Trans-Arterial Chemoembolization for HCC and Other Oligo-Metastasis

Trans-arterial chemoembolization (TACE) allows the introduction of medication (chemotherapy) and synthetic materials known as embolic agents into a blood vessel feeding cancer. It cuts off the tumor’s blood supply and deposits chemotherapy in the tumor.

It is mainly used to manage HCC (a type of liver cancer), but it can also help manage cancer that comes from other parts of the body to the liver (oligo-metastasis). Trans-arterial chemoembolization can be used alone or in combination with ablation, surgery, or radiation therapy.

Let’s understand more about this procedure!

Trans-Arterial Chemoembolization

TACE, as mentioned above, combines chemotherapy and embolization to cut off the supply of a tumor, usually HCC. It is a non-surgical and minimally invasive procedure performed by an interventional radiologist.

In this procedure, chemotherapy agents are introduced into the blood vessel supplying the cancerous tumor by taking a hollow tube (catheter) selectively into that vessel. In addition, the embolic agent is introduced into the blood vessel, trapping the chemotherapy in the tumor and blocking blood flow to the cancerous cells.

Uses

Some common applications of the procedure is for the mentioned cancer types:

• Hepatocellular carcinoma (HCC)
• Cholangiocarcinoma
• Metastasis to liver from cancers of other parts such as breast, colon, and pancreas

Before The Procedure

Your doctor will enquire about medicine and health history before recommending the procedure. They will review the general condition of the patient, the liver function and get imaging done for the liver tumor (CT scan or MRI). Once they decide that TACE is the right option for you, they will recommend precautions and medications to prepare the patient before the procedure.

If the doctor plans on giving a sedative, you may be asked not to have water or food for four to eight hours before the procedure.

The Procedure

The TACE procedure has two parts: delivering chemotherapy agent and cutting off cancer’s blood supply, trapping the chemotherapy agent in the tumor.

The chemotherapy agent reaches cancer through the artery, sparing other body parts and most healthy liver tissue. Blocking of the artery devoids cancer cells of oxygen. The liver is unique as it gets blood supply from two blood vessels, the hepatic artery and the portal vein whereas the tumor gets supply mostly from the hepatic artery. So, while the blood supply to the cancer cells is prevented by blocking the artery, the normal liver cells continue to get blood supply from the portal vein.

An interventional radiologist will take the help of an X-ray and contrast material to map the path to cancer. The doctor may also give some fluids to protect your kidneys from the chemotherapy drug and byproducts of dying cancer cells. They may also prescribe medication to prevent pain and infection.

You may be given a sedative, and a small needle whole is made under local anesthesia in the artery of your leg.. The doctor will now introduce a catheter through the incision and advance it to the liver under X-Ray guidance.

Once the catheter reaches the branch of the artery supplying the tumor, chemotherapy and embolic agents are mixed and injected.

After the procedure is complete, the doctor will remove the catheter and apply pressure on the puncture site to stop the bleeding. The tiny opening will be covered with a dressing.

After The procedure

You may be advised to breathe through a spirometer, which helps expand your lungs and prevent pneumonia. You may be able to do your daily activities within a week. Your doctor will also advise regular CT and MRI to monitor the size of the treated tumor.