Transcatheter arterial chemoembolization (TACE) is a minimally invasive medical procedure designed to treat certain types of cancer, particularly those in the liver. It represents a targeted approach that aims to deliver treatment directly to cancerous cells while minimizing impact on healthy surrounding tissue.
What TACE Is
TACE combines two strategies: localized chemotherapy delivery and embolization. During the procedure, cancer-fighting drugs are administered directly into the arteries supplying a tumor. Simultaneously, tiny particles are introduced to block the blood vessels feeding the tumor, restricting its blood supply. This dual action maximizes the chemotherapy’s effect and deprives the tumor of oxygen and nutrients. The process is performed through a catheter, a thin, flexible tube.
How TACE Works
TACE leverages the unique blood supply of liver tumors. Normal liver tissue receives most of its blood supply from the portal vein, while liver tumors typically draw their blood almost entirely from the hepatic artery. This difference allows for selective targeting of the tumor.
Chemotherapy drugs are delivered directly into the hepatic artery branch supplying the tumor. This localized delivery allows for a higher concentration of the anti-cancer medication at the tumor site compared to systemic chemotherapy. By concentrating the drugs, TACE aims to enhance their destructive effect on cancer cells while reducing systemic side effects that can occur with traditional chemotherapy.
Following the chemotherapy, tiny embolic particles are injected into the same artery. These particles block the blood flow to the tumor, starving it of the oxygen and nutrients it needs to grow and survive. The embolization also traps the chemotherapy drugs within the tumor, preventing them from washing away quickly and allowing for prolonged exposure to the cancer cells. This approach of direct drug delivery and blood supply deprivation makes TACE a potent treatment for liver malignancies.
Conditions Treated by TACE
TACE is most commonly applied as a treatment for primary liver cancer, hepatocellular carcinoma (HCC). TACE is often a recommended first-line non-curative therapy for intermediate-stage HCC in patients who are not candidates for surgery or liver transplantation. It can be used to control tumor growth, shrink tumor size, and even serve as a bridge therapy to keep tumors small while a patient awaits a liver transplant.
Beyond HCC, TACE may also be used to treat other cancers that have spread to the liver (liver metastases). These can include metastases from breast cancer, colorectal cancer, neuroendocrine tumors, and ocular melanoma. The suitability of TACE for these conditions often relates to the tumors’ vascularity, meaning how much blood supply they receive, which makes them responsive to the embolization component of the procedure.
The TACE Procedure
Undergoing a TACE procedure involves several steps, beginning with preparation. Patients undergo pre-procedure tests, which may include imaging studies to map the tumor’s blood supply, along with laboratory tests to assess liver and kidney function and blood clotting ability. Patients are usually advised not to eat or drink for several hours before the procedure, and sedation is commonly administered to help them relax and feel comfortable.
The procedure is performed in an angiography suite by an interventional radiologist. A small incision is made, typically in the groin, to access the femoral artery. A thin catheter is then inserted into this artery and carefully guided through the body’s arterial system, using real-time X-ray imaging (fluoroscopy) as a guide, until it reaches the hepatic artery branches supplying the tumor in the liver. A contrast dye may be injected to visualize the tumor and its blood vessels more clearly.
Once the catheter is precisely positioned within the tumor-feeding artery, the chemotherapy drugs, often mixed with an oily substance like Lipiodol or loaded into drug-eluting beads, are injected. Following this, embolic agents, such as gelatin sponge particles or microscopic beads, are delivered to block the blood flow. The entire procedure typically lasts between one to two hours, and patients are monitored throughout.
After the TACE Procedure
Following the TACE procedure, patients are moved to a recovery area. Pressure is applied to the incision site to prevent bleeding. Patients are then typically required to lie flat on their back for several hours, often two to four hours, to allow the access site to heal. Most patients can resume eating and drinking as normal after recovery and are encouraged to drink plenty of fluids to help flush out the contrast dye used during the procedure.
Common side effects experienced within the first few days post-procedure include pain in the abdomen, right side, back, or right shoulder, nausea, vomiting, and a low-grade fever, known as post-embolization syndrome. These symptoms are generally managed with prescribed medications for pain and nausea and usually subside within a few days to a week. Fatigue and loss of appetite are also common and may persist for a few weeks. A typical hospital stay is usually one to two nights, and follow-up appointments with imaging scans are scheduled to assess the tumor’s response to the treatment.