications related to the catheter insertion site. The medical team will provide detailed guidance on what to expect and how to manage these potential issues at home.
Treatment Outcomes and Next Steps
The effectiveness of TACE is evaluated through follow-up imaging scans several weeks to a few months after treatment. Patients undergo a CT or MRI scan to assess the tumor’s response by observing changes in its size and blood supply. A significant reduction in the tumor’s viability indicates the treatment was successful.
If the tumor shows a partial response or if new tumors appear, additional TACE sessions may be recommended. It is not uncommon for patients to undergo multiple rounds of TACE to control the cancer’s growth.
If TACE is no longer effective or the cancer progresses, the medical team will consider other options. These may include localized treatments like radiation therapy or systemic therapies using targeted drugs or immunotherapy. The long-term management of HCC involves adjusting treatments over time based on the cancer’s response.