Liver Transarterial Chemoembolisation (TACE) in Cyprus
Liver Transarterial Chemoembolisation describes the procedure in which Dr Zertalis uses ultrasound (US) and X-Rays (fluoroscopy) to navigate and position a fine plastic tube (catheter) in the liver blood vessels supplying an area of abnormal liver tissue (tumour).
Once the blood vessels that supply the tumour are identified, treatment is administered and works in two ways:
- Delivering high dose chemotherapy to the tumour.
- Blocking the blood vessels, reducing blood flow and starving the tumour from oxygen and nutrients it needs to grow.
Treatment options for patients with liver cancer include surgery, ablation, TACE and radiotherapy.
A team of specialists including Dr Zertalis will have discussed your treatment plan and decided that TACE is the best option for you. The aim of TACE is to control the size, growth and spread of the tumour. TACE will not provide a cure.
We know from studies around the world that some patients treated with TACE have improved survival and quality of life compared to patients who did not receive treatment.
TACE is a safe, effective and accurate procedure, but as with any medical procedure there are some risks and complications that you may uncommonly experience. The overall risk of a problem requiring further treatment is low (1–2%).
Pain: This can occur at the right side of your abdomen, the tip of the shoulders or between the shoulder blades. You will be given strong pain relief during and after the procedure.
Bleeding: Bruising at the entry site gradually improves a few days or weeks after the procedure. Significant bleeding requiring treatment is rare (0.1%).
Infection: This uncommon complication can occur at the area of treatment in the liver and may require antibiotics or a small operation. You will be given antibiotics before the procedure and you will be monitored during and after the procedure to check for signs of infection.
Acute Liver Failure: This can happen when the liver is unable to cope once the blood supply to the tumour is blocked. Up to 20% of patients can experience reversible transient liver function derangement. Irreversible liver failure is a rare but serious complication occurring in 1% of patients. You will have blood tests before the procedure to check the function of the liver and make sure we avoid this complication.
Post-embolisation syndrome: This is how your body reacts to having the blood supply to the tumour in the liver blocked. Up to half of patients can experience flu like symptoms such as tiredness, muscle aches, mild fever and shakes. These symptoms are controlled with rest and pain killers. Fatigue is common after the procedure lasting for about two weeks.
Inflammation of the gallbladder, pancreas or stomach: This rare complication occurs when injection of the treatment accidentally blocks the blood supply to the gallbladder, pancreas or stomach.
Allergy to contrast (X-ray dye): Most adverse events are mild and can be managed safely in our department. A major life-threatening contrast reaction is rare (<0.005%).
Kidney Impairment: Impairment of kidney function can occur following the treatment due to the contrast agent, the anti-cancer drug or dehydration. You will have a drip placed before the procedure. This is to give you sufficient fluids to minimise the risk of problems with kidney function.
Radiation Risk: Immediate harmful effects such as skin burns, or radiation sickness are rare. The radiation dose you receive during the procedure is monitored to prevent this. On rare occasions the procedure will have to be stopped if the threshold for immediate harmful effects is reached. Increase in lifetime risk of cancer due to radiation per examination is also rare (<0.001%).
Chemotherapy related side effects: The aim of chemotherapy is to be delivered at the area of liver tumour. Rarely this can move to your bloodstream and cause side effects including hair loss, sore mouth and marrow suppression making you more vulnerable to infection. These are rare and temporary side effects.
Dr Zertalis will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
Before the procedure
The procedure is performed with local anaesthetic and sedation. You will be asked not to eat or drink for 6 hours before the procedure. Relevant bloods test will be undertaken before the procedure.
A short and thin plastic tube (cannula) will be placed into a vein in your arm. This is standard for all minimally invasive interventional radiology procedures performed in Cyprus.
Please let Dr Zertalis know about any medications you take, any allergies you may have and if you previously have had a reaction to the x-ray dye (contrast).
You will be asked to change into a hospital gown and lie on the X-ray table flat on your back. You will have devices attached to your chest, arm and finger to monitor you pulse, blood pressure and oxygen levels. You will be given a sedative to relieve anxiety. This is standard for all minimally invasive interventional radiology procedures performed in Cyprus.
The procedure is performed under sterile conditions and Dr Zertalis will wear sterile gowns and gloves. The skin near the point of insertion at the top of the leg (usually the right groin) will be cleaned with antiseptic and you will be covered with sterile drapes.
Dr Zertalis will use ultrasound to inject local anaesthetic in your groin and place a fine plastic tube (vascular sheath) into the artery (common femoral artery).
Dr Zertalis will use X-ray equipment to navigate and guide another fine plastic tube (catheter) through the sheath into the arteries, which supply the liver tumour(s). X-ray dye (contrast) will be injected through the catheter to identify the tumour(s) and define the anatomy of your liver. You may experience a warm feeling in your abdomen – this is normal. The arteries supplying the tumour(s) are blocked by injecting a suspension containing small spheres (particles) and a chemotherapeutic drug.
At the end of the procedure the catheter and vascular sheath are removed and pressure is applied to the groin for 10-15 minutes to prevent bleeding.
Every patient is different, however, expect to be in the radiology department for about up to 1 hour.
After the procedure
You will be transferred to your ward where your pulse, blood pressure, oxygen levels and the entry site in the groin will be checked by our team at regular intervals. You should expect to be in bed for 6 hours and to stay in hospital for 24 hours. Some patients need to stay longer although this is unlikely.
You will be advised to rest at home for 72 hours. If you experience pain, weakness and mild fever this can be well controlled with pain killers and anti-inflammatory medication. Please discuss return to work and exercise with Dr Zertalis as this varies between patients.
Dr Zertalis will organise a follow-up appointment and a CT or MRI scan 4-6 weeks after the procedure to evaluate response to treatment. It may take two or more separate courses of the treatment to treat the tumour(s).