Embolisation treatment for liver cancer (TAE and TACE)

Embolisation is a treatment that blocks or reduces the blood supply to the cancer. There are different types:

• trans arterial embolisation (TAE)
• trans arterial chemoembolisation (TACE)

You have the treatment in the x-ray (radiology) department. The procedure takes 1 to 2 hours. You might have embolisation treatment more than once.

These are treatments for primary liver cancer . Primary liver cancer is different to cancer that spreads to your liver from somewhere else in your body. This is called secondary liver cancer or liver metastases.

Trans arterial embolisation (TAE)

Trans arterial embolisation (TAE) is also called bland embolisation. A specialist doctor injects a substance such as a gel or tiny beads to block the liver's blood supply. This starves it of oxygen and the nutrients it needs to grow

Trans arterial chemoembolisation

For trans arterial chemoembolisation (TACE) you have chemotherapy into the blood vessel that feeds the cancer. You then have a substance such as a gel or tiny beads injected to block the blood supply. 

Chemotherapy drugs used in TACE include:

• doxorubicin
• cisplatin 

When you might have embolisation treatment

You usually have embolisation treatment if you can't have surgery. It won’t cure your cancer, but it can control its growth, relieve symptoms and help you to live longer.

You might have embolisation to shrink a tumour so that surgery is then possible. Or to help control the cancer while you are waiting for a liver transplant.

Embolisation is not a suitable treatment if the cancer has spread into the blood vessels, lymph nodes or other parts of your body. You need to be generally healthy, and the rest of your liver and your kidneys must be working well.

Preparing for embolisation

You usually go into hospital on the morning of your treatment or the day before.

Your doctor or specialist nurse explains what happens and how they do the treatment. They then ask you to sign a consent form saying that you agree to have the procedure. Do ask them any questions that you have. 

Tell your doctor if you're having medicine that changes how your blood clots. This includes:

• aspirin
• clopidogrel
• arthritis medicines
• warfarin or heparin
• apixaban or rivaroxaban
• ticagrelor

Your doctor will tell you if you need to stop taking these or any other medicines for a while before your treatment.

You might have embolisation done under a local anaesthetic. Or you may have a drug during the procedure to make you sleepy (sedation). If you have sedation you usually can’t eat for 4 to 6 hours before the procedure. You can usually drink water up to 2 hours beforehand. 

Your appointment letter will give more detail about how to prepare for your treatment. This will include a number to ring if you have any questions. 

Having embolisation treatment

A specialist doctor called an interventional radiologist carries out the procedure. Radiographers and nurses will also be with you in the room.

First you get changed into a hospital gown. You lie on your back on the x-ray table. Your doctor or nurse puts a small tube (cannula) into your arm or back of your hand. They use the cannula to give you any medicines you might need, such as antibiotics, sedation, or pain relief. Your nurse regularly checks your heart rate and blood pressure. You might have oxygen through a small plastic tube or sponge which sits just inside your nostril. 

The radiologist cleans the area at the top of your leg (your groin) and injects local anaesthetic to numb the area. They make a small cut and put a thin flexible tube (catheter) into a blood vessel called the femoral artery. They thread the catheter along the artery until it reaches the hepatic artery that supplies blood to the liver.

They inject contrast medium into the catheter. This might cause a warm sensation through your body for a few seconds. You have x-rays to show the blood vessels that feed the cancer in the liver.

If you are having TAE

Your radiologist injects a substance such as a gel or tiny beads into the catheter. This blocks the blood vessels to the cancer.

If you are having TACE 

Your radiologist injects the chemotherapy through the catheter and into the blood vessels that feed the cancer. Then they inject a substance to block the blood vessels. 

Some hospitals use tiny beads called microspheres. These block the blood vessels and slowly release the chemotherapy. 

After they block the blood vessels, your radiologist removes the catheter and puts a pressure dressing onto the site in your groin.

After treatment

You go back to the ward where your nurse will monitor you. You need to stay lying down for a few hours afterwards. Your nurse will tell you when you can get up.

You can usually eat and drink as normal after the test. Drink plenty afterwards to help flush the dye out of your body.

You usually stay in hospital for a night or two.

What are the side effects of embolisation?

Embolisation treatment can cause side effects. 

Some people have flu-like symptoms that start about 3 to 5 days after treatment. You feel generally unwell, have body aches and you may feel sick. This might last 1 to 2 weeks. This is due to a side effect called post embolisation syndrome. Before you go home, your healthcare team will explain this syndrome. They will go through what medicines you can take to relieve your symptoms. 

Other common side effects include pain in the area around your liver (right hand side of your tummy) and nausea. These may last for a few days after the procedure. Your doctors may give you pain killers and anti sickness medications to help.

Tiredness is also a common side effect of embolisation treatment. It can last for a couple of weeks.

Other possible risks include:

• a small bruise where the catheter was put in

• infection in the treated area – you would need antibiotics through a drip

• damage to the blood vessel by the catheter – this is very rare

• damage to the kidneys – this could be due to the contrast medium, or a lack of fluid in your body (dehydration)

• an allergic reaction to the contrast medium

• liver failure - this is very rare

If you have TACE

There is a risk that some of the chemotherapy drug moves out of the liver and goes around the body in your bloodstream. This can cause temporary side effects such as:

• an increased risk of infection due to a drop in white blood cells

• tiredness and breathlessness due to a drop in red blood cells (anaemia)

• bruising easily or bleeding due to a drop in blood cells called platelets

• a sore mouth

• hair loss

Contact your healthcare team if you have an increase in pain or get a high temperature when you are at home.