TACE (Transarterial Chemoembolization)

Introduction

If you or someone in your family has been diagnosed with liver cancer or a tumour that has spread to the liver, you may have heard your doctor mention TACE. TACE stands for transarterial chemoembolization. It is a treatment that targets a tumour through the blood vessels that feed it, rather than through surgery or whole-body chemotherapy.

This article explains what TACE is, who it is used for, how it fits into the broader treatment of liver tumours, what to expect on the day of the procedure, and what recovery and follow-up usually look like. It is written for patients and families who are planning treatment and want a clear picture of what lies ahead. It is not a substitute for the personal advice of your treating team, but it should help you ask better questions and feel less unsure about the road ahead.

What Is TACE?

TACE is a minimally invasive procedure performed by an interventional radiologist — a doctor trained to treat conditions using image-guided techniques through small punctures in the skin, rather than open surgery. In TACE, a thin tube called a catheter is threaded through an artery (usually in the groin or wrist) up to the arteries that supply blood to the liver. Once the catheter is in the right place, two things are delivered directly into the tumour’s blood supply:

• Chemotherapy: anti-cancer drugs that act on the tumour cells.
• Embolic material: tiny particles or a thick oily substance that block the small blood vessels feeding the tumour.

The idea behind TACE is based on a key feature of liver tumours. The healthy liver gets most of its blood supply from a vein called the portal vein, while most liver tumours get their blood mainly from the hepatic artery. This difference allows interventional radiologists to deliver a high dose of chemotherapy and blockage material into the artery feeding the tumour while sparing most of the healthy liver tissue.

The combined effect is twofold. The chemotherapy attacks the cancer cells at a higher concentration than would be possible with whole-body chemotherapy. At the same time, the embolic particles cut off the tumour’s oxygen and nutrient supply, causing the tumour to shrink or die. Because the drug is trapped inside the tumour by the embolization, it stays in contact with the cancer cells for longer than it would in standard chemotherapy.

Types of TACE

Not all TACE procedures are the same. Over the years, two main approaches have become standard, and your interventional radiologist will choose the one that fits your tumour and overall situation.

Conventional TACE (cTACE)

In conventional TACE, the chemotherapy drug (most commonly doxorubicin, sometimes combined with other drugs) is mixed with an oily liquid called lipiodol. This mixture is injected into the artery feeding the tumour, and the oil acts as both a carrier for the drug and a temporary blockage. After this, small particles such as gelatin sponge are often added to further block the vessel. Conventional TACE has been used for decades and remains widely practised.

Drug-Eluting Bead TACE (DEB-TACE)

In DEB-TACE, tiny beads are pre-loaded with chemotherapy drug. When these beads are injected into the tumour’s artery, they block the vessel and then slowly release the drug over hours and days. The aim is to give a more controlled, sustained dose of chemotherapy to the tumour while reducing the amount of drug that escapes into the rest of the body. This approach was developed to make the procedure more predictable and to reduce some side effects.

Clinical studies have compared conventional TACE and DEB-TACE without finding a clear winner in survival. Both are accepted options under major international guidelines such as those from the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD). The choice often depends on tumour size and location, the patient’s liver function, and the experience of the centre performing the procedure.

A related procedure called TARE (transarterial radioembolization, also called Y-90 radioembolization) uses radioactive beads instead of chemotherapy. TARE is not the same as TACE but is sometimes considered as an alternative, especially for larger tumours or when chemotherapy is not suitable.

Why Is TACE Performed?

