Embolisation treatments for liver cancer

These treatments may be used when:

• the cancer is only in the liver
• the cancer cannot be removed with surgery or treated with ablation.

Sometimes they might be used before surgery or ablation.

These treatments are not commonly used to treat secondary liver cancer. Some people might have:

• Chemoembolisation (TACE) to treat secondary liver cancer that has spread from the bowel or a neuroendocrine tumour (NET) in the liver.
• Trans-artrial embolisation (TAE) to shrink a cancer that has spread to the liver from a NET tumour.

Embolisation treatments are not suitable for everyone. They may be given as part of a clinical trial.

You may need to stay in hospital for 1 to 2 nights. Before the treatment, the nurse or doctor usually gives 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 and into a blood vessel called an artery in your groin. The doctor then passes the catheter along the artery until it reaches the blood vessel that takes blood to the liver and tumour. This is called the hepatic artery.

They also put a dye into the blood vessel through the catheter. This shows the blood supply on an x-ray and shows the doctor where the catheter is. This is called an angiogram.

After this, the doctor injects the chemotherapy drugs or tiny beads coated with chemotherapy directly into the blood vessel going to the tumour. You usually then have an injection of an embolising substance to block this blood vessel. This cuts off the blood supply to the tumour or tumours in the liver (embolisation).

Some hospitals use beads that gradually release chemotherapy and also block the blood vessels. This is called DEB-TACE. DEB is short for drug-eluting bead.

The chemotherapy drug irinotecan may be given this way to treat bowel cancer that has spread to the liver. This treatment is called DEBIRI-TACE.

Chemoembolisation can cause side effects such as:

• a high temperature and flu-like symptoms
• pain in the upper right side of the tummy area (abdomen)
• feeling sick (nausea)
• feeling very tired (fatigue).

You will be given anti-sickness drugs and painkillers until the side effects get better. This usually takes 1 to 2 weeks.

It is unusual for chemotherapy given in this way to cause side effects outside of your liver. Serious complications are rare, but sometimes it can damage the liver.

You have different tests before the treatment. This includes an angiogram, which is an x-ray that checks the blood vessels. You usually have this up to 2 weeks before SIRT. It shows the doctor where the SIRT beads should go when they are injected.

You usually stay in hospital overnight to have SIRT. You are awake during SIRT. You might have medication to help you to relax and feel sleepy before it.

You have SIRT through a fine tube (catheter). Your doctor puts the catheter into an artery in the top of your leg (groin). They guide it through the artery into a blood vessel that takes blood to the liver. They then inject tiny radioactive beads (microspheres) through the catheter into this blood vessel.

The beads stick permanently in the small blood vessels in and around the liver tumour. They also give off radiation. This damages the cancer cells and destroys the small blood vessels in and around the tumour. Without a blood supply, tumours shrink and may die.

The radiation from each bead only affects tissue nearby. This reduces the risk of damage to healthy cells. The beads lose their radiation quickly. They stay in the liver permanently but are harmless.

There are some precautions you will need to take for a short while after SIRT. These are to protect other people around you. Your doctors and nurses will explain this to you.

The main blood vessel that carries blood to the liver is called the portal vein. A portal vein embolisation (PVE) is a procedure to block a branch of this vein.

This blocks the blood flow to the part of liver to be removed. The blood flow is redirected to the healthy part of the liver and encourages it to grow. This can make sure there is enough liver left behind after surgery for it to work properly.

You usually have a PVE in the x-ray department. You have a local anaesthetic injection to numb an area of your tummy (abdomen). The doctor uses an ultrasound scan to find the area of the portal vein that supplies blood to the part of the liver with the tumour(s). 

They make a small cut in the skin just below the ribcage on the right side of the tummy. Then they gently push a fine tube (catheter) into the portal vein. When the catheter is in place, the doctor injects special glue or very small metal coils into it. This blocks the blood supply to that part of the liver.

PVE usually takes 1½ to 2 hours. You may feel some gentle pushing as the doctor inserts the catheter. Tell them if you feel any pain or discomfort, so they can give you painkillers. You usually stay in hospital overnight after this treatment.

Some people might have a PVE before a liver resection. It is usually done when surgery is possible but there might not be enough remaining liver left afterwards to work properly. 
If the liver has grown enough after a PVE, you have a liver resection operation about 3 to 6 weeks later. You may have more scans of your liver during this time.