Transarterial Chemoembolisation (TACE) in Delhi, India

Transarterial Chemoembolisation (TACE) is a procedure that uses chemotherapy and special embolic agents to cut off the blood supply to the cancerous tumour. The procedure is done to treat primary hepatic cancer. Embolisation is a treatment that blocks or slows down the blood going to the organ. The agent used to stop the blood flow also carries chemotherapy drugs, known as chemoembolisation.

The procedure is done when the liver cancer cannot be treated with other options. Transarterial chemoembolisation (TACE) may be used as a standalone treatment or combined with chemotherapy, radiation therapy, ablation, or surgery. TACE is a palliative treatment, which means that it will not cure cancer. However, it is primarily used to control tumour growth or try to shrink it. TACE procedure has more benefits compared to traditional chemotherapy. The TACE procedure has its fair share of risks and side effects, though it is usually less than conventional chemotherapy.

Who are the best candidates for Transarterial Chemoembolisation (TACE)?

The transarterial chemoembolisation procedure is helpful for patients with the following conditions:

• Patients with localised hepatic cancer.
• Have a life expectancy of at least three months.
• Liver cancer is not treatable with other options like surgery or ablation.
• Patients with good liver function.
• Lower BMI.
• Healthy personal.

Who should not consider Transarterial Chemoembolisation (TACE)?

Patients are generally not advised to go for the transarterial chemoembolisation procedure for the following reasons:

• Kidney dysfunction
• Abnormal blood clotting
• Prior stenting of the bile duct
• Portal vein thrombosis
• Portosystemic Anastomoses
• Advanced liver dysfunction
• Extensive tumour growth
• Bleeding disorder or some chronic illness
• History of medical conditions
• Jaundice
• Hepatofugal portal blood flow

How to prepare for Transarterial chemoembolisation (TACE)?

Several days before the procedure, there will be a consultation with the interventional radiologist. The radiologist will explain the TACE procedure in great length and its risks and benefits. The doctor may also order some blood tests to check for any kidney-related problems or if there is any form of blood clots. The patient should also tell if they are taking any over-the-counter drugs or medicines like aspirin or herbal supplements. The doctor will also consult whether the patient has any allergies, especially to local or general anaesthesia or any contrast materials.

The radiologist will perform an angiography test seven to 10 days before the surgery. The test is done to make a map of the tumour's blood vessels. The doctor will also advise you to stop taking aspirin, anti-inflammatory drugs, or some blood thinners at least five days before the procedure. Apart from this, other preparations for transarterial chemoembolisation include:

• Avoid eating or drinking anything after midnight before the procedure.
• Pre-arrange a ride home after the procedure.

How Transarterial chemoembolisation (TACE) is done?

The transarterial chemoembolisation procedure is usually under local or general anaesthesia. The liver has two blood supplies: around 75 per cent of the blood goes through the portal vein, and the rest, 25 per cent, through the hepatic artery. The radiologist blocks the hepatic artery as it supplies blood to the tumour.

The interventional radiologist inserts a thin, flexible tube (catheter) into the femoral artery present in the groin during the procedure. The doctor then moves the catheter up through the artery to reach the hepatic artery in the liver. The doctor then injects a dye, and X-rays are taken to find the artery branches feeding the cancerous tumour.

The doctor then moves the catheter to the artery and injects contrast material soaked in a chemotherapy drug. The drug is given directly to the tumour while the material blocks the blood supply. In some cases, the doctor may use the DEB-TACE technique during the procedure. In this, the surgeon uses special beads that are filled with chemotherapy drugs. The beads slowly release the chemotherapy drugs to live tumours. The whole procedure is completed in around 90 minutes, and the patient is shifted to the recovery room.

Possible Complications of Transarterial Chemoembolisation

Like any other surgical procedure, patients may suffer from some complications. These may include:

• Fever
• Pain in the upper-right abdomen
• Nausea and vomiting
• Fatigue
• Bleeding at the catheter site
• Hair loss
• Abnormal live function
• Inflammation of the gallbladder
• Collection of puss at the tumour site
• Liver failure
• Infection
• Blood vessel damage
• Damage to another part of the body
• Blood clots
• Reaction to anaesthesia
• Bloating

Taking Care After the Surgery

The patient may need to stay in the hospital for two to three days after the Transarterial chemoembolisation procedure. The procedure may have usual side effects, including low-grade fever for one week, the feeling of nausea or vomiting, some bruising at the site or some hair loss. The symptoms usually last for five to seven days. The interventional radiologist will provide special care instructions after Transarterial chemoembolisation to reduce the risk of developing any complications.

The radiologist may perform cross-sectional abdominal imaging like CT scans and MRI scans at regular intervals of time to check whether the tumour has shrunken or not. The doctor may also advise the following to ensure a speedy recovery:

• Avoid indulging in strenuous physical activities for four to six weeks.
• Take medications as directed by the doctor.
• Do not drink alcohol for a few weeks.
• Resume light activity within a couple of days.
• Eat a balanced diet and drink proper fluid.
• Follow up with the doctor regularly.

One should call the doctor in case of:

• Persistent nausea and vomiting that are not relieved with medication.
• High-grade temperature
• Severe abdominal pain
• Loss of sense of balance
• Trouble with constipation
• Pain that doesn't go away with medications
• Problems with the leg where the catheter was inserted

Review

Reviewed by Dr. Vikas Goswami, Director - Medical Oncology (Head & Neck, Gastrointestinal, Urology, Musculoskeletal).