Prof. Dr. Rahmi Çubuk

Non-Surgical Cancer Treatments

Non-Surgical Cancer Treatments

Transarterial Chemoembolization (TACE) Procedure

What is TACE ?
TACE is a procedure used to treat cancerous tumors located within the liver. During the procedure, a catheter is inserted via an artery to directly access the tumor’s blood supply. Through this catheter, a combination of high-dose chemotherapy and embolizing particles are injected directly into the tumor’s feeding artery. This approach allows a large amount of medication to reach the tumor, while blocking the artery that supplies the tumor, leading to its shrinkage. Unlike standard chemotherapy administered through veins, only a small amount of the drug enters the bloodstream, leading to fewer systemic side effects.

How Can TACE Benefit Me ?
TACE is typically recommended by your doctor or tumor board if you have tumors in the liver that cannot be treated by other methods.
The goal of TACE is to shrink the tumor and halt its growth, while minimizing the systemic side effects. Approximately 70% of patients experience minimal side effects and benefit from TACE, which can also be used alongside other treatments.
TACE can also assist patients in being placed on the liver transplant list, especially if the tumors are inoperable. If the tumor is large, located in both halves of the liver, or depending on the tumor’s location, multiple TACE treatments may be required.

How Should I Prepare for TACE ?
Before the procedure, blood tests will be done to assess liver and kidney function and to check coagulation values.
You must inform your doctor about all the medications you are taking and any allergies you may have. Your doctor might recommend stopping some medications before the procedure.
Recent contrast-enhanced CT or MRI images of your liver (taken within the last month) are required. If not available, these tests will be ordered.
Since the procedure will be done under anesthesia in an angiography room, you will need to fast for 6-8 hours before the procedure.

How is the TACE Procedure Done ?
The procedure will be performed in a hospital setting in the interventional radiology department using angiography equipment.

  1. You will be taken to the angiography room, where your oxygen levels, heart rate, and blood pressure will be monitored. Sedatives and pain-relieving medications will be administered.
  2. After local anesthesia is applied to your skin, the interventional radiologist will insert a needle into an artery in your groin, followed by a guidewire. A small catheter (a hollow plastic tube) will be advanced through the artery to reach the liver and the tumor’s feeding arteries.
  3. Contrast dye will be injected through the catheter to make the arteries visible on the screen, allowing the radiologist to guide the catheter to the tumor’s feeding vessels.
  4. Once the catheter is in place, a mixture of chemotherapy drugs and embolizing particles will be injected into the artery, blocking the tumor’s blood supply.
  5. After the procedure, the catheter will be removed, and the insertion site will be closed. You may need to remain on bed rest for up to 12 hours to reduce the risk of bleeding at the insertion site.

What Are the Risks of TACE ?
Side effects are generally minimal but may include mild symptoms like a cold or flu-like feeling, pain, nausea, and fever. These symptoms are typically treatable with medication and usually improve within a few days. Some bruising may occur at the insertion site.
Rare complications include:

  • Arterial bleeding or blockage
  • Liver infection requiring antibiotic treatment
  • Acute liver failure or unintended embolization

What to Expect After TACE ?
Most patients may experience symptoms known as “post-embolization syndrome,” including pain, nausea, or fever, which are usually manageable with medication.
You can resume normal eating within the day, and most patients are discharged within 24-48 hours. Mild fever, fatigue, and loss of appetite may occur in the first 1-2 weeks, which is expected.
You should contact your doctor if you experience:

  • Pale or cold legs
  • Bleeding at the groin site
  • Severe or changing leg or abdominal pain
  • Severe difficulty breathing
  • Fever over 38°C
  • Symptoms of infection
  • Frequent diarrhea
  • Cough with yellow or green sputum
  • Red, hot, or draining wound

In the following weeks, your oncologist or hepatologist will conduct blood tests to monitor liver and kidney function. Imaging (CT or MRI) will likely be scheduled 1-3 months later to check tumor size.

Note:
This document is based on materials from the European Society of Cardiovascular and Interventional Radiology (CIRSE). The information provided here is for general informational purposes and should not be used as a substitute for professional medical advice, diagnosis, or treatment.