TACE Procedure: A Guide to Transarterial Chemoembolization
Know about the tace procedure, what it is, the goal of therapy, who is the right candidate, how it works, procedure for tace, what to expect, results, effectiveness and potential risks and more.
Written by Dr. M L Ezhilarasan
Reviewed by Dr. Rohinipriyanka Pondugula MBBS
Last updated on 17th Sep, 2025
Introduction
Facing a liver cancer diagnosis can be overwhelming, especially when you hear that surgery isn't an option. But what if there were a highly targeted treatment that could attack the tumour from within, sparing healthy tissue? Enter Transarterial Chemoembolization, or TACE. This minimally invasive procedure is a cornerstone treatment for unresectable liver tumours, offering hope and extended survival to thousands of patients. This guide will demystify the TACE procedure, breaking down everything you need to know from how it works and who it's for, to what you can expect during recovery.
What is Transarterial Chemoembolization (TACE)?
Transarterial Chemoembolization (TACE) is a minimally invasive, image-guided procedure used to treat liver cancers. It's not a surgery with large incisions; instead, it's performed by an interventional radiologist who uses thin catheters threaded through your blood vessels to deliver treatment directly to the tumour. The name itself explains the process: "Transarterial" means through the artery, "Chemo" refers to chemotherapy drugs, and "Embolisation" means blocking blood vessels. By combining these two actions, TACE effectively starves the tumour of its nutrient supply while simultaneously bombarding it with a high dose of cancer-killing drugs.
Consult an Oncologist for Personalised Advice
The Goal of TACE Therapy
The primary goal of TACE is to control localised liver cancer, shrink tumours, and prolong survival. It is often used as a "bridge to transplant," meaning it helps keep the cancer in check while a patient waits for a donor liver. For others, it's a definitive treatment that can provide long-term control of the disease, significantly improving quality of life.
Who is a Candidate for TACE?
TACE is not for everyone. Ideal candidates are typically patients with:
- Hepatocellular Carcinoma (HCC), the most common primary liver cancer.
- Tumours that are confined to the liver but are not suitable for surgical removal due to size, location, or number.
- Adequate liver function (often assessed by the Child-Pugh score).
- No major blood vessel invasion or spread of cancer outside the liver.
- A multidisciplinary team of oncologists, hepatologists, and interventional radiologists will determine if TACE for liver cancer is the right approach for your specific case.
How TACE Works: A Dual-Action Attack on Tumours
TACE's effectiveness lies in its clever two-pronged approach. Liver tumours are unique because they derive almost all their blood supply from the hepatic artery, while healthy liver tissue gets most of its supply from the portal vein. TACE exploits this vulnerability.
The Chemotherapy Component
A high concentration of chemotherapy drugs is delivered directly into the artery feeding the tumour. This allows for a dose up to 20 times stronger than what could be given systemically (through the whole bloodstream), with drastically reduced overall side effects because the drugs are largely contained within the liver.
The Embolisation Component
After the chemotherapy is delivered, the artery is intentionally blocked (embolized) using tiny particles. This cuts off the oxygen and nutrients the tumour needs to grow, effectively starving it. It also traps the chemotherapy drugs inside the tumour, allowing them to work for a longer period.
The Synergistic Effect
The combination is greater than the sum of its parts. Embolisation not only starves the tumour but also creates a low-oxygen environment that makes cancer cells more vulnerable to the effects of chemotherapy. This synergistic effect is why TACE treatment is so potent against liver tumours.
Preparing for Your TACE Procedure
Proper preparation is key to a smooth procedure and recovery. Your medical team will guide you through each step.
Pre-Procedure Tests and Consultations
In the days leading up to your procedure, you will undergo several tests to ensure your safety. These typically include blood tests (to check liver and kidney function, clotting ability), imaging scans (like an MRI or CT scan to map the tumour's blood supply), and a thorough physical exam. You will also meet with the interventional radiologist who will perform the TACE procedure and an anesthesiologist to discuss sedation.
What to Do the Day Before
You will likely be instructed not to eat or drink after midnight the night before your procedure. It's crucial to inform your doctor of all medications you are taking, especially blood thinners like aspirin or warfarin, as you may need to stop them temporarily. If your blood work indicates any imbalances, your doctor might recommend specific preparations. Apollo24|7 offers convenient home collection for tests like liver function tests (LFTs) and complete blood count (CBC), making this pre-process easier.
