Transarterial Liver Tumour Treatment (TACE) in Lucknow

It is a way of treating a liver tumour from inside the blood vessels that feed it. The liver has two blood supplies. The portal vein carries most of the blood to healthy liver tissue, while most liver tumours draw their blood from the hepatic artery. Treating that artery can reach the tumour while sparing much of the healthy liver.

A thin flexible tube called a catheter is passed into an artery, usually at the groin or the wrist, and steered up to the liver under live imaging, called fluoroscopy, which uses X-rays. Dye is injected to show the arteries. The team then places treatment in the branch that feeds the tumour.

In TACE, a chemotherapy medicine is delivered together with tiny particles that block the artery. In bland embolization, particles are used without the medicine. Another form, radioembolization, uses tiny radioactive beads and needs specialised facilities and planning.

Transarterial treatment is considered for selected people whose tumour cannot be removed by surgery or treated by ablation alone. It is often used for liver cancer that starts in the liver, and sometimes for tumours that have spread to the liver from elsewhere.

The liver has to be working well enough to cope with a reduced blood supply. The team checks this with blood tests such as bilirubin and albumin, for example in a liver function panel, and looks at scans for signs such as a blocked portal vein. People with poor liver function or a blocked main portal vein may be advised against it.

The kidneys matter too, because the dye used to show the arteries is cleared by the kidneys. Your doctor may ask for a kidney function panel beforehand.

Many people develop post-embolization symptoms within hours: pain in the upper right abdomen, nausea or vomiting, fever and tiredness. They come from the treated tumour and nearby liver tissue losing their blood supply. They usually settle over several days, though tiredness can last longer, and medicines are given to ease them.

Treatment is often given in sessions, with scans in between to see how the tumour has responded. Your specialist decides how many sessions are needed.

A fever that is high or lasts beyond the first days needs to be checked, because it can mean an infection rather than the usual reaction. The team gives you written advice on the warning signs.

The aim is to control a tumour that cannot be removed, to slow its growth or shrink it, or to bring it within reach of another treatment. It does not remove the whole tumour in every case, and it is often one part of a longer plan.

The risks to know about before you consent:

• Liver damage: liver function can worsen, which is a particular concern when the liver is already scarred or weak.
• Infection: an abscess in the treated area, or inflammation of the gallbladder.
• Treatment reaching the wrong place: particles can occasionally lodge in a nearby artery and damage the stomach, gallbladder or another organ.
• Dye and kidneys: an allergic reaction to the dye, or strain on the kidneys.
• Puncture site: bruising, bleeding or a damaged artery at the groin or wrist.
• Medicine effects: some of the chemotherapy reaches the rest of the body, so nausea, tiredness or a fall in blood counts can occur.

Your own risks depend on your liver and general health. The team explains them before asking for your consent.

Transarterial treatment is decided by a team: usually a liver specialist or oncologist, a surgeon where relevant, and an interventional radiologist. They compare it with ablation, surgery, drug treatment and radiotherapy for your particular tumour.

At our centre, the team reviews your referral, scans and reports first and checks which tests are missing. The detailed scan of the liver and its arteries is usually a CT or MRI. We do not offer CT or MRI scans, so your doctor advises where to get it done, and we can review the images.

After that review, we confirm whether the procedure is carried out at the centre or elsewhere, and by whom. If the tumour is pressing on the bile ducts, a different procedure such as biliary stenting may be needed first or alongside.