Treatment of liver cancer by transcatheter arterial chemoembolization: Youan Intervention Center’s minimally invasive procedure precisely combats this “Silent Killer”

Yingmei Feng^1*

¹Department of Science and Technology, Beijing Youan Hospital, Capital Medical University, Beijing, China.

*Correspondence:

Yingmei Feng; Email: yingmeif13@ccmu.edu.cn.

Liver cancer is known as the “silent killer” because it often lurks within the body undetected until it has progressed to an advanced stage. In China, both the incidence and mortality remain consistently high. The most common type of liver cancer is hepatocellular carcinoma (HCC), which accounts for approximately 75%–85% of all cases. It is closely associated with hepatitis B, hepatitis C, long-term heavy drinking, fatty liver disease, and foods contaminated with aflatoxin. The paucity of obvious symptoms in the early stages results in many patients already having advanced disease by the time they are diagnosed, thus missing the optimal timing for surgery. Developing a safe, effective, and minimally invasive means of treatment is therefore particularly important. In this setting, transcatheter arterial chemoembolization (TACE) has emerged as an important therapeutic approach to liver cancer treatment. Being minimally invasive, precisely targeted, and efficient, it frequently prolongs survival and improves the patient’s quality of life.

What is TACE Treatment?  

TACE, a minimally invasive procedure, delivers treatment precisely to the affected foci via liver cancer blood vessels. In this procedure, physicians puncture either the femoral artery (groin) or radial artery (wrist), under the guidance of imaging equipment (digital subtraction angiography) thread a micro-catheter to the desired site and then deliver chemotherapy drugs directly into the tumor-feeding vessels. They then administer embolic agents to occlude these vessels, thus cutting off the tumor’s life-sustaining blood supply and inducing targeted tumor necrosis.

TACE can be classified into the following two types depending on the embolic materials used:

1.Conventional TACE: uses lipiodol emulsion + particulate embolic agents.

2.Drug-eluting beads TACE: uses microspheres that release drugs over an extended period, extending therapeutic efficacy.

These localized approaches eradicate tumor cells while minimizing systemic adverse effects.

What are the advantages of TACE?

TACE offers the following distinct advantages over traditional surgery and radiotherapy:

1.Minimally invasive with rapid recovery: requires only 1–2 mm micro-incisions (no laparotomy), enabling discharge within days.

2.Precision tumor targeting: concentrates chemotherapy in tumor-feeding vessels, thus preserving healthy liver tissue, making this approach particularly suitable for patients with liver cirrhosis. 3.Clinically proven efficacy: significantly extends survival in intermediate or advanced HCC patients, either as monotherapy or combined with targeted drugs/immunotherapy.

4.Repeatable treatment protocol: enables multiple sessions for multifocal or recurrent HCC, facilitating long-term disease management.

Who is suitable for TACE treatment?

According to the latest edition of the “Guidelines for Diagnosis and Treatment of Primary Liver Cancer (2024)”, TACE therapy is suitable for the following patient groups: 1.Patients with intermediate or advanced stages of liver cancer. In particular, it is the preferred treatment method for stages IIb and IIIa according to the China Liver Cancer classification. 2.Patients considered unsuitable for surgery, including older individuals, those with poor liver function, and those with early-to-mid-stage disease in challenging locations.

What are the advantages of TACE?

TACE offers the following distinct advantages over traditional surgery and radiotherapy:

1.Minimally invasive with rapid recovery: requires only 1–2 mm micro-incisions (no laparotomy), enabling discharge within days.

2.Precision tumor targeting: concentrates chemotherapy in tumor-feeding vessels, thus preserving healthy liver tissue, making this approach particularly suitable for patients with liver cirrhosis. 3.Clinically proven efficacy: significantly extends survival in intermediate or advanced HCC patients, either as monotherapy or combined with targeted drugs/immunotherapy.

4.Repeatable treatment protocol: enables multiple sessions for multifocal or recurrent HCC, facilitating long-term disease management.

Who is suitable for TACE treatment?

According to the latest edition of the “Guidelines for Diagnosis and Treatment of Primary Liver Cancer (2024)”, TACE therapy is suitable for the following patient groups:

1.Patients with intermediate or advanced stages of liver cancer. In particular, it is the preferred treatment method for stages IIb and IIIa according to the China Liver Cancer classification.

2.Patients considered unsuitable for surgery, including older individuals, those with poor liver function, and those with early-to-mid-stage disease in challenging locations.

3.Patients who may become eligible for surgery after tumor control. For example, reducing tumor size via TACE may enable subsequent resection, transplantation, or ablation.

4.Patients awaiting liver transplantation: TACE can control disease progression and create favorable conditions for transplantation.

5.As an emergency intervention for controlling bleeding in patients with liver cancer rupture or portal hypertension.

6.Patients at high risk of postoperative recurrence: adjuvant TACE can reduce the risk of recurrence.

In summary, TACE has a wide range of applications, especially for patients with intermediate or advanced stage or non-operable liver cancer.

What preparation is required before TACE treatment?

To ensure a safe and smooth procedure, the following preparatory measures should be taken before surgery:

1.Skin preparation: the relevant area of skin should be shaved one day prior to maximize cleanliness and dryness at the puncture site.

2.Diet management: the patient should fast (no food or water) for 4 hours before local anesthesia.

3.Daily supplies: A bedpan or urinal should be available, as 6 hours of bed rest is required post-procedure.

4.Additional precautions: All metal accessories should be removed and the bladder emptied. Female patients should avoid scheduling the procedure during menstruation.

What are the common reactions after TACE?

The most common post-TACE reaction is post-embolization syndrome, which manifests as fever, abdominal pain, nausea, fatigue, and other symptoms. Most cases are mild and gradually resolve with symptomatic management over several days. However, a minority of patients have the following complications: temporary abnormalities in hepatic or renal function, gastrointestinal bleeding, liver abscess, and migration of drugs or embolic materials to non-target areas (ectopic embolization). With adequate preoperative assessment, standardized intraoperative procedures, and active postoperative care, these complications can be minimized and managed effectively.

What is the recommended follow-up protocol after TACE?

A follow-up outpatient check is recommended within the first month after the procedure to evaluate treatment efficacy and formulate the subsequent treatment plan. Key examinations include:

1.Blood tests: Liver/kidney function, coagulation prof ile, tumor markers (e.g. alpha-fetoprotein).

2.Imaging studies: Contrast enhanced abdominal computed tomography or magnetic resonance imaging to assess tumor shrinkage or necrosis and detect new lesions. Based on the findings of these tests, the medical team then determines whether repeat TACE or additional therapies are required.

Conclusion: TACE empowers more liver cancer patients to gain the upper hand over their disease.

TACE has become a pivotal weapon in liver cancer treatment, offering new hope to patients with intermediate or advanced stage disease. With ongoing advances in TACE techniques and their synergistic application with targeted therapies, immunotherapy, and other approaches, an increasing proportion of liver cancer patients are benefiting from this modality. Liver cancer treatment is a long-term process. In addition to selection and administration of appropriate therapies, consistent follow-up, maintenance of a healthy lifestyle, and active cooperation between doctor and patient are equally crucial for achieving the best outcomes. When an