The TACE Procedure Step-by-Step
Understanding what happens during TACE can alleviate much of the anxiety surrounding it. The procedure typically takes 1 to 2 hours.
Step 1: Arterial Access and Catheter Guidance
You will be placed under conscious sedation or general anaesthesia. The radiologist will make a tiny incision, usually in the groin, and insert a catheter into the femoral artery. Using real-time X-ray guidance (fluoroscopy), they will skillfully navigate this catheter up into the aorta and then into the hepatic artery leading to your liver.
Step 2: Delivering the Chemoembolic Agents
Once the catheter is positioned in the precise artery feeding the tumour, the radiologist injects the chemoembolic mixture. This is often a combination of chemotherapy drugs (like doxorubicin or cisplatin) mixed with embolic agents (either oily contrast that lodges in the vessels or modern drug-eluting beads that slowly release the chemotherapy).
Step 3: Post-Embolisation and Catheter Removal
After the agents are delivered, the catheter is carefully withdrawn. Pressure is applied to the small puncture site to prevent bleeding, which is then covered with a bandage. No stitches are needed. You will be moved to a recovery room for monitoring.
What to Expect After TACE: Recovery and Side Effects
Recovery from TACE is manageable but requires patience, as some side effects are expected and actually indicate the treatment is working.
Immediate Post-Procedure Care
You will need to lie flat for several hours to ensure the access site heals properly. Most patients stay in the hospital for 1-3 nights for observation, pain management, and hydration.
Managing Common Side Effects
Common side effects include nausea, vomiting, fever, fatigue, and abdominal pain. These are usually temporary and can be effectively managed with medications provided by your hospital team.
The Post-Embolisation Syndrome (PES)
This is a common cluster of symptoms, including pain, fever, nausea, and fatigue, that occurs as the tumour breaks down and the body reacts. It is a sign that the treatment is effective and usually peaks within the first few days before gradually subsiding over 1-2 weeks.
Results and Effectiveness of TACE Treatment
TACE has a well-established track record. Studies show that it can significantly improve survival for patients with intermediate-stage HCC. According to a seminal study, TACE improved 2-year survival from 27% with supportive care alone to 63% with treatment.
How Success is Measured
Success is measured by follow-up imaging (CT or MRI scans), typically done 4-6 weeks after the procedure. Radiologists look for a reduction in tumour size and evidence of "necrosis," where the tumour tissue has died and been replaced by non-enhancing scar tissue.
Factors Influencing TACE Outcomes
Outcomes depend on several factors, including the tumour's size and number, the patient's overall liver function and health, and how well the cancer responds to the first treatment. TACE is often repeated every few months if needed to control the disease.
Potential Risks and Complications of TACE
While generally safe, TACE carries risks, as all medical procedures do. Serious complications are rare (<5%) but can include:
- Liver failure, especially in patients with already poor liver function.
- Infection or abscess formation in the treated area.
- Damage to the gallbladder or bile ducts.
- Non-target embolisation, where the particles accidentally block blood flow to other organs like the stomach or spleen.
- Your care team takes every precaution to minimise these risks.
Life After TACE: Follow-up and Long-Term Care
Life after TACE involves regular monitoring. You will have periodic scans and blood tests (including checks for the tumour marker AFP) to monitor the treatment's effect and watch for any recurrence. Maintaining a healthy lifestyle, including a liver-friendly diet, avoiding alcohol, and managing your weight, is crucial to supporting your liver health. If you experience new or worsening symptoms like persistent pain or jaundice, consult a doctor online with Apollo24|7 for further evaluation and guidance on the next steps.
Conclusion
Transarterial Chemoembolization (TACE) represents a significant advancement in the fight against liver cancer, offering a targeted and effective option for patients who are not candidates for surgery. By understanding the procedure—from its dual-action mechanism to the realistic expectations for recovery, you can approach your treatment journey with greater confidence and clarity. While it requires careful management of side effects and diligent follow-up, TACE has proven to be a life-extending therapy for countless individuals. If you or a loved one is facing a liver cancer diagnosis, the most important step is to have a detailed conversation with a multidisciplinary medical team to determine if this innovative procedure is the right path forward.