TACE is used mainly to treat tumours in the liver. The most common reasons it is performed are:

• Hepatocellular carcinoma (HCC): the most common type of primary liver cancer, which usually develops in a liver damaged by hepatitis B, hepatitis C, fatty liver disease, or long-standing alcohol use. TACE is one of the standard treatments for HCC that cannot be removed by surgery but has not yet spread beyond the liver.
• Liver metastases: tumours that have spread to the liver from cancers elsewhere in the body, such as colorectal cancer, neuroendocrine tumours, breast cancer, or uveal (eye) melanoma. TACE is most often used for metastases when other treatments are no longer controlling the liver disease.
• Intrahepatic cholangiocarcinoma: a cancer of the bile ducts inside the liver. TACE is considered in selected cases.
• Bridging or downstaging before liver transplant: TACE may be used to keep a tumour from growing while a patient waits for a transplant (bridging), or to shrink a tumour to within transplant criteria (downstaging).

For hepatocellular carcinoma in particular, an internationally used framework called the Barcelona Clinic Liver Cancer (BCLC) staging system guides treatment choices. Within this framework, TACE is the standard first-line treatment for what is called intermediate-stage HCC — tumours that are confined to the liver, have grown beyond what can be removed surgically or treated with local ablation, but have not yet invaded major blood vessels or spread outside the liver. Interventional radiologists also use TACE in selected earlier-stage or more advanced situations when other options are not suitable.

Who Is a Candidate for TACE?

Whether TACE is the right next step for any individual patient is a decision made by a multidisciplinary team — usually including a hepatologist, an oncologist, a surgeon, and an interventional radiologist. They look at three main things: the tumour, the liver, and the patient’s overall health.

Factors that generally favour TACE include:

• Tumour or tumours confined to the liver
• Reasonably preserved liver function (often described by doctors as Child-Pugh A or early B)
• No invasion of the main portal vein by the tumour
• Good general health and ability to tolerate a procedure under sedation or anaesthesia
• No untreated, severe blockage of the bile ducts

Factors that may make TACE unsafe or unsuitable include:

• Advanced liver failure
• Tumour spread outside the liver that is not controlled
• Complete blockage of the main portal vein by tumour or clot
• Severe kidney problems (because of the contrast dye used)
• Severe bleeding tendency that cannot be corrected
• Active, uncontrolled infection

Your team will also weigh whether a single TACE session or a planned series is likely to be useful, and whether other treatments — such as surgery, ablation, radioembolization, systemic therapy, or transplant — may serve you better either now or after TACE.

Alternatives to TACE

TACE is one of several options for liver tumours. The main alternatives, considered alongside TACE, include:

• Surgical resection: removing the part of the liver that contains the tumour. This is generally favoured for smaller tumours in patients with good liver function.
• Liver transplantation: for selected patients with small tumours and significant underlying liver disease, transplant offers the chance to treat both the cancer and the diseased liver.
• Local ablation: destroying the tumour with heat (radiofrequency or microwave) or cold (cryoablation), usually through a needle guided by imaging. Ablation is often used for small tumours, sometimes in combination with TACE.
• Transarterial radioembolization (TARE / Y-90): as described earlier, this uses radiation-emitting beads delivered through the artery rather than chemotherapy and embolic material.
• Systemic therapy: drugs given by mouth or into a vein that travel throughout the body. For liver cancer, this category now includes targeted therapies such as sorafenib and lenvatinib, and immunotherapy combinations such as atezolizumab with bevacizumab. Systemic therapy is often used when cancer has spread beyond the liver or when local treatments are no longer effective.
• External-beam radiotherapy, including stereotactic body radiotherapy (SBRT): highly focused radiation delivered from outside the body. This is used in selected cases.

In many patients, these options are not mutually exclusive. TACE may be combined with ablation, used to bridge to transplant, or sequenced with systemic therapy. The right combination depends on the tumour, the liver, and the goals of treatment.

Preparing for TACE

Preparation for TACE usually takes place over several days to a few weeks before the procedure, depending on what tests have already been done.

Tests and assessments

Before TACE, your team will typically arrange:

• Imaging: a recent multiphase CT scan or MRI of the liver to map the tumour and the blood vessels feeding it.
• Blood tests: liver function tests, kidney function, full blood count, clotting tests, and tumour markers such as alpha-fetoprotein (AFP) for HCC.
• Hepatitis testing and treatment: if hepatitis B or C is active, antiviral treatment may be started or optimised first.
• Cardiac and anaesthetic assessment: particularly for older patients or those with heart or lung conditions.

