Transarterial Chemoembolization (TACE) Treatment in India

Transarterial Chemoembolization (TACE) is a minimally invasive, image-guided procedure used to treat liver cancer, especially hepatocellular carcinoma (HCC) and certain metastatic liver tumors. In this procedure, a specialized interventional radiologist inserts a thin catheter through an artery (usually in the groin or wrist) and guides it to the blood vessels supplying the liver tumor. High-dose chemotherapy is then delivered directly into the tumor, followed by embolic agents that block the tumor’s blood supply. This dual action helps trap the chemotherapy inside the tumor while starving the cancer cells of oxygen and nutrients. TACE is commonly recommended for patients who are not suitable for surgery or liver transplant and can help shrink tumors, control cancer progression, and improve survival outcomes. The procedure usually requires short hospital stay and is often repeated in multiple sessions depending on the tumor response.

Transarterial Chemoembolization (TACE) is recommended for patients with liver tumors who are not suitable candidates for surgery or liver transplant. It is commonly used to slow tumor growth, reduce tumor size, and improve survival outcomes by delivering chemotherapy directly to the tumor while blocking its blood supply.

Candidates Who May Benefit From TACE

1. Hepatocellular Carcinoma (HCC)

TACE is most commonly recommended for patients with primary liver cancer (HCC), especially when the tumor is confined to the liver and cannot be removed surgically. It is often used for:

• Intermediate-stage liver cancer (BCLC stage B)
• Multiple liver tumors without spread outside the liver
• Patients waiting for liver transplant (bridge therapy)

2. Liver Metastases (Secondary Liver Cancer)

TACE may also be used for cancers that have spread to the liver from other organs, such as:

• Colorectal cancer liver metastases
• Neuroendocrine tumor metastases
• Breast cancer metastases (selected cases)
• Other solid tumor liver metastases (case-dependent)

3. Patients Not Eligible for Surgery

TACE is often recommended for patients who cannot undergo surgery due to tumor location, multiple tumors, or medical conditions such as:

• Reduced liver reserve
• High surgical risk due to age or comorbidities
• Advanced cirrhosis (selected patients)

4. Tumor Control Before Surgery or Transplant

TACE may be used as a pre-treatment approach to control tumor progression, including:

• Downstaging liver tumors to meet transplant criteria
• Reducing tumor size before surgical resection
• Preventing tumor growth while waiting for transplant

5. Patients with Good Liver Function

TACE is most effective and safer in patients whose liver is still functioning reasonably well. It is typically preferred for patients with:

• Child-Pugh A or early Child-Pugh B liver function
• No major liver failure symptoms
• Stable bilirubin and liver enzyme levels

Who Is Not Typically a Suitable Candidate?

TACE may not be recommended for individuals with:

• Severe liver failure or decompensated cirrhosis
• Advanced tumor spread outside the liver
• Complete blockage of the main portal vein (in some cases)
• Severe kidney dysfunction
• Uncontrolled infection or sepsis
• Severe bleeding disorders

How Candidates Are Evaluated

Before undergoing TACE, patients undergo a detailed evaluation to confirm eligibility and safety. This may include:

• Blood tests (LFT, CBC, kidney function, clotting profile)
• Imaging tests such as CT scan, MRI, or ultrasound of the liver
• Assessment of liver function (Child-Pugh score, MELD score)
• Evaluation of tumor size, location, and blood supply
• Cardiac and general fitness evaluation (if needed)
• Consultation with interventional radiology and oncology specialists

Preparing for Transarterial Chemoembolization (TACE) involves completing medical evaluations, following doctor instructions, adjusting medications, and understanding what to expect before and after the procedure. Proper preparation helps reduce complications and improves treatment outcomes.

1. Complete the Pre-TACE Evaluation

Before undergoing TACE, your doctor will perform a detailed evaluation to ensure the procedure is safe and suitable for your condition.

• Blood tests (Liver function test, Kidney function test, CBC, clotting profile)
• Imaging scans (CT scan, MRI, ultrasound of the liver)
• Tumor assessment and staging
• Review of portal vein and liver blood flow
• Assessment of liver function (Child-Pugh / MELD score)
• Consultation with interventional radiologist and oncologist/hepatologist

2. Follow All Medical Instructions

Your healthcare team will provide specific instructions to prepare your body and reduce risks during the procedure.

