Chemoembolization (TACE)

Transarterial chemoembolization (TACE) treats tumors in the liver in two ways at once. "Chemo" means we deliver chemotherapy medicine right into the tumor. "Embolization" means we then block the tumor's blood supply with tiny particles, cutting off its oxygen and food.

This works because of how the liver is built. Healthy liver gets about three quarters of its blood from the portal vein. Liver tumors, however, feed mainly from the hepatic artery. By working inside that artery, we can hit the tumor hard while the healthy liver keeps its main blood supply.

There are two common types. In conventional TACE (cTACE), the chemotherapy is mixed with an oily contrast agent called Lipiodol, which the tumor soaks up, and then the artery is blocked. In drug-eluting bead TACE (DEB-TACE), tiny plastic beads are loaded with chemotherapy, often doxorubicin, and release it slowly into the tumor over days to weeks. We usually use drug-eluting beads, but the choice depends on your tumor.

What we see

Chemoembolization is most often used for hepatocellular carcinoma (HCC), the most common cancer that starts in the liver. It is a standard treatment when there are several tumors, or tumors too large for ablation, and the cancer has not spread outside the liver. It is also used to shrink or control tumors while someone waits for a liver transplant, and for some cancers that have spread to the liver, such as neuroendocrine tumors. See liver tumors for the full picture.

For most people with larger or multiple tumors, the goal is control rather than cure: shrinking tumors, slowing growth and extending life. For some, TACE shrinks the cancer enough to make surgery, ablation or transplant possible.

Liver tumors are best planned by a team. Surgeons, oncologists, radiation doctors and interventional radiologists look at your scans together and choose, and often combine, treatments.

Small tumors are often treated with microwave ablation or surgery instead. Y-90 radioembolization is a close cousin of TACE that uses radiation instead of chemotherapy. Newer options include histotripsy.

The procedure is done at El Camino Hospital. A nurse starts an IV, checks your labs, and gives fluids and medicines before the procedure, usually an antibiotic, an anti-nausea medicine and sometimes a steroid to reduce side effects.

1. 1
   Getting comfortable

   You lie on your back on the X-ray table and receive moderate sedation through your IV. You will be relaxed and drowsy but breathing on your own. We clean and numb the skin at the top of your leg.

2. 2
   Reaching the liver

   Through a pinhole in the groin artery, we pass a thin tube called a catheter up to the liver. Using X-ray and contrast dye, we map the arteries and find the branches feeding the tumor.

3. 3
   Treating the tumor

   We guide an even smaller catheter as close to the tumor as we safely can and slowly inject the chemotherapy and blocking particles. Keeping the treatment close to the tumor protects healthy liver.

4. 4
   Closing up

   We remove the catheter and close the artery with a small plug or firm pressure. No stitches are needed.

Most people feel pressure at the groin and brief warmth when contrast is injected. Some feel upper belly pain during the injection, and we give pain medicine through your IV right away.

Many people have post-embolization syndrome for a few days: pain under the right ribs, low fever, nausea and tiredness. It is a sign the tumor is reacting, not a sign something went wrong. We treat it with pain and nausea medicines. You may stay overnight so we can keep you comfortable.

1. First few hours
   You lie flat with your leg straight, usually for about 2 hours and sometimes up to 6, to protect the groin puncture.
2. Day 1
   Most people go home the same evening or the next morning. No driving for at least 24 hours.
3. Days 2–7
   Pain, nausea and low fever are common and ease day by day. Vomiting, if any, usually settles in a couple of days. Avoid lifting more than 10 pounds for about 5 days.
4. Weeks 1–2
   Tiredness is the last thing to fade. Most people are back to normal activities after about two weeks. We see you for a check-up and blood tests.
5. About 4–6 weeks
   A CT or MRI and blood tests show how the tumor responded and whether another session would help.

In intermediate-stage liver cancer, chemoembolization has been shown to help people live longer than supportive care alone, and it often shrinks tumors or stops them from growing. Many people need more than one session, planned based on follow-up scans. TACE is also commonly combined with ablation, radiation or medicines.

Before a chemoembolization I look hard at two things: how well the liver is working, and how the arteries reach each tumor. The closer I can get the catheter to the tumor, the more of the medicine goes where it should and the better most people feel afterward. I warn patients that the first few days can be rough, and that this usually means the treatment is doing its job.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos