ENDOVASCULAR MANAGEMENT OF HEPATOCELLULAR CARCINOMA

WHAT IS TRANS ARTERIAL CHEMOEMBOLISATION (TACE)?

Trans arterial Chemoembolization, known as TACE, is a minimally-invasive, image-guided treatment for liver cancer. It helps shrink or eradicate tumors by targeting them and blocking their blood flow and delivering chemotherapy directly to the tumor. It allows doctors to treat tumors that are not accessible using conventional surgery or radiation.

During TACE, an interventional radiologist delivers chemotherapy medicine directly to the blood vessels supplying the liver tumor using real-time image guidance through a tiny incision in the groin. The interventional radiologist also physically blocks the blood vessels feeding the tumor. TACE typically takes about two hours and may require an overnight hospital stay so we can monitor your condition.

WHY TRANS-ARTERIAL CHEMOEMBOLIZATION (TACE) IS PERFORMED

Patients who are typically referred for TACE have either primary liver cancer (hepatocellular carcinoma) or metastatic liver cancer and are not eligible for a surgical tumor removal because of the tumor’s size or location. In these cases, TACE may be offered as a minimally invasive approach to help improve patient quality of life and overall survivability. Cancer patients who are candidates for a liver transplant may undergo TACE to extend their lifespan while waiting for a liver to become available.

WHAT TO EXPECT DURING TRANS-ARTERIAL CHEMOEMBOLIZATION (TACE)

TACE is a one to two-hour procedure typically performed in a radiology suite. A numbing medication will be placed on the thigh. Next, an interventional radiologist makes a small puncture to place a catheter (thin plastic tube) in the patient’s thigh to reach the femoral artery (a large artery that carries blood to the leg). Using X-ray guidance, the catheter is threaded from the femoral artery through to the hepatic (liver) artery. Once the catheter is at the site, chemotherapy medication (commonly doxorubicin or cisplatin, which kill cancerous cells) and embolization materials (specialized beads and coils that block off the tumor’s blood supply) are simultaneously released.

RISKS AND BENEFITS OF TRANS-ARTERIAL CHEMOEMBOLIZATION (TACE)

TACE is primarily considered to be a palliative treatment for liver cancer. In other words, TACE will not cure a patient but may open up other treatment opportunities. For example, if TACE can shrink the tumor significantly and the staging can be improved, surgical tumor resection may become an option for previously inoperable patients. If surgery is still not plausible, TACE still provides the benefit of improved symptoms from a smaller tumor mass.

While the side effects of TACE are typically minimal, a patient’s post-treatment experience will be dictated by the size of the original tumor, liver function, and overall health. Symptoms experienced after the procedure may be related to “post-embolization syndrome” which includes problems such as fever, bruising, nausea, and fatigue. Other risks associated with catheter insertion and the medications and embolizing materials delivered include:

• Bruising at the catheter insertion site
• Reduced liver function
• Fluid in the lungs
• Blood clots
• Fluid in the abdomen (ascites)