Liver Cancer (cont.)

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Chemoembolization (trans-arterial chemoembolization or TACE)

This technique takes advantage of the fact that liver cancer is a very vascular (contains many blood vessels) tumor and gets its blood supply exclusively from the branches of the hepatic artery. This procedure is similar to intra-arterial infusion of chemotherapy. But in TACE, there is the additional step of blocking (embolizing) the small blood vessels with different types of compounds, such as gel foam or even small metal coils. Thus, TACE has the advantages of exposing the tumor to high concentrations of chemotherapy and confining the agents locally since they are not carried away by the bloodstream. At the same time, this technique deprives the tumor of its needed blood supply, which can result in the damage or death of the tumor cells. In fact, TACE originally grew out of the observation that patients undergoing intraarterial chemotherapy who accidentally had their catheters clotted off did better!

By relying upon blocking blood flow to the tumor, TACE will also cause some damage to the surrounding liver, and this is its primary limitation. Although the tumor may shrink up to 70% of the time, the associated liver damage can cause pain, fever, nausea, infection, fluid accumulation, and rarely, death. Nonetheless, TACE has been shown to be better than no treatment in several studies. There are newer techniques for delivering chemotherapy intra-arterially and blocking the blood vessels at the same time (microscopic drug-eluting beads); while the side effects seem to be less, it is not clear whether this method is more effective.

While TACE is not suitable for people with very sick livers or who are otherwise medically compromised, it is one of the most widely used techniques to control liver cancer around the world. It is important to realize, though, that it is not a cure and can only control the cancer for a limited time. However, in many individual patients appropriately chosen by their physicians, TACE can help to keep them alive longer.

Medically Reviewed by a Doctor on 4/17/2014

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