What are embolisation treatments?

Embolisation is when substances are injected into the liver to block the blood flow to the cancer cells. This reduces the oxygen going to the cancer and can help to shrink it.

For HCC embolisation is usually given along with chemotherapy – called chemoembolisation. Less commonly, it’s given with radiotherapy – called radioembolisation (or SIRT). Doctors don’t use these treatments if the cancer has spread outside the liver.

With chemoembolisation a doctor injects chemotherapy into the liver through a tube (catheter). After this they inject a gel or tiny plastic beads to block the blood supply to the tumour.

With radioembolisation (SIRT) they inject radioactive ‘beads’ into blood vessels close to the tumour. They give it through a catheter in the same way as chemoembolisation. The radiation destroys the blood vessels and stops the blood flow to the tumour.

You usually need a short stay in hospital for these treatments. Side effects may include pain, high temperature, sickness and tiredness. Your doctor or nurse will tell you what to expect. They can prescribe drugs to control your side effects until they improve.

Embolisation treatments

Embolisation is when substances are injected into the liver to try to block the blood flow to the cancer cells. This reduces the supply of oxygen and food to the cancer, which can make it shrink or stop it from growing. In HCC, embolisation is usually given in combination with chemotherapy and is called chemoembolisation. You need to be reasonably well to have this done, and the part of your liver that’s not affected needs to have a good blood supply.

Less commonly, embolisation is done with radiation, called radioembolisation or SIRT. These treatments can be used when the cancer has spread throughout the liver and cannot be removed with surgery or treated with ablation. They are not used if the cancer has spread outside the liver.


Chemoembolisation

In chemoembolisation, a chemotherapy drug is injected directly into the liver. This means the tumour gets a higher concentration of the drugs. Because the drug is mixed with a substance called lipiodol, it stays in the liver for longer and works better. After the chemotherapy drug is given, you have treatment to cut off the blood supply (embolisation).

In some centres, the chemotherapy drug is loaded into special beads, which keep the drug in the tumour and cut off the blood supply at the same time.

Chemoembolisation is sometimes called TACE (trans-arterial chemoembolisation) or CT-ACE (computerised tomography-guided arterial chemoembolisation).

The drugs most often used are doxorubicin and cisplatin

How it is given

You may need to stay in hospital overnight and possibly for a day or two. Before treatment, the nurse or doctor will usually give you a mild sedative to help you relax. They then inject some local anaesthetic into the skin at the top of your leg (your groin) to numb the area. After this, the doctor makes a tiny cut in the skin. They put a fine tube called a catheter through the cut into a blood vessel called the femoral artery in your groin.

The doctor passes the catheter up along the artery until it reaches the blood vessels that take blood to the liver (hepatic artery) and supply the tumour. You have an x-ray of the blood vessels (called an angiogram) at the same time and a dye is put into the catheter first. This shows the blood supply on the x-ray so the doctor sees exactly where the catheter is. After this, they slowly inject the chemotherapy into the liver through the catheter. A while later the doctor injects a gel or tiny plastic beads to block the blood supply to the tumour. Or you have the chemotherapy drug in a bead given at the same time.

You can have chemoembolisation several times. It is sometimes given with radiofrequency ablation. Your doctor can explain if this would be helpful for you.

Side effects

Chemoembolisation can cause side effects such as sickness, pain, a raised temperature and feeling very tired. You’ll be given anti-sickness drugs and painkillers to take until the side effects reduce. This is usually within 1–2 weeks. 

It’s unusual for chemoembolisation to cause side effects on your blood unlike chemotherapy into a vein, because the drugs are concentrated in the liver. Serious complications are rare, but occasionally it can damage the liver.


Radioembolisation or selective internal radiotherapy (SIRT)

This treatment is done less often and is not available in all hospitals. A doctor injects tiny radioactive ‘beads’ (microspheres) into a blood vessel close to the tumour. The radiation destroys the blood vessels and stops blood flow to the tumours. Without a blood supply, the tumours shrink and may die. The radiation only travels a few millimeters so other parts of the liver aren’t affected and you are not radioactive. The beads stay in the liver permanently and are harmless.

You have radioembolisation through a fine tube (catheter) placed in an artery in your groin in the same way as chemoembolisation. You have an angiogram about a week before to check the blood flow to the liver.

You stay in hospital for 1–4 days to have SIRT. The side effects can last for a few days and include a high temperature and tummy pain straight after the injection. Other side effects include feeling sick and diarrhoea. Your doctor will prescribe drugs to control these until they go away. Rarely it may damage the liver. You may be able to have SIRT again, depending on how well it works for you.

We have more information about SIRT that you may find useful.