Background Information:

What are the other Names for the Procedure?

• Hepatic Chemoembolization
• TACE (Transcatheter Arterial Chemoembolization)
• Transarterial Chemoembolization

What is Chemoembolization radiology procedure? (General Explanation)

• Chemoembolization uses a combination of chemotherapy and embolization to treat cancer
• Embolization is a nonsurgical, minimally invasive procedure that purposely introduces emboli or blockers of a blood vessel
• In this procedure, chemotherapy drugs are injected directly into blood vessels that feed the tumor. Also, embolic agents are injected into the blood vessels supplying the tumor to trap the chemotherapy agents in the tumor

What part of the Body does the Procedure involve?

Depending upon the location of the tumor, different blood vessels are used to inject the agents.

Why is the Chemoembolization radiology procedure Performed?

• Chemoembolization is mainly used for liver cancer originated in the liver or one that has metastasized from other organs, such as hepatoma or hepatocellular carcinoma. In such cases, it is also known as Transarterial Hepatic Chemoembolization
• Chemoembolization treatment may be combined with chemotherapy, radiation therapy, surgery, or radiofrequency ablation, if needed

What is the Equipment used? (Description of Equipment)

A Chemoembolization procedure uses the following equipment:

• A catheter
• X-ray machine
• An X-ray tube
• Embolic agents, depending upon the size of blood vessel, type of malformation, and treatment to be provided
• A computer monitor to view the images
• Fluoroscopy is used to convert the X-ray images into video images

What are the Recent Advances in the Procedure?

There have been no recent advances to replace the Chemoembolization procedure. 

What is the Cost of performing the Chemoembolization radiology procedure?

The cost of a Chemoembolization procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding a Chemoembolization procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.radiologyinfo.org/en/info.cfm?pg=chemoembol (accessed on June 7, 2014)

Prior to Chemoembolization radiology procedure:

How does the Chemoembolization radiology procedure work?

The Chemoembolization procedure works in two steps:

• First, chemotherapy agents are injected directly into the blood vessels feeding the tumor, so that these anti-cancer agents directly reach the tumor
• Embolic agents are then injected into the blood vessels feeding the tumor to block those vessels. Blocking the vessels cuts of oxygen supply and nutrition going to the tumor; it also traps the chemotherapy agents in the tumor

Chemoembolization is used mainly for liver cancers, because the liver has a dual blood supply from the hepatic artery and the portal vein.

• When a tumor grows in the liver, it only receives blood from the hepatic artery. Thus, injecting chemotherapy agents into the hepatic artery directly reaches the tumor without affecting other healthy tissues supplied by portal vein blood supply
• Embolic agents are also used to block the hepatic artery. This affects the tumor, as its blood supply is provided by the hepatic artery. However, the remaining portion of the liver still gets its blood supply from the portal vein

How is the Chemoembolization radiology procedure Performed?

A Chemoembolization procedure is performed as follows:

• The patient is positioned on the examination table
• X-ray images are taken to see which blood vessels are supplying blood to the tumor
• The patient may be given medications to prevent nausea and pain due to chemotherapy, and antibiotic medication, to prevent any infections
• The patient’s blood pressure, heart rate, and pulse are monitored
• The area, where the catheter is to be inserted is cleaned and sterilized
• An intravenous (IV) line is inserted into the patient’s arm, to give sedative medication during the procedure
• In the case of the liver, the catheter is inserted through the femoral artery and sent to the liver
• The contrast material is injected through the catheter; an x-ray machine is used to visualize the site
• Chemotherapy and embolic agents are sent to the site of the abnormality by injecting it through the catheter
• X-rays are taken to check success of the treatment procedure
• Both the catheter and intravenous lines are removed at the end of the procedure

Where is the Procedure Performed?

A Chemoembolization procedure is performed as an outpatient procedure at a hospital.  

Who Performs the Procedure?

An interventional radiologist performs the Chemoembolization procedure.

How long will the Procedure take?

The Chemoembolization procedure usually takes about 90 minutes. 

Who interprets the Result?

An interventional radiologist interprets the result of the Chemoembolization procedure.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
• Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
• Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
• It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the x-ray
• It is highly recommended to inform your healthcare professional if you are pregnant or breastfeeding
• The patient may be asked to avoid eating or drinking, several hours before the test
• The patient will meet with the interventional radiologist before the procedure for consultation. Blood tests may be performed to check kidney function
• Patients are needed to be admitted to the hospital and will be required to stay overnight at the hospital; the period of hospital stay may be for one or more days

What is the Consent Process before the Procedure?

