Trans arterial chemoembolisation (TACE)

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells.

Chemoembolisation is a treatment directly into the liver. You have chemotherapy into the blood vessel that feeds the tumour. Then you have small particles injected into the blood vessel to block off the blood supply. It’s also called trans arterial chemoembolisation (TACE).

Chemoembolisation works in two ways:

• it gives high doses of chemotherapy to the tumour
• it reduces the blood supply to the tumour and so starves it of oxygen and the nutrients it needs to grow

When you might have it

You usually have this treatment if you can't have surgery. It can control the cancer, relieve symptoms and help you to live longer.

To benefit from chemoembolisation the cancer must not have spread into blood vessels, lymph nodes or other parts of your body. And the rest of your liver must be healthy. You might have chemoembolisation more than once.

In some cases, chemoembolisation might shrink a tumour so that surgery is then possible.

You might also have chemoembolisation to help control the cancer while you are waiting for a liver transplant.

How do you have chemoembolisation?

Before chemoembolisation

You usually can’t eat for 4 to 6 hours before the procedure. This is because you might have a drug during the procedure to make you sleepy (sedation). You can usually drink water up to 2 hours beforehand. Your appointment letter will give more detail about this. This will include a number to ring if you have any questions. 

Tell them if you:

• have had an allergic reaction to the dye used in the procedure before (the contrast medium)
• are diabetic
• are taking medicines to thin your blood (anticoagulants) such as warfarin

Having chemoembolisation

You have the treatment in the x-ray (radiology) department. The procedure takes up to an hour and a half.

A specialist doctor called an interventional radiologist carries out the procedure. Radiographers and nurses will also be with you in the room.

First you get changed into a hospital gown. You lie on your back on the x-ray table. Your doctor or nurse puts a small tube (cannula) into your arm or back of your hand. They use the cannula to give sedation and other drugs you might need, such as anti sickness medicines. Your nurse regularly checks your heart rate and blood pressure.

Your doctor cleans the area at the top of your leg (your groin) and injects a local anaesthetic to numb the area. They make a small cut and put a long flexible tube called a catheter into a blood vessel called the femoral artery. They then thread the catheter along the artery until it reaches the hepatic artery that supplies blood to the liver.

They inject a type of dye that shows up on x-rays (contrast medium). You might have a warm sensation through your body for a few seconds. This is normal.

The x-rays show the blood vessels that feed the tumour in the liver. They inject the chemotherapy and then the particles block the blood vessels. Some hospitals might use tiny beads (microspheres) that block the blood vessels and slowly release the chemotherapy.

Chemotherapy drugs used in TACE include:

• doxorubicin
• cisplatin

After chemoembolisation

Your doctor removes the catheter and puts a pressure dressing onto the site in your groin. You need to stay lying down for about 4 to 6 hours afterwards. Your nurse checks the site for bleeding before you get up.

You can usually eat and drink as normal after the test. Drink plenty afterwards to help flush the dye out of your body.

You usually stay in hospital for a night or two.

Side effects

Chemoembolisation can cause side effects. 

Some people have flu-like symptoms that start about 3 to 5 days after treatment and can last up to a week. You feel generally unwell, have body aches and you may feel sick. This is due to a side effect called post ablation syndrome. Before you go home, your healthcare team will explain this syndrome. They will go through what medicines you can take to relieve your symptoms. 

Contact your healthcare team if you feel unwell after this time or have a temperature above 38°C. You may have an infection that needs treatment. 

Tiredness is also a common side effect of chemoembolisation, and can last for a couple of weeks.

Other possible risks include:

• a small bruise where the catheter was put in
• infection in the treated area – you would need antibiotics through a drip
• damage to the blood vessel by the catheter – this is very rare
• leakage of contrast medium out of the blood vessels
• an allergic reaction to the contrast medium

There is a risk that some of the chemotherapy drug goes out of the liver and goes around the body in your bloodstream. This can cause temporary side effects such as;

• an increased risk of infection due to a drop in white blood cells
• tiredness and breathlessness due to a drop in red blood cells (anaemia)
• bruising easily or bleeding due to a drop in blood cells called platelets
• a sore mouth
• hair loss

Rarely, chemoembolisation can cause liver failure. Because of this risk you usually won’t be able to have chemoembolisation if you have moderate or severe cirrhosis.   

Contact the hospital if you have an increase in pain or get a high temperature when you are at home.