Transarterial Chemoembolization (TACE) is a minimally invasive procedure in which chemotherapy and embolic agents are directly delivered to a cancerous tumour via its blood supply. It is most often used to treat primary liver cancer, and sometimes in other types of cancer that have spread to the liver. The embolic agents are used to cut off the blood supply to the tumour without affecting the rest of the liver. Compared to receiving conventional chemotherapy, TACE allows for the maximum amount of chemotherapy agent to reach the tumour, while limiting the amount released into the bloodstream.
Typically, liver cancer does not cause any symptoms by itself. Some patients may experience having a lump or pain in the upper abdomen, loss of appetite or weight, feeling full early during meals, swelling of the abdomen or legs, or yellowing of the skin and white of the eyes.
You can reduce the risk of chronic liver disease or cirrhosis by protecting against bloodstream or sexual transmission of hepatitis B and C, getting vaccinated against hepatitis B, drinking alcohol in moderation, and maintaining a healthy weight.
If you are suspected to have liver cancer, an MRI or CT scan of the liver and blood tests may be requested by your doctor. Occasionally, a biopsy of the liver may be required for the diagnosis.
There are various treatments for liver cancer, and the choice of treatment often depends on the stage of liver cancer and how healthy your liver is. Treatment options include surgery, liver transplant, ablation therapy, chemoembolisation, radioembolisation, chemotherapy, and immunotherapy. It is important to have a discussion with your doctor on the treatment options.
Transarterial Chemoembolization (TACE) is a minimally invasive procedure in which chemotherapy and embolic agents are directly delivered to a cancerous tumour via its blood supply. The embolic agents are used to cut off the blood supply to the tumour without affecting the rest of the liver. Compared to receiving conventional chemotherapy, TACE allows for the maximum amount of chemotherapy agent to reach the tumour, while limiting the amount released into the bloodstream.
The procedure will be performed by a trained interventional radiologist and the team, under the guidance of X-ray and ultrasound imaging, in an interventional radiology suite. Devices will be attached to you to measure your heart rate and blood pressure. You will be given a local anaesthetic to numb the area of needle puncture (groin or wrist) and catheter placement, so that you may only feel some discomfort during the procedure. Occasionally, sedatives may be given. A contrast agent will be given through your intravenous cannula to map out the blood vessels at the tumour so that chemotherapy and embolic agents can be administered directly. A temporary sensation of warmth may be felt when the contrast agent is administered. The procedure usually takes less than 2 hours.
Before the treatment, you will be seen in the clinic by your interventional radiologist for a clinical assessment, which includes checking medical history, drug allergies, blood tests (blood count, liver and kidney function, clotting times). If you are on certain blood-thinning medications, they may need to be stopped a few days before the procedure. You will receive specific instructions on how to prepare, such as fasting 4 to 6 hours before the time of the planned procedure. You should plan to stay overnight at the hospital for one or two days after the procedure for monitoring.
After the procedure, you will be expected to stay overnight at the hospital for one or two days for monitoring. You may experience symptoms such as abdominal pain, nausea, vomiting, and fever, which are part of the expected post-embolisation syndrome. These symptoms can be treated with medications in the ward. There may be mild bruising or bleeding at the groin or wrist needle puncture site. You will be monitored for rare complications such as severe bleeding or bruising from damaged blood vessels, embolisation of an unintended artery, liver infection, and kidney damage. Some patients do not experience any discomfort at all post-procedure.
You may resume your normal activities in a week. A follow-up clinic visit with a CT/MRI scan of your liver and blood tests may be arranged to evaluate the effects of the treatment and to plan for further treatment.
Please seek medical attention if you have the following symptoms after the procedure: bleeding, pain, redness, or discharge over the puncture site; hand or leg turning pale and cold; high fever (more than 38 degree Celcius); worsening or change in the character of the abdominal pain; shortness of breath or productive cough.