Transarterial Chemoembolisation (TACE)
Date issued: November 2024
For review: November 2026
Ref: B-296/RA/Imaging/Transarterial Chemoembolisation TACE v2
PDF: Transarterial Chemoembolisation TACE.pdf [pdf] 217KB
This leaflet tells you about having a Transarterial Chemoembolisation (TACE). It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Referral and consent
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. You will be referred to an Interventional Radiologist for this procedure.
Interventional Radiologists are doctors who have trained and specialised in imaging and x-ray treatments.
Before the procedure you will need to sign a consent form, if one hasn’t previously been completed. This form says that you need to know what risks are involved. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or radiologist, you do not want this examination then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary, then they will explain this to you and communicate with the referring clinician. You will return to your referring clinician for review.
At all times the radiologist and referring clinician will be acting in your best interests.
What is a Transarterial Chemoembolisation (TACE)?
Chemoembolisation is a treatment for liver cancer, using a combination of an anti-cancer drug (chemotherapy) and an agent to block the blood vessels supplying the tumour (embolisation).
Why is a TACE recommended?
Patients who have been referred for this procedure have tumours in the liver. These may be from a primary cancer arising in the liver, or cancer spreading to the liver from somewhere else in the body. You will have seen a specialist liver doctor and, after discussion, will have explained that a TACE is the best procedure for you.
What are the benefits of TACE?
The purpose of TACE is to provide relief of symptoms related to the tumour, to reduce the size or rate of growth of the tumour and to improve survival time from the tumour.
It is not intended to provide a cure for the liver tumour.
Evidence from published data suggests that selected patients with liver cancer treated by TACE have an improved survival, approximately 50% greater survival at two years, compared with patients having no treatment. A TACE can also be performed on patients awaiting a liver transplant.
Are there any risks?
TACE is a safe procedure, but as with any medical procedure there are some risks and complications that can arise. The overall risk of a problem requiring further treatment is low (1–2%). It is not guaranteed to always work.
It is common to have some bruising at the puncture site. This may be sore for a few days but will resolve. Very rarely, significant bleeding or blockage of the artery can occur, which may require a small operation (less than 1 in 1,000).
Bile duct injury is very rare but could lead to surgery being required.
Pain, nausea and flu-like symptoms can occur after the procedure. These can vary from being very mild to severe. Treatment with strong painkillers and anti-sickness tablets will be available if you require them. The symptoms may take 1–2 weeks to settle.
Fatigue is a very common symptom after the procedure. Almost all people experience a feeling of general tiredness lasting for about two weeks, this is normal.
Infection can occur in the area of the liver treated and will need treatment with antibiotic injections.
Acute liver failure is a rare, but serious, complication occurring in approximately 1% of patients.
Impairment of kidney function can occur following the treatment. This can be due to the contrast, the anti-cancer drug or dehydration. You may have a drip placed before the procedure. This is to give you sufficient fluids to reduce the risk of problems with the kidney function.
If you are pregnant or suspect that you may be pregnant you should notify the department. A baby in the womb may be more sensitive to radiation than an adult. There is no problem with something like an x-ray of the hand or chest because the radiation field is at a safe distance from the foetus. However, special precautions are required for examinations where the womb is in, or near, the beam of radiation. If you are a female of childbearing age the radiographer will ask you if there is any chance of you being pregnant before the examination begins and you will be asked to sign a form. If there is a possibility of pregnancy, then your case will be discussed with the team looking after you to decide whether or not to recommend postponing the investigation.
There will be occasions when diagnosing and treating your illness is essential for your health and where the benefit clearly outweighs the small radiation risks. The procedure may go ahead after discussing all the options with you.
Are you required to make any special preparations?
A TACE is usually carried out as a day case procedure under local anaesthetic.
If you have a morning appointment, you will be asked to have nothing to eat from midnight although you may still drink water up to 6am then sips of water for the 2 hours before your examination.
If you have an afternoon appointment you may eat normally up to 6am and then water only up to 10am with sips of water for the 2 hours before your examination.
This is because the procedure may be painful, and you may need sedation. If it is decided that the procedure will be performed with just local anaesthetic, then you may eat and drink normally.
If you are taking warfarin, rivaroxaban, apixaban, ticagrelor (anticoagulants) this will be stopped before the procedure and you may require admission to hospital to give you an alternative.
If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.
If you are pregnant or suspect that you may be pregnant you should notify the department. A baby in the womb may be more sensitive to radiation than an adult. There is no problem with something like an x-ray of the hand or chest because the radiation field is at a safe distance from the foetus. However, special precautions are required for examinations where the womb is in, or near, the beam of radiation. If you are a female of childbearing age the radiographer will ask you if there is any chance of you being pregnant before the examination begins and you will be asked to sign a form. If there is a possibility of pregnancy, then your case will be discussed with the team looking after you to decide whether or not to recommend postponing the investigation.
There will be occasions when diagnosing and treating your illness is essential for your health and where the benefit clearly outweighs the small radiation risks. The procedure may go ahead after discussing all the options with you.
Who will you see?
A specially trained team led by an Interventional Radiologist within the radiology department. Interventional radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
If you are having the procedure as a day case, then you will attend PIU/Postbridge ward prior. You will be asked to get undressed and put on a hospital gown. A small cannula (thin tube) may be placed into a vein in your arm.
Our porters will collect you and bring you to the interventional radiology suite which is located within
X-ray East. This is similar to an operating theatre into which specialised X-ray equipment has been installed.
What happens during a TACE?
You may receive a sedative to relieve anxiety, as well as an antibiotic.
The procedure is performed using local anaesthetic and often sedation. The skin at the top of the leg (groin) is numbed and a small tube (catheter) is placed in the artery.
The catheter is passed into the artery to the liver under X-ray guidance. X-rays are taken to identify the blood vessels supplying the tumour by injecting dye (contrast agent) into the catheter. The catheter is passed as close as possible to the blood vessels supplying the tumour and treatment is given.
It may take two or more separate courses of the treatment to treat the tumour.
Will it hurt?
It may sting a little when the local anaesthetic is injected. You may feel a warm sensation for a few seconds when the dye is injected and feel like you are passing urine.
If you feel pain at any stage, please let the doctor and nurses know so that they can adjust the medications.
How long will it take?
Every patient's situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. As a guide, expect to be in the X-ray department for about two hours altogether.
What happens afterwards?
You will be taken back to your ward. Nursing staff will carry out routine observations including pulse and blood pressure and will also check the treatment site. You will generally stay in bed for a few hours, until you have recovered.
Assuming you are feeling well, you will normally be discharged after 24-48 hours.
Other Risks
TACE is a safe procedure but as with any procedure or operation complications are possible. We have included the most common risks and complications in this leaflet.
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. X-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of ~1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of X-rays read the publication: “X-rays how safe are they” on the Health Protection Agency website
Finally
Some of your questions should have been answered by this leaflet but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact:
Interventional Radiology Department
01752 430838 - IR Co-ordinator
01752 432063 – Bookings Clerk
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
Park and Ride:
Buses (1/1A/42C/34) run from the George Junction Park and Ride Mon-Sat (except Bank Holidays) every 15/20 mins from 6am. The last bus leaves the hospital at 11:30pm.
Plympton Park and Ride (52) runs from Coypool Park and Ride.
Parking is free although you will need to purchase a ticket to travel on the bus.
Patient Transport:
For patients unable to use private or public transport please contact The Patient Transport Service:
Devon GP: 0345 155 1009
Cornwall GP: 01872 252211
Comments and Suggestions
We welcome comments and suggestions to help us improve our service.