• Take medications exactly as prescribed
• Inform your doctor about all medicines, supplements, and herbal products
• Report any fever, infection, or new symptoms before the procedure
• Follow fasting instructions (usually no food or drink for 6–8 hours before TACE)
• Get clearance if you have diabetes, heart disease, or kidney problems

3. Adjust Blood Thinners and Other Medications

Some medications may increase bleeding risk during catheter-based procedures. Your doctor may advise stopping or adjusting certain medicines before TACE.

• Blood thinners (Aspirin, Warfarin, Clopidogrel, etc.) may need temporary stopping
• Diabetes medicines may require dose adjustment on procedure day
• Inform the doctor if you are allergic to contrast dye or iodine
• Antibiotics may be prescribed before the procedure to prevent infection

4. Make Lifestyle and Diet Preparations

Healthy habits can improve liver stability and reduce complications during and after TACE.

• Avoid alcohol completely
• Stop smoking or tobacco use if possible
• Follow a liver-friendly diet (low salt, balanced protein)
• Stay hydrated as advised by your doctor
• Get enough rest before the procedure

5. Arrange Support for Hospital Stay and Recovery

TACE usually requires short hospital observation. Having support helps with safe recovery and follow-up.

• Arrange a family member or caregiver to accompany you
• Plan transportation (you may not be able to drive after the procedure)
• Prepare for 1–2 days of rest after treatment
• Keep all medical records, scan reports, and prescriptions ready
• Plan follow-up visits for imaging and blood tests

6. Understand What to Expect After TACE

Most patients experience mild side effects after TACE. Knowing them in advance helps reduce anxiety and ensures timely care.

• Mild fever, nausea, fatigue, or abdominal pain (post-embolization syndrome)
• Temporary loss of appetite and weakness
• Hospital monitoring for a few hours to 1 day
• Follow-up scans after a few weeks to check tumor response
• Multiple TACE sessions may be needed depending on tumor response

Transarterial Chemoembolization (TACE) is a minimally invasive and widely used treatment for liver tumors. While it is generally considered safe and effective, it can still carry certain risks and potential complications. Understanding these risks helps patients and families prepare and know what symptoms to monitor during recovery.

Procedure-Related Risks

• Bleeding or bruising at the catheter insertion site (groin or wrist)
• Damage to the blood vessel during catheter placement
• Allergic reaction to contrast dye used in imaging
• Injury to nearby organs due to accidental embolization (rare)

Post-Embolization Syndrome

This is the most common side effect after TACE and usually lasts a few days.

• Fever
• Abdominal pain or discomfort
• Nausea and vomiting
• Fatigue and weakness
• Loss of appetite

Liver-Related Complications

Since TACE blocks blood flow to the tumor, it can also temporarily affect healthy liver tissue.

• Temporary liver function worsening (rise in bilirubin or liver enzymes)
• Liver inflammation or swelling
• Liver failure in patients with severe cirrhosis (rare but serious)
• Ascites (fluid buildup in the abdomen)

Infection Risks

Although TACE is minimally invasive, infection may occur, especially in patients with bile duct obstruction or weakened immunity.

• Infection at the catheter insertion site
• Liver abscess (rare but serious)
• Bloodstream infection (very rare)

Gallbladder and Bile Duct Complications

In some cases, embolization particles may affect nearby bile ducts or gallbladder blood supply.

• Bile duct injury or narrowing
• Gallbladder inflammation (cholecystitis)
• Bile leakage (rare)

Kidney and Contrast-Related Complications

• Temporary kidney function worsening (especially in elderly or diabetic patients)
• Contrast-induced nephropathy (rare)
• Dehydration-related kidney stress

Other Potential Complications

• Temporary hair loss or low blood counts due to chemotherapy exposure (less common)
• Blood clot formation in liver vessels (rare)
• Shortness of breath if embolic material reaches lungs (very rare)
• Need for repeat TACE sessions if tumor response is incomplete

While these risks are possible, TACE is performed by experienced interventional radiologists under imaging guidance, and patients are closely monitored before, during, and after the procedure to minimize complications and ensure safe recovery.