Liver cancer is a disease that affects more than 41,000 adults in the United States each year. While it can be difficult to treat, patients in the Phoenix area have access to a number of minimally invasive options at Vascular and Interventional Partners. As a center of excellence for liver cancer treatments, we provide a high level of personalized care aimed at shrinking or stopping tumor growth while minimizing the harm done to the body. One of the most common procedures we perform is transarterial chemoembolization, which delivers cancer-fighting drugs directly into the liver and keeps them there. If you’ve been diagnosed with liver cancer, keep reading to learn more about this highly targeted approach or schedule a consultation today.
Transarterial chemoembolization (TACE) is a minimally invasive, nonsurgical treatment for certain liver cancers, such as hepatocellular carcinoma. It can also be used for cancers that have spread to the liver from other areas of the body. The goal of TACE is to control tumor growth, alleviate symptoms and improve the survivability of patients with liver cancer. In some cases, this treatment can also act as a “bridge therapy” to stop or slow the progression of disease for those awaiting a liver transplant.
Your doctor may recommend TACE as a standalone procedure or combine it with other cancer treatments, including radiation, chemotherapy, tumor ablation or surgery.
The liver is a special organ in a few different ways. First, it performs more than 300 essential functions in the body, including filtering the blood and breaking down nutrients, chemicals and toxins for easier processing or removal. Second, the liver is remarkable in that it can regenerate after injury, damage or resection. While disease and chronic scarring (cirrhosis) can limit this ability, the liver is the only visceral organ capable of regrowth.
The liver is also unique in that it has two blood supplies: the portal vein and hepatic artery. Most normal, healthy liver cells are fed by the portal vein, while cancer in the liver thrives on oxygenated blood from the hepatic artery. Embolization is a procedure used to treat liver cancer by blocking this blood supply, depriving the tumors of the nutrients and oxygen needed for growth. When embolization is also combined with chemotherapy, it’s known as chemoembolization.
Transarterial chemoembolization works by using a thin, flexible tube called a catheter to deliver chemotherapy drugs and embolic agents into the hepatic artery. This allows doctors to target the liver tumors directly and limit systemic exposure to cancer-fighting drugs, which are known for causing severe side effects when spread throughout the body. Once the chemotherapy is injected, embolic agents are then added to cut off blood flow, simultaneously starving cancer cells and keeping the drugs in the target area. Together, these techniques create a synergistic effect that can help slow or stop the growth of liver tumors.
Transarterial chemoembolization is a minimally invasive procedure performed by an interventional radiologist. It generally takes a few hours to complete, but this can vary depending on the size, number and location of the tumors. Before treatment, your doctor will identify and map the blood vessels that supply your liver using advanced imaging technology to minimize the risk of complications. Liver function and blood tests may also be conducted to ensure that the procedure can be done safely.
When you arrive for your appointment, local anesthesia will be administered with or without sedation. You’ll also receive other medications for pain, infection and nausea. Then, a catheter is inserted through a small incision made in the groin and guided to the hepatic artery, as close to the cancer as possible. Additional imaging will be performed to ensure proper placement. Once in position, the catheter will slowly inject chemotherapy drugs and embolic agents directly into the liver, targeting the tumors and stopping blood flow. Your doctor will then remove the catheter and apply a dressing to the incision site.
Afterward, you’ll need to remain lying down for several hours. An overnight hospital stay might be recommended for observation and post-procedure care, but some patients can return home the same day. This depends on your health status and the extent of your treatment. If a hospital stay is required, you’ll likely be discharged within 48 hours.
You may experience tenderness and swelling in the groin area after your procedure. Some people also develop post-embolization syndrome, which is a collection of symptoms that includes abdominal pain, nausea, fever and fatigue. Your doctor can prescribe medications to help mitigate these side effects, but they should subside within a few days. The effects of chemotherapy can last longer and may include a sore mouth, hair loss, tiredness and a drop in white blood cells. You should seek medical attention if worsening pain, shortness of breath, cold limbs, jaundice or significant swelling occur, as these may be signs of complications or liver damage.
You will need to take it easy immediately following your procedure, but most patients can resume their normal routine within a week. It will be important to follow up with your doctor as you recover. Imaging tests such as a CT scan of your liver can help determine if your treatment was effective. If needed, a second round of TACE may be scheduled to control tumor growth, as long as you’re healthy enough to tolerate a repeat procedure.
Transarterial chemoembolization is often recommended for patients with intermediate hepatocellular carcinoma and other liver cancers. It is one of the most commonly performed procedures to control tumor growth in those who are not candidates for surgery. Depending on the type or stage of your cancer, TACE may also be combined with tumor ablation, radiation therapy or surgery for the best possible outcome. Your doctor will evaluate your overall health and may recommend a number of tests, including a CT scan, MRI and liver function test, to determine if TACE is right for you.
Vascular and Interventional Partners provides minimally invasive treatment options for patients in the Phoenix area with a range of medical concerns, including cancers of the liver. Staffed by a team of highly credentialed, board-certified physicians who specialize in the field, you can be sure that you’re receiving top-quality care in a convenient, comfortable setting. To schedule a consultation or learn more about transarterial chemoembolization, don’t hesitate to contact or call us today at (480) 435-9100.
During treatment, your doctor will administer local anesthesia with or without sedation to ensure your comfort. In some cases, general anesthesia may be used. At most, you may feel some pressure as the catheter is inserted into the groin. You may also feel a warm sensation as the contrast materials used for imaging are injected, but this will quickly pass.
Most of the liver gets its blood supply from the portal vein, receiving only about 10-20% from the hepatic artery. As long blood flow is normal in the portal vein, TACE does minimal harm to healthy tissues but greatly impacts liver tumors. Your doctor will calculate a dose that is effective against the cancer cells but largely spares the rest of the liver.
Embolic agents are small particles that block blood flow when injected into a vein or artery. When used for liver cancer, this deprives the tumors of oxygen and nutrients and traps the chemotherapy within a localized area, where it’s needed most.
There is a small risk that embolic agents can lodge in the wrong place and deprive normal liver tissue of oxygen and nutrients. To avoid this outcome, your doctor will use advanced imaging technology to map the pathway of the blood vessels feeding the liver tumor(s). Other risks involved with TACE include infection, blood clots, kidney damage and liver failure, but these complications are rare. You may also experience pain or nausea from the chemotherapy. Before treatment, your overall health condition and possible side effects will be reviewed to ensure that you’re a good candidate for TACE.