Consult an Oncologist for Personalised Advice
Consult an Oncologist for Personalised Advice
Dr Sunita Samleti
Oncologist
18 Years • M.D. (Pathology)- TN Medical College, Mumbai University, Mumbai, Mar 2005 M.B.B.S. Grant Medical College, Mumbai University, Mumbai, Oct 1999
Chinagadila
Apollo Hospitals Health City Unit, Chinagadila
Dr. Sanchayan Mandal
Oncologist
17 Years • MBBS, DNB Raditherapy, DrNB Medical Oncology
East Midnapore
VIVEKANANDA SEBA SADAN, East Midnapore
Dr.sanchayan Mandal
Oncologist
17 Years • MBBS, DrNB( MEDICAL ONCOLOGY), DNB (RADIOTHERAPY),ECMO. PDCR. ASCO
Kolkata
Dr. Sanchayan Mandal Oncology Clinic, Kolkata
Dr Gowshikk Rajkumar
Oncologist
10 Years • MBBS, DMRT, DNB in Radiation oncology
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr. Gopal Kumar
Head, Neck and Thyroid Cancer Surgeon
15 Years • MBBS, MS , FARHNS ( Seoul, South Korea ), FGOLF ( MSKCC, New York )
Delhi
Apollo Hospitals Indraprastha, Delhi
(25+ Patients)
Consult an Oncologist for Personalised Advice
Dr Sunita Samleti
Oncologist
18 Years • M.D. (Pathology)- TN Medical College, Mumbai University, Mumbai, Mar 2005 M.B.B.S. Grant Medical College, Mumbai University, Mumbai, Oct 1999
Chinagadila
Apollo Hospitals Health City Unit, Chinagadila
Dr. Sanchayan Mandal
Oncologist
17 Years • MBBS, DNB Raditherapy, DrNB Medical Oncology
East Midnapore
VIVEKANANDA SEBA SADAN, East Midnapore
Dr.sanchayan Mandal
Oncologist
17 Years • MBBS, DrNB( MEDICAL ONCOLOGY), DNB (RADIOTHERAPY),ECMO. PDCR. ASCO
Kolkata
Dr. Sanchayan Mandal Oncology Clinic, Kolkata
Dr Gowshikk Rajkumar
Oncologist
10 Years • MBBS, DMRT, DNB in Radiation oncology
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr. Gopal Kumar
Head, Neck and Thyroid Cancer Surgeon
15 Years • MBBS, MS , FARHNS ( Seoul, South Korea ), FGOLF ( MSKCC, New York )
Delhi
Apollo Hospitals Indraprastha, Delhi
(25+ Patients)
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Frequently Asked Questions
How long does it take to recover from a TACE procedure?
Most people need about one to two weeks to feel back to their normal energy levels after TACE. The first few days involve managing post-embolisation syndrome (fatigue, pain, nausea), but symptoms steadily improve. Full recovery to normal activities is usually within two weeks.
Is TACE considered a form of chemotherapy?
Yes, but it's very different from systemic chemotherapy. Traditional chemo circul throughout the entire body, causing widespread side effects. TACE delivers chemo directly to the liver tumour, resulting in higher local doses and significantly fewer whole-body side effects.
What is the difference between TACE and TARE (Y-90)?
Both are intra-arterial liver treatments. TACE uses chemotherapy and blocks blood vessels. TARE (Transarterial Radioembolization), or Y-90, uses tiny radioactive beads that emit radiation to destroy the tumour without a strong embolic effect. The choice depends on your specific tumour characteristics.
How many TACE sessions will I need?
The number of sessions varies per patient. It depends on how your tumour responds to the first treatment. Some patients only need one, while others may need repeated sessions every few months to control the disease. Your doctor will determine this based on follow-up scans.
Can TACE cure liver cancer?
While TACE can destroy some tumours, it is not always considered a curative treatment. Its primary goal is to control the cancer, shrink tumours, prolong survival, and improve quality of life. In some cases, it can be a bridge to a potentially curative treatment like a liver transplant.