Your doctor has recommended for you to undergo Trans-arterial Chemo-embolisation. This information will explain what this operation involves, the intended outcomes and the possible risks.
What is a Trans-arterial Chemo-embolisation (TACE)?
Trans-arterial chemo-embolisation is one of the treatment options for Liver Cancer. It involves using a Chemotherapy drug (Doxorubicin or Cisplatin) coated on a particle or mixed with poppy seed oil, to block the blood supply to the tumour and hopefully halt the growth of the tumour. TACE is a palliative procedure not a curative one.
How do I prepare?
You will be admitted into a liver ward the night before and have a cannula inserted to obtain blood for tests and for giving fluids to hydrate you. Blood tests are performed to check if you have increased risk of bleeding. The pharmacist will also check your blood results before releasing the chemotherapy drug that will be used for TACE. You do not need to fast for this procedure, unless instructed by your referring doctor.
How is a TACE performed?
Consent
On the day of the procedure, the Interventional Radiologist performing the procedure will provide you with a detailed explanation of the treatment, its risks, and benefits, allowing you to ask questions and understand fully before you sign a consent form. You would have had a formal consultation where your medical history is discussed, and your concerns are addressed ahead by your referring doctor. It is crucial to understand the procedure to provide informed, voluntary consent for TACE.
Anaesthetic
Most TACE procedures are done under local anaesthetic, so you do not need to fast beforehand. The doctor will inject a medication called Lidocaine to numb the insertion site (usually the groin) where a thin tube is inserted and guided to the liver using x -rays, to deliver chemotherapy coated on particles or mixed with poppy seed oil, directly to the tumour, that block its blood supply and deliver the chemotherapy.
Operation
The Interventional Radiologist passes the catheter along the artery until it reaches the blood vessels that take blood to the liver and tumour. A dye is put into the blood vessel through the catheter, and an x ray is taken. This is called an angiogram. This shows the blood supply to the tumour to enable the doctor to get the catheter close to the tumour. After this, they slowly inject the particles with chemotherapy into the liver through the catheter. You can have chemoembolization several times. It is sometimes given with radiofrequency ablation. Your doctor can explain this treatment to you in more detail.
Staff Involved
Interventional Radiology (IR) procedures are performed by a multidisciplinary team. The team includes the following key Staff:
- Interventional Radiologist (Consultant/Fellow): A doctor specially trained in minimally invasive, image-guided techniques who performs the procedure.
- Radiology Nurses: Highly trained nurses who care for the patient before, during, and after the procedure. They assist with sedation, monitor vital signs (heart rate, breathing, oxygen levels), and “scrub in” to assist the radiologist directly.
- Radiographers: Experts in imaging equipment who operate the machines to provide real-time guidance for the doctor.
- Senior Clinical Support Workers (SCSWs): Assist with the setup of the room, patient positioning, and maintenance of sterile conditions
What are the risks?
TACE is generally considered a safe and effective procedure for liver tumours, but like any medical intervention, it carries risks and potential complications.
- Bruising or bleeding at the puncture site from the procedure.
- The treatment may extend to areas of the Liver that the medical team had not intended.
- You may experience Post-embolisation Syndrome which gives you pain, fever, nausea and general malaise.
- Post TACE infection: one can develop infection in the segment or area of liver that lost its blood supply. you will be given antibiotics to prevent this . However, some patients can still develop infection , form liver abscess or become septic needing Intra venous antibiotics, hospital admission.
- Post TACE liver failure: rarely the normal liver if effected or if there is accidental damage to the artery supply the liver , one can develop liver failure that can affect life.
- Allergic reaction to contrast dye (mild symptoms like nausea, itchiness and rashes occur in 3%; moderate to severe symptoms such as severe vomiting, bronchospasm occur in less than 1%; risk of death is rare, estimated at 1:170,000)
- Radiation can increase your chances of developing cancer many years or decades after the exposure. The chances of this happening to you because of this procedure are very low.
- Rarely, you might experience some reddening of your skin in the area that was treated. If this happens, you should contact your clinical team who will be able to give some advice on the simple steps you can take to look after your skin.
- It is important to remember that your doctor thinks that the benefits of this procedure outweigh any risks from the radiation. We will make sure that the amount of radiation used in your procedure is as low as possible.
- Sometimes Chemoembolisation may not be possible or effective and you may have to explore other options
What to expect from this operation?
Admission
On the day of the operation, you will be brought down to the Radiology Theatres where you will be introduced to the staff, and they will obtain relevant information from you and carry out some routine observations. The Interventional Radiologist will then obtain your consent having explained the risks and the benefits. Then you will go back to Liver ward post operation.
Recovery
The groin puncture site which was used to get into your artery will be pressed upon manually to stop any bleeding. You will remain in angio theatre recovery for 30 minutes and then return to your ward.
Aftercare
After a TACE procedure, you will rest on the ward for two hours, monitoring vitals and the puncture site, with some patients experiencing post-embolisation syndrome (flu-like symptoms and fatigue). You can typically resume normal eating and drinking and should increase fluid intake to help flush out the dye.
You will stay overnight in a specialised liver ward for observation before being discharged home when considered safe. A repeat blood test to assess your liver function will be taken before you go home. At home, take it easy, manage any constipation from pain medication by increasing fluids and fiber, and contact your medical team for any high fever, severe pain, or other concerning symptoms.
Care at home
- Self-care: You can selfcare and do your routine household work when sent home. You should wait at least 48-72 hours before resuming more physically demanding exercise after TACE.
- Work – You may be able to resume normal activities and work within a week after a TACE procedure, but this can vary depending on your individual recovery and how well you feel.
- Driving/travel –You generally should not drive or travel for 48-72 hours after TACE due to potential weakness, and the risk of bleeding from the catheter site, usually in the groin.
- Medicines – you can typically resume your normal medications as prescribed. You may need pain reliever and anti-sickness medications prescribed.
- Follow-up – clinical evaluation for liver decompensation and CT or MRI scan is performed for tumour assessment in 4-6 weeks to guide further therapy decisions.
- Please seek immediate medical attention if you experience an increase in pain, a high temperature, or other concerning symptoms at home after the procedure.
Contact information
We hope some of your questions have been answered by this information. If there are any questions you would like to ask before you come for your operation, please get in touch.
Via telephone
ĢtvƵ Teaching Hospitals switchboard
Ask to speak to secretary of the consultant hepatologist (liver specialist) or hepatobiliary surgeon (liver surgeon) in charge of your care
How to get to our department
We are in the Lincoln Wing of SJUH, Ground Floor. Check the link below to see how to get to us.
Some illustrations in this leaflet have been generated using artificial intelligence (AI), and are intended to support understanding of the information provided.
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