Transarterial chemoembolization (TACE) for liver cancer
Embolization is a treatment that blocks or slows down the blood supply 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.
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. This type of tumour grows a large number of blood vessels. 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.
The healthcare team will only offer TACE if you have good liver function, you don’t have any fluid in your abdomen (called ascites) and there are no problems with the portal vein in your liver. TACE may be used if your liver cancer can’t be removed with surgery but it hasn’t spread to the major blood vessels in the liver, lymph nodes 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 2 or 3 treatments to shrink these 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 first TACE treatment.
How TACE is done
TACE is done in the x-ray department of a hospital. You may be given a local anesthetic with a drug to help you relax, or you may be given a general anesthetic to put you to sleep.
The doctor places a thin tube (called a catheter) into the large blood vessel in your 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 radio-opaque dye is injected into the catheter and an x-ray is taken to find the branches of the artery that are feeding the liver tumour (called an angiogram). The doctor then moves the catheter to these arteries. The doctor injects a material into the arteries feeding the tumour. The material blocks these arteries. Some types of blocking material dissolve so the arteries are not permanently blocked.
The most commonly used material for TACE is a gelatin sponge. Sometimes the gelatin sponge is soaked in a chemotherapy drug and an oily liquid called lipiodol before the doctor injects it into the artery. The sponge traps the chemotherapy drugs inside the liver so that they are concentrated in the area of the tumours. Lipiodol lengthens the amount of time that the drugs are held in the liver. If the chemotherapy drugs are not in the sponge, they are injected into the arteries after they are blocked.
DEB-TACE is a new way of delivering chemotherapy during TACE. It uses special beads that already have the chemotherapy drug in them (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. These drug-eluting beads 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.
If the cancer is in only one lobe of the liver, doctors may give a small amount of chemotherapy to the other lobe to treat any tumours that might be in it.
After the chemoembolization is done, the doctor pulls the catheter out through the femoral artery. Pressure and ice are placed over the incision to help reduce swelling and stop bleeding.
Chemotherapy drugs used in TACE
There are no standard recommended chemotherapy drugs for TACE. The drugs that may be used alone or together are:
- doxorubicin (Adriamycin)
- cisplatin (Platinol AQ)
- mitomycin (Mutamycin)
Follow-up after TACE
You may have a CT scan 2 or 3 months after TACE. Doctors use this imaging test to see how much the tumours have shrunk and to look for any new tumours in the liver.
Many people will need another TACE procedure because liver tumours often grow back in 10–16 months. TACE can be repeated as many times as needed, as long as you are still healthy enough to have it done.
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 few or none at all.
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.
Because TACE is a local treatment given to the liver, there are fewer side effects from the chemotherapy drugs than if they are given as a systemic therapy. 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:
TACE can also cause:
- bruising or bleeding at the catheter site
- hair loss
- lowered ability to fight off infections
- abnormal liver function
- lung infection (called pneumonia)
- a buildup of fluid in the pleural cavity, which is the space between the lungs and the walls of the chest (called pleural effusion)
- blood clots in the lung (called pulmonary embolism)
- inflammation of the gallbladder
- a buildup of fluid in the abdomen (called ascites)
- a collection of pus in the place where the tumour was destroyed (called an abscess)
- tumour lysis syndrome
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.
Information about specific cancer drugs
Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.
A drug that causes anesthesia (the loss of some or all feeling or awareness).
General anesthetics put a person to sleep. Regional anesthetics cause a loss of feeling in a part of the body, such as an arm or leg, but the person does not lose awareness. Local anesthetics numb only a small area of the body.
Treatment that travels through the bloodstream to reach cells all over the body.
Systemic therapy may be given by injection into a vein or muscle, or by mouth.
Also called systemic treatment.
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What’s the lifetime risk of getting cancer?
The latest Canadian Cancer Statistics report shows about half of Canadians are expected to be diagnosed with cancer in their lifetime.