Transarterial chemoembolization (TACE) for liver cancer

Embolization is a treatment that blocks or slows down the blood going to tissues or an organ. It can be used to block the flow of blood to a tumour so the cancer cells die. When the material used to block the blood supply also delivers chemotherapy drugs to the tumour, it is called chemoembolization. Transarterial chemoembolization (TACE) is a specific type of chemoembolization that blocks the hepatic artery to treat liver cancer.

Liver cancer tumours can grow new blood vessels (called angiogenesis). These blood vessels get most of their blood supply from the hepatic artery, while the rest of the liver tissue gets blood from the portal vein. Because of this, doctors can block the hepatic artery to cut off the blood supply to the tumour without affecting the rest of the liver as long as blood is normally flowing toward the liver in the portal vein.

You will be offered TACE only if you have good liver function, you don't have any fluid in your abdomen (called ascites) and there are no blood clots in the portal vein (called portal vein thrombosis). TACE may be used if the liver cancer can't be removed with surgery, can't be treated with ablation therapy and hasn't spread to the major blood vessels in the liver or other parts of the body. You may also be offered TACE to keep a liver tumour small if you are waiting for a liver transplant (called bridging therapy).

Doctors may offer TACE to treat liver tumours that are larger than 5 cm, but it may take many treatments to shrink these larger tumours. If cancer is in both lobes of the liver, doctors will treat one lobe at a time. Treatment to each lobe is usually given a month apart so that you have time to recover from the previous TACE treatment.

TACE is done in the x-ray department of a hospital. You may be given a local anesthetic and medicines to help you relax, or you may be given a general anesthetic to put you to sleep.

The doctor places a thin, flexible tube (called a catheter) into an artery in the groin (called the femoral artery). The doctor then moves the catheter up through the artery until it reaches the hepatic artery in the liver. A dye is injected into the catheter and an x-ray (called an angiogram) is taken to find the branches of the artery that are feeding the liver tumour. The doctor then moves the catheter to these arteries. The doctor injects a material into the arteries feeding the tumour to block them.

The most commonly used material for TACE is a gelatin sponge. Sometimes the gelatin sponge is soaked in a chemotherapy drug before the doctor injects it into the artery. The drug is given directly to the tumour while the gelatin sponge blocks the blood supply to the tumour.

DEB-TACE is a new way of delivering chemotherapy during TACE. It uses special beads that are filled with a chemotherapy drug (called drug-eluting beads, or DEBs). After these beads are injected into the arteries in the liver, they slowly release the drug to treat the tumour. DEBs are as effective as using the sponge or injecting chemotherapy drugs in the arteries. DEB-TACE may have fewer side effects than the other methods.

There are no standard recommended chemotherapy drugs for TACE. The drugs that may be used alone or together are:

• doxorubicin
• cisplatin

Side effects can happen with any type of treatment for liver cancer, but everyone's experience is different. Some people have many side effects. Other people have only a few side effects.

TACE may cause side effects because it can damage healthy cells as it kills cancer cells. Side effects can develop any time during, immediately after or a few days or weeks after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects will depend mainly on the number of tumours being treated, the amount of scarring in the liver (called cirrhosis) and your overall health.

TACE for liver cancer may cause post-embolization syndrome, which is a group of symptoms that includes:

• fever
• pain in the upper-right abdomen, under the ribs
• nausea and vomiting
• fatigue

TACE can also cause:

• bruising or bleeding at the catheter site
• hair loss
• lowered ability to fight off infections
• abnormal liver function
• inflammation of the gallbladder or bile ducts
• a collection of pus in the place where the tumour was destroyed (called an abscess)
• liver failure, especially in advanced cirrhosis

Tell your healthcare team if you have these side effects or others you think might be from TACE. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.