A physician will request your consent for a Chemoembolization procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied with the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Chemoembolization procedure:

• Chemoembolization stops the liver tumors from growing, while still preserving normal liver function
• The procedure can be repeated after 10-14 months, if necessary

Following are the risks of the Chemoembolization procedure:

• Sometimes, the catheter used in the procedure may damage the blood vessels
• Insertion made in the skin to insert the catheter may increase the chance of an infection
• The contrast material used in the procedure may cause allergic reactions in some patients. The contrast material may also damage the kidneys, especially in diabetic patients or patients with kidney disease
• The embolic agent may lodge at the wrong location and stop blood supply to parts of the body
• Chemotherapy used in this procedure may cause nausea, anemia, decreased platelet count, and hair loss
• Children are at an increased risk of getting a blood clot in the leg after the Chemoembolization procedure
• Chemoembolization may lead to serious complications, such as liver damage or liver infection. Approximately 1 in 100 procedures results in a death due to liver failure

What are the Limitations of the Chemoembolization radiology procedure?

• Chemoembolization improves the survival rate and quality of life by improving liver function. However, it may not bring about a cure
• This procedure cannot be done if there is severe liver or kidney dysfunction, or blocked bile ducts

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is a Chemoembolization procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• Are there any follow-up tests or periodic visits to the healthcare facility required after the procedure?
• Is there any medication that needs to be taken for life after the procedure?
• What are the costs involved?

During the Chemoembolization radiology procedure:

What is to be expected during the Chemoembolization radiology procedure?

• The patient will feel a slight prick due to the insertion of the intravenous line and catheter
• Slight pressure may be experienced when the catheter is inserted
• The patient may experience a warm feeling when the contrast material is injected

What kind of Anesthesia is given, during the Procedure?

The patient is administered general anesthesia for the Chemoembolization procedure.  

How much Blood will you lose, during the Procedure?

The Chemoembolization procedure is a minimally invasive procedure. It involves little or no blood loss.  

What are the possible Risks and Complications during the Chemoembolization radiology procedure?

The risks of Chemoembolization procedure include the following:

• The catheter used in the procedure may damage the blood vessels in some cases
• Insertion made into the skin to insert the catheter may cause an infection
• The contrast material used in the procedure may cause allergic reactions in some patients. In diabetic patients or patients with kidney disease, the contrast material may damage the kidneys
• The embolic agent used for the procedure may lodge at the wrong location and stop blood supply to the region
• There may be side effects of chemotherapy (used in the procedure) such as nausea, anemia, decreased platelets, and hair loss
• Children are at increased risk of getting blood clots in their legs after the procedure
• Chemoembolization may lead to serious complications such as liver damage or liver infection. It is generally observed that approximately 1 in 100 procedures results in fatalities, due to liver failure

What Post-Operative Care is needed at the Healthcare Facility after the Chemoembolization radiology procedure?

The patient is required to stay in the hospital for an overnight observation. Sometimes, they may be required to stay in the hospital for a few more days, as determined by the healthcare provider. 

After the Chemoembolization radiology procedure:

What is to be expected after the Chemoembolization radiology procedure?

• Normally, patients may run a fever for about a week and may feel fatigued for about two weeks or longer
• The patient is given antibiotics and medications for nausea and pain. The side effects of embolization are painful, but it may be controlled with medications
• The patient is required to use an incentive spirometer to inflate the lungs, in order to prevent pneumonia
• During the first month, the patient needs to routinely visit their healthcare providers to check progress and recovery
• After the first month, a CT or MRI scan is performed every 3 months following the Chemoembolization procedure to check for tumor shrinkage and development of any new tumors
• Other Chemoembolization procedures may be performed after 10-14 months and it may be repeated over many years
• Most patients experience post-embolization syndrome in which they may develop fever, loss of appetite, nausea, or vomiting. The post-embolization syndrome can be treated with oral or IV medications

When do you need to call your Physician?

• Patients are recommended to contact their physicians, if the nature of pain changes or if there are any other abnormal changes observed
• During the first month, patients need to routinely visit their healthcare provider to check progress and recovery
• If patients experience post-embolization syndrome in which they develop symptoms such as fever, loss of appetite, nausea, or vomiting

What Post-Operative Care is needed at Home after the Chemoembolization radiology procedure?

• Patients may have to use incentive spirometer to inflate their lungs, in order to prevent pneumonia
• The prescribed medications have to be taken regularly including pain and nausea medications

How long does it normally take to fully recover, from the Procedure?

The patient is required to take bed rest for 6-8 hours after the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

No tissue sample is taken during a Chemoembolization procedure. 

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient. 

Who will you receive a Bill from, after the Chemoembolization radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• A radiologist performing the procedure
• Healthcare providers, physicians, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Chemoembolization procedure is performed.