Medications and lifestyle

Your interventional radiologist will give specific instructions, which may include:

• Stopping or adjusting blood thinners (such as warfarin, aspirin, or newer anticoagulants) for a defined period before the procedure
• Adjusting diabetes medications, especially metformin, around the time of contrast use
• Not eating for several hours before the procedure (clear fluids may be allowed up to a few hours before)
• Continuing most regular medications with small sips of water unless told otherwise

You will usually be admitted to hospital on the day of the procedure or the night before. Arrange for someone to stay with you in hospital if possible, and for help at home for the first few days after discharge.

Talking about goals

Before the procedure, it helps to be clear with your team about what the aim of this TACE is: shrinking the tumour, controlling its growth, bridging to transplant, or relieving symptoms. Knowing the goal makes it easier to understand how success will be judged on follow-up imaging.

What Happens During TACE

Anaesthesia and monitoring

Most TACE procedures are done under conscious sedation — you are awake but very relaxed and drowsy, with strong pain relief on board. Some patients receive general anaesthesia. During the procedure, your heart rate, blood pressure, breathing, and oxygen levels are continuously monitored.

Step by step

1. Vascular access: the skin over the groin (femoral artery) or wrist (radial artery) is cleaned and numbed. A small puncture is made, and a thin tube called a sheath is placed into the artery.
2. Catheter navigation: using X-ray guidance, the interventional radiologist threads a catheter from the access point up through the aorta and into the hepatic artery that supplies the liver.
3. Angiogram: contrast dye is injected and X-ray images are taken. This map shows exactly which branches feed the tumour. In many centres, a special CT-like imaging system called cone-beam CT is used inside the angiography suite to refine this map.
4. Selective catheterisation: a smaller catheter (a microcatheter) is advanced into the small branches that feed the tumour. The more selective the position, the more the treatment targets the tumour and spares healthy liver.
5. Delivery of treatment: the chemotherapy and embolic material are injected slowly. In conventional TACE, the drug-lipiodol mixture is given first, followed by particles to block the vessel. In DEB-TACE, drug-loaded beads are injected directly. The radiologist watches the flow on the screen and stops once the target vessel is blocked.
6. Final imaging and closure: a final angiogram confirms the result. The catheter and sheath are removed. The puncture site is closed with manual pressure or a small closure device.

In hospital

After TACE, you will rest in bed for several hours, especially if the groin was used, to allow the artery to seal. Nurses will check the puncture site, your blood pressure, and your pulses regularly. Most patients stay in hospital for one to three nights.

It is very common to experience what is called post-embolization syndrome in the first few days. This is not a complication but the body’s response to the treatment. It can include:

• Pain in the upper right side of the abdomen
• Fever
• Nausea and vomiting
• Tiredness and loss of appetite

These symptoms usually peak in the first 48 to 72 hours and settle over the following days to a week or two. Your team will manage them with pain relief, anti-nausea medication, fluids, and rest. Tell your nurses if pain is poorly controlled or if anything feels wrong — comfort is part of the treatment.

At home

Once you are home, the focus is on rest, hydration, and watching for warning signs. General points include:

• Take pain and anti-nausea medication as prescribed; do not wait for pain to become severe.
• Drink fluids regularly to help your kidneys clear the contrast dye.
• Eat small, frequent meals; appetite may be poor for a week or two.
• Avoid heavy lifting and strenuous activity for about a week, especially if the groin was used.
• Keep the puncture site clean and dry as advised.
• Resume light walking from the day after the procedure to reduce the risk of blood clots.

Most people feel substantially better within one to two weeks, although tiredness can linger longer. Liver function tests done a few days after the procedure may show a temporary worsening before improving.

