TACE & TARE for Liver and Renal Cancer

Cancer is considered one of the most dreaded diseases and one of the most common causes of death around the world. Cancer is characterised by the abnormal growth of cells in the body. These cells can also spread from the primary organ to different secondary organs by uncontrollably dividing and destroying the healthy tissues. Liver and Renal cancers are some common cancers that affect the global population.

Renal or Kidney cancer begins in the kidneys. Renal Cell Carcinoma is the common form of Renal cancer in adults, while Wilms’ tumour is a type of kidney cancer that can affect children more. Liver cancer, on the other hand, is cancer that begins in the liver, and its most common form is Hepatocellular Carcinoma. Other common liver cancers include Intrahepatic Cholangiocarcinoma and Hepatoblastoma.

Treatment Options for Liver & Renal Cancer

Most cancer treatments require a multidisciplinary approach depending on various factors, including the type, location, severity of cancer, age, and health of the patient. Liver and Renal Cancer can be treated through surgical or non-surgical methods.

Interventional Radiology (IR) can also be effectively used for their treatment. Minimally invasive IR methods of treatment are now being increasingly explored to treat such cancers.

Two common minimally invasive methods to treat Liver and Renal Cancer are:

1. TACE – Trans-Arterial Chemoembolization
2. TARE – Trans-Arterial Radioembolization

Trans-Arterial Chemoembolization (TACE)

TACE is a minimally invasive interventional radiology surgical procedure performed to cut off the blood supply of a tumour. It is effective for cancers that cannot be surgically removed, like Renal Cell Carcinoma and Liver Cancer. It is a palliative treatment which means that it does not cure cancer but can slow down the disease and alleviate symptoms.

What happens before Trans-Arterial Chemoembolization (TACE)?

Before a Trans-Arterial Chemoembolization (TACE)) is scheduled, you may expect the following:

• Before scheduling a TACE procedure, doctors will perform blood tests, CT scans or MRIs to see if you are eligible for the procedure and do not have any underlying conditions.
• You will have to go for an office consultation with the interventional radiologist who will be performing your TACE surgery. At this appointment, you will receive instructions from the radiologist regarding the procedure. You can ask any questions that you may have regarding the procedure.
• If you are on any medication like blood thinners, you must inform the doctor before your surgery. Doctors may also prescribe certain medications.
• You are expected to inform the doctor if you are pregnant.
• It is advisable to arrange for someone who can drive you home after the procedure and stay with you during recovery.

What to expect during a Trans-Arterial Chemoembolization (TACE)?

TACE can administer high doses of chemotherapy or anti-cancer drugs directly into the tumour. It will also cut off the blood supply to the tumour. This is how the procedure will be performed:

• The doctors will administer anaesthesia to begin the procedure. Children will receive general anaesthesia, while adults will usually be given sedatives or local anaesthesia.
• A small incision will be made near the wrist or groyne area.
• A catheter will be inserted through the incision.
• The doctors will guide the catheter towards the tumour using real-time imaging techniques like fluoroscopy.
• A special dye will be passed through the catheter to make it easy for the interventional radiologist to see what’s happening inside.
• The catheter will be used to inject a mix of chemotherapy drugs and an embolic agent directly into the tumour.
• Once the procedure is completed, the catheter will be reserved, and the incision will be closed with a bandage. No stitches will be necessary.

What to expect after the TACE procedure?

The procedure can take up to 90 minutes. The patient will be transferred to a recovery room for two to six hours. Patients will usually be discharged within 24-48 hours. They may feel what is known as post-embolisation syndrome one to seven days after the procedure. Doctors will prescribe medications to control symptoms like nausea, pain, etc. Patients will have to undergo imaging tests every three months to see how much the tumour has shrunk.

Complications & Risks

Some complications that can occur due to a TACE procedure include the following:

1. Increased risk of blood clots in children
2. Infections
3. Kidney damage
4. Liver damage
5. Nausea
6. Hair loss
7. Anaemia
8. Need for repeating the procedure

Who is not eligible for TACE?

