Transarterial Chemoembolisation (TACE)

What is Transarterial Chemoembolisation (TACE)?

Transarterial chemoembolisation (TACE) is a minimally invasive treatment used to manage liver cancer, particularly when surgery is not an option. It involves delivering anti-cancer drugs directly into the blood vessels feeding the tumour, followed by blocking those vessels to cut off the tumour’s blood supply.

TACE is considered a palliative treatment. Its goal is not to cure, but to shrink or stabilise tumours, relieve symptoms, and help prolong survival. It is commonly used for primary liver cancers, such as hepatocellular carcinoma (HCC), and in selected cases of secondary liver cancers that have spread to the liver. The procedure can be repeated several times and may be used alone or in combination with other therapies.

Benefits of TACE

• Minimally invasive approach via a groin puncture
• Does not require general anaesthesia
• Can be performed multiple times if needed

How it works

The procedure is typically performed by an interventional radiologist in an angiography suite. Under X-ray guidance, a catheter is inserted through a small puncture in the groin (or sometimes the wrist) and guided to the hepatic artery, which supplies blood to the liver.

Once the tumour’s feeding artery is identified, chemotherapy is delivered directly into it, often mixed with an oily contrast agent called Lipiodol to help trap the drug within the tumour. This is immediately followed by the injection of embolic agents, which are small particles that block the artery, cutting off the tumour’s blood supply and enhancing the effectiveness of chemotherapy.

TACE is usually performed under local anaesthetic, though some patients may receive light sedation or conscious anaesthesia. The procedure is generally well tolerated, and because chemotherapy remains concentrated in the liver, systemic side effects are often milder than those seen with traditional chemotherapy.

TACE is a repeatable treatment and may be performed multiple times, depending on the tumour’s response and the patient’s liver function. It may be used alone or in combination with other therapies, including systemic chemotherapy, targeted therapy, immunotherapy, or as a bridging or downstaging strategy to enable liver transplant or surgery.

Drug-eluting bead transarterial chemoembolisation (DEB-TACE)

Drug-eluting bead TACE (DEB-TACE) is a more advanced form of TACE. Instead of using chemotherapy in liquid form, it employs tiny polymer beads that are pre-loaded with chemotherapy drugs—commonly doxorubicin. These beads are delivered directly into the tumour’s feeding artery and remain there, slowly releasing the drug over time.

Benefits of DEB-TACE include:

• Better tumour response and disease control
• Longer duration of disease-free progression
• Significant reduction in side effects associated with anti-cancer drugs
• Reduction in serious liver toxicity
• Advantages for patients with compromised liver function, poorer performance status, bilobar disease, or recurrent disease
• Greater tumour response, improved disease control, and enhanced safety profile

Why do you need transarterial chemoembolisation (TACE)?

TACE may be recommended in the following situations:

• Unresectable hepatocellular carcinoma (HCC) – where the tumour cannot be removed surgically
• Liver-predominant metastases from cancers such as colorectal, neuroendocrine, or breast cancer
• Bridge or downstaging therapy for patients awaiting liver transplantation or surgery
• Palliative treatment to control symptoms, reduce tumour burden, and improve quality of life

TACE is typically considered when surgery or other curative treatments are not feasible, but tumour control remains an important goal.

What are the risks and complications of transarterial chemoembolisation (TACE)?

While TACE is generally considered safe, it carries some small risks. Major complications are uncommon, and serious adverse events, such as death from liver failure, occur in fewer than 1 in 100 cases.

Risks of angiography

• Bleeding from the puncture site
• Injury to the artery used for access or to the hepatic artery
• Allergic reaction to contrast dye
• Renal failure

Specific risks of TACE

• Post-embolisation syndrome (in up to 30% of patients): Flu-like symptoms such as low-grade fever (<38.5°C), fatigue, muscle aches, nausea, and loss of appetite, typically lasting 7–10 days
• Non-target embolisation: Accidental blockage of arteries supplying other organs, such as the gallbladder, stomach, or bowel, which can cause inflammation or injury

How do you prepare for transarterial chemoembolisation (TACE)?

Before your procedure:

• You will undergo blood tests to evaluate your liver function, clotting ability, and kidney health.
• Inform your doctor about all medications you are taking:
  • Blood thinners (e.g. warfarin, aspirin, clopidogrel) may need to be stopped 3–5 days beforehand.
  • Diabetes medications may need to be adjusted due to fasting requirements.
  • Fasting for 4–6 hours before the procedure is typically required, especially if sedation is planned.
  • Arrive early to allow time for hospital admission and preparation:
    • Outpatient cases: Arrive at least 20 minutes before your scheduled time.
    • Day surgery/inpatient cases: Arrive at least 2 hours before the procedure.

You will also be asked to provide consent and may undergo additional imaging to help plan the procedure accurately.

What can you expect during transarterial chemoembolisation (TACE)?

Estimated duration

The procedure takes approximately 1.5–3 hours, followed by a period of post-procedure monitoring.

During the procedure

• A catheter is inserted through the artery in the groin and guided into the hepatic artery.
• Contrast dye is injected to identify the artery feeding the tumour.
• The prescribed chemotherapy (either mixed with Lipiodol or in bead form) is infused.
• Embolic agents are then used to block the blood flow to the tumour.
• The catheter is removed, and pressure is applied to prevent bleeding.

You may feel a warm sensation when contrast is used, but the procedure itself should not be painful.

After the procedure

• Tight pressure dressing will be applied to the groin.
• You must remain lying down for several hours to allow the artery to seal.
• You will usually be observed overnight.
• Mild side effects such as fever, nausea, abdominal pain, or fatigue may occur and are usually short-lived.
• Most patients are discharged the next day if stable.

Care and recovery after transarterial chemoembolisation (TACE)

Expected recovery

Most patients recover within 7–10 days. Fatigue, mild discomfort, and appetite loss are common during the first week. TACE may need to be repeated multiple times for full therapeutic effect.

Recovery tips

• Rest at home for at least a few days.
• Avoid strenuous activity or heavy lifting.
• Keep the groin puncture site clean and dry.
• Eat light meals and stay hydrated.
• Take all medications as prescribed, including pain relief or antibiotics.
• Monitor for signs of complications (e.g. high fever, jaundice, or worsening abdominal pain).

Your recovery will depend on:

• Your baseline liver function.
• The extent and type of tumour.
• Whether any complications occur.
• Your overall cancer treatment plan.

Follow-up and monitoring

You will require:

• Imaging tests (CT or MRI) to evaluate how the tumour responded.
• Blood tests to check liver function and treatment effectiveness.
• Follow-up appointments with your oncologist or referring doctor.

If a residual or recurrent tumour is detected, repeat TACE may be recommended.