When to call your team

Contact your treating team or seek urgent medical care if you develop:

• High fever lasting beyond a few days, or fever with shaking chills
• Severe abdominal pain not controlled by your medication
• Bleeding, swelling, or a rapidly growing lump at the puncture site
• A cold, pale, or numb leg or arm on the side that was used
• Yellowing of the skin or eyes (jaundice) worse than before
• Confusion, drowsiness, or unusual sleepiness
• Black stools or vomiting of blood

Cycles of treatment

TACE is often given as a series. Many patients receive two to four sessions, spaced four to eight weeks apart, with imaging in between to see how the tumour is responding. The exact schedule depends on the tumour’s response and your liver function. If imaging shows that TACE is still controlling the disease, your team may continue. If it is no longer working, the conversation shifts to other treatments.

Risks and Complications

TACE is generally considered safe in experienced hands, but it is a real medical procedure with real risks. Most patients have only the temporary post-embolization syndrome described above. A smaller number develop more serious complications.

Possible complications include:

• Liver injury: a temporary rise in liver enzymes is common; in a small number of patients, more significant liver damage or even liver failure can occur, particularly when liver function is already poor.
• Infection: infection of the liver (liver abscess) is uncommon but more likely in patients who have had previous bile duct surgery or stents.
• Bile duct injury: the bile ducts share some of their blood supply with the tumour’s artery, so they can occasionally be affected.
• Non-target embolization: particles or drug travelling to areas other than the tumour, such as the gallbladder, stomach, or intestine. Modern selective techniques and imaging have reduced this risk.
• Bleeding or bruising at the puncture site: usually minor, occasionally needing further treatment.
• Contrast reactions and kidney injury: related to the dye used during the procedure.
• Tumour rupture: rare, but recognised, particularly with large surface tumours.
• Worsening of underlying liver disease: including ascites (fluid in the abdomen) or hepatic encephalopathy (confusion from liver dysfunction).

The risk of serious complications depends mostly on the state of the liver before treatment, the size and location of the tumour, and how selectively the chemoembolization can be delivered. Interventional radiologists and hepatologists weigh these risks against the expected benefit before recommending TACE.

Life After TACE

Follow-up imaging and response

About four to eight weeks after each TACE session, you will usually have a follow-up CT or MRI scan. Your team will use standardised criteria (often called mRECIST for HCC) to judge how much of the tumour is no longer active. A tumour that has lost its blood supply and shows no enhancement on contrast imaging is described as having a complete response in that area. Tumours that have shrunk but still show some live tissue may be re-treated.

Most tumours treated with TACE show some response. Some patients have many years of disease control. Others find that TACE works for a time and then loses effect, at which point the next step is discussed.

Survival and outlook

For intermediate-stage HCC, TACE is one of the treatments that has been shown in clinical studies to extend life compared with no treatment. Exact survival depends on tumour size and number, liver function, and response to treatment. Your hepatologist or oncologist is best placed to discuss what is realistic in your situation. The general pattern is that patients with better liver function and a good response to the first one or two TACE sessions tend to do best.

Combining TACE with other treatments

TACE is often part of a wider plan. It may be combined with:

• Ablation for small residual tumour areas
• Systemic therapy (targeted drugs or immunotherapy) when disease becomes more advanced or to enhance response
• Liver transplantation as bridging or downstaging therapy
• Radiotherapy in selected situations

Treatment of the underlying liver disease — antiviral therapy for hepatitis, abstinence from alcohol, weight management for fatty liver — remains a central part of long-term care, because the liver itself is the soil in which new tumours can form.

Lifestyle and ongoing care

Living well with liver cancer that is being treated with TACE includes:

• Keeping all follow-up appointments and scans
• Maintaining adequate nutrition and a healthy weight
• Avoiding alcohol
• Avoiding medications and supplements that can stress the liver, unless cleared by your doctor
• Vaccinations as advised by your hepatologist (such as for hepatitis A, B, influenza, and pneumococcus)
• Attention to mental health: a cancer diagnosis and a series of procedures take an emotional toll. Counselling, peer support, and family support are all part of care.