Patients with the following medical conditions are not eligible for a TACE procedure:

1. Allergy to contrast dye
2. Bile duct blockage.
3. Blood clotting disorders.
4. Hepatic encephalopathy
5. Kidney disease
6. Metastatic cancer that has spread to several organs
7. Portal vein thrombosis

Other factors, including age, pregnancy, health, etc., can also make a patient ineligible for the procedure. Doctors will carefully screen every patient to see if they are eligible for Trans-Arterial Chemoembolization.

Trans-Arterial Radioembolization (TARE)

TARE is a minimally invasive interventional radiology procedure performed to cut off the blood supply of a tumour. It is a combination of radiotherapy as well as embolisation. It is effective for cancers that cannot be surgically removed, like renal cell carcinoma and liver cancer. It is a palliative treatment which means that it does not cure cancer but can slow down the disease and alleviate symptoms.

What happens before Trans-Arterial Radioembolization (TARE)?

Before a Trans-Arterial Radioembolization (TARE) is scheduled, you may expect the following:

• Before scheduling a TARE procedure, doctors will perform blood tests, CT scans or MRIs to see if you are eligible for the procedure and do not have any underlying conditions.
• You will have to go for an office consultation with the interventional radiologist who will be performing your TARE surgery. At this appointment, you will receive instructions from the radiologist regarding the procedure. You can ask any questions that you may have regarding the procedure.
• A week or so prior to the procedure, angiography may be performed to map blood vessels supplying blood to the tumour.
• The doctor will prescribe a few pre-surgery medications. If you are on any medication like blood thinners, you must inform the doctor before your appointment.
• You may need someone to drive you home after discharge and stay with you during recovery.

What to expect during a Trans-Arterial Radioembolization (TARE)?

TARE is a type of Nuclear Medicine Therapy. The procedure works at eliminating cancer cells and shrinking tumours by using a specific type of energy termed ionising radiation.

• The procedure will be performed by an experienced team of doctors consisting of a team of medical professionals, including medical oncologists, radiation oncologists and surgeons.
• The doctors will administer anaesthesia to begin the procedure. Children will receive general anaesthesia, while adults will usually be given sedatives to help them calm down.
• The radiologist will puncture the femoral artery and put the catheter into the hepatic artery. The hepatic artery will then be cannulated, followed by cannulating the specific artery which is supplying blood to the tumour.
• The radioisotope will then be delivered directly through that feeding artery.
• The catheter will be resected after the dose is delivered and the blood supply to the tumour is cut-off.

What to expect after the TARE procedure?

The patient will be transferred to a recovery room after the procedure. They will usually need to stay in the hospital for two to three days. This is because radioactive material administered to the patient makes him radioactive for a period of time. The patient must be kept in relative isolation to protect others from radioactive exposure.

Doctors will prescribe medications to control symptoms like nausea, pain, etc. Patients will have to undergo imaging tests every three months to see how much the tumour has shrunk.

Complications & Risks of TARE

Some complications that can occur due to a TARE procedure include the following:

1. Allergic reaction to the contrast.
2. Bruising
3. Chances of infection.
4. Fatigue
5. Groyne pain
6. Nausea
7. Stomach or Duodenal ulcer
8. Vomiting

Who is not eligible for TARE?

Patients with the following medical conditions are not eligible for a TARE procedure:

1. Allergy to contrast dye
2. Bile duct blockage.
3. Blood clotting disorders.
4. Hepatic encephalopathy
5. Kidney disease
6. Metastatic cancer that has spread to several organs
7. Portal vein thrombosis

Other factors, including age, pregnancy, health, etc., can also make a patient ineligible for the procedure. Doctors will carefully screen every patient to see if they are eligible for Trans-Arterial Radioembolization.

TACE and TARE are safe & effective methods to treat Liver and Renal Cancer. These procedures are minimally invasive and especially beneficial for patients who cannot undergo surgery for a specific type of cancer.

If you have Liver or Renal Cancer and want to know if any of these procedures is better for your specific condition, you can make an appointment at Apollo Hospitals, Karnataka. Our doctors are available to answer all queries regarding the procedure. We also have experienced interventional radiologists with experience in performing such minimally invasive procedures successfully.