Transarterial chemoembolization or TACE combines the local delivery of chemotherapy with a procedure called embolization to treat cancer, most often of the liver. It is a non-surgical and minimally invasive procedure performed in radiology, usually by an interventional radiologist.

In TACE, anti-cancer drugs are injected directly into the blood vessel feeding a cancerous tumor. In addition, synthetic material called an embolic agent is placed inside the blood vessels that supply blood to the tumor, in effect trapping the chemotherapy in the tumor and blocking blood flow to the tumor.

Image-guided, minimally invasive procedures such as TACE are most often performed by an interventional radiologist in an interventional radiology suite or occasionally in the operating room.

X-ray images will be taken to map the path of the blood vessels feeding the tumor. Contrast material may also be used to map the path.

You may be given a medication called Allopurinol, which may help protect the kidneys from the chemotherapy and the byproducts produced by the dying tumor cells.

Your doctor may provide medications to help prevent nausea and pain and antibiotics to help prevent infection.

You will lie on the procedure table.

The doctor or nurse may connect you to monitors that track your heart rate, blood pressure, oxygen level, and pulse.

A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm to administer a sedative. This procedure may use moderate sedation. It does not require a breathing tube. However, some patients may require general anesthesia.

The doctor will make a very small skin incision at the site.

Using x-ray guidance, the doctor inserts a thin catheter through the skin into an artery, either in the groin or in the wrist, and advances it to the liver. Then contrast material is injected through the catheter and another series of x-rays will be taken.

Once the catheter is positioned in the branches of the artery that are feeding the tumor, the anti-cancer drugs and embolic agents are mixed together and injected.

Additional x-rays will be taken to confirm that the entire tumor has been treated.

When the procedure is complete, the doctor will remove the catheter and apply pressure to stop any bleeding. Sometimes, your doctor may use a closure device to seal the small hole in the artery. This will allow you to move around more quickly. No stitches are visible on the skin. The nurse will cover this tiny opening in the skin with a dressing.

You can expect to stay in the recovery room between two to six hours, which depends on which artery was accessed and if a closure device was used.

TACE is usually completed within 90 minutes.

Several days before the procedure, you will have an office consultation with the interventional radiologist who will be performing your procedure.

Prior to your procedure, your doctor may test your blood.

Tell your doctor about all the medications you take, including herbal supplements. List any allergies, especially to local anesthetic, general anesthesia, or contrast materials. Your doctor may tell you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners before your procedure.

Patients should always tell their doctor and technologist if they are pregnant. Doctors will not perform many tests during pregnancy to avoid exposing the fetus to radiation. If an x-ray is necessary, the doctor will take precautions to minimize radiation exposure to the baby. See the Radiation Safety page for more information about pregnancy and x-rays.

You will receive specific instructions on how to prepare, including any changes you need to make to your regular medication schedule.

If you are to receive a sedative during the procedure, the doctor may tell you not to eat or drink anything for four to eight hours before your exam. If you are sedated, have someone accompany you and drive you home afterward.

Children may require general anesthesia for the procedure to help them hold still and be comfortable for the procedure. The anesthesia department will provide instructions to the family.

While TACE can be done as an outpatient procedure, be prepared to stay overnight at the hospital for one or more days.

The nurse will give you a gown to wear during the procedure.

One to seven days after the procedure most patients experience some side effects called post-embolization syndrome. Symptoms include pain, nausea, vomiting and fever. Most people describe their symptoms as similar to the flu. Pain is the most common side effect that occurs because the blood supply to the treated area is cut off. It can readily be controlled by medications given by mouth or your IV.

You should be able to leave the hospital within 24-48 hours after the procedure once your pain and nausea are controlled with oral medication.

You will be sent home with prescriptions for pain and nausea medicine. You may be sent home with antibiotics. It is normal for you to run a fever up to a week following the procedure. Fatigue and loss of appetite are also common and may last two weeks or longer. In general, these are all signs of a normal recuperation.

If your pain suddenly changes in degree or character, if your fever becomes suddenly higher or you notice any other unusual changes, you should contact your physician.

You may receive a breathing apparatus called an incentive spirometer. Your nurse will instruct you how to use it. This will help you inflate your lungs so that you will not develop pneumonia.

You should be able to resume your normal activities within a week.

During the first month following the procedure, you should check in routinely to let your physician know how your recovery is progressing. You will return for a CT scan or MRI and blood tests to determine the size and status of the treated tumor.

The liver is divided into two parts—a right hepatic lobe and a left hepatic lobe. If there is tumor involving both lobes, this is usually treated in a staged fashion. During the first setting, one of the lobes is treated. The second lobe is usually treated approximately one to two months later.

CT or MRI will be performed every three months thereafter to determine how much the tumors ultimately shrink, and to see if any new tumors arise in the liver. The average time before a second round of TACE is necessary (because of new tumor) is between 10 and 14 months. TACE can be repeated many times over the course of many years, as long as it remains technically possible and you continue to be healthy enough to tolerate repeat procedures.

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