TACE in Children

TACE is mainly an adult treatment, but it is used in selected children with liver tumours, most often a primary liver cancer of childhood called hepatoblastoma and, less commonly, paediatric hepatocellular carcinoma. In children, the usual first-line approach is systemic chemotherapy followed by surgery or transplant. TACE is generally considered when standard chemotherapy alone has not shrunk the tumour enough to allow surgery, or when surgery is not possible.

Paediatric TACE is performed in specialist centres by interventional radiologists experienced with children. The principles — selective catheterisation, drug delivery, and embolization — are the same as in adults, but doses, equipment sizes, anaesthesia, and supportive care are adapted to the child. Decisions are made by a paediatric oncology team in close partnership with the family.

Frequently Asked Questions

How long does a TACE session take?

The procedure itself usually takes between one and three hours. With preparation, sedation, recovery in the procedure suite, and time on the ward, plan for the whole day.

Will I be awake during TACE?

Most TACE procedures are done under conscious sedation. You are drowsy and comfortable, often without clear memory of the procedure, but you are not fully asleep. Some centres use general anaesthesia, especially for longer or more complex cases.

Does TACE hurt?

You should not feel pain during the procedure itself because of sedation and local anaesthetic. The most common discomfort is the pain that comes in the day or two after the procedure as the tumour’s blood supply is cut off. This is treated with regular pain medication and usually settles within a few days.

How many TACE sessions will I need?

It varies. Many patients have two to four sessions over several months. Some have only one if the response is excellent and the tumour does not regrow. Others have repeated sessions over years. Your team will base the plan on follow-up scans and how your liver is coping.

Can TACE cure liver cancer?

TACE is usually not described as a curative treatment on its own. It can sometimes destroy a tumour completely, especially smaller ones, and it can keep the disease under control for a long time. When cure is the goal, TACE is often used as a bridge to surgery or transplant. Your team will be honest with you about whether the goal in your situation is cure or long-term control.

Will my hair fall out after TACE?

Hair loss is uncommon after TACE because most of the chemotherapy stays in the liver. This is one of the differences between TACE and standard intravenous chemotherapy.

Can I have TACE if I have already had surgery or ablation?

Yes, in many cases. TACE is often used after, or in combination with, other liver treatments. Your interventional radiologist will study your previous imaging and surgical history to plan the safest approach.

What is the difference between TACE and TARE (Y-90)?

Both are delivered through a catheter into the artery feeding the tumour. TACE uses chemotherapy plus small particles. TARE uses tiny beads that emit radiation (yttrium-90). They have different indications, different side effect patterns, and different planning requirements. Your team will discuss which one fits your situation, and sometimes both are options.

How will we know if TACE is working?

Follow-up imaging (CT or MRI) is the main way. Doctors look for the areas of tumour that no longer take up contrast dye, which suggests they are no longer alive. Blood tumour markers such as AFP can also help track response in some patients.

What happens if TACE stops working?

If imaging shows that the tumour is growing despite TACE, or if liver function is no longer good enough for further sessions, the conversation moves to other options — systemic therapy with targeted drugs or immunotherapy, radioembolization, radiotherapy, or supportive care. The path forward is decided together with your treating team, taking into account the disease and your overall wellbeing.

Conclusion

TACE is a well-established, image-guided treatment that targets liver tumours through their own blood supply. For many patients with hepatocellular carcinoma and selected liver metastases, it offers a way to shrink tumours, control disease, relieve symptoms, or buy time on the way to surgery or transplant, while sparing most of the healthy liver and avoiding many of the side effects of whole-body chemotherapy.

Like any cancer treatment, TACE is one piece of a larger picture. Decisions about whether and when to use it, how often to repeat it, and what to combine it with are made by a team that knows your tumour, your liver, and you. Understanding what TACE is, how it works, and what to expect afterwards can make those decisions feel less daunting and help you take an active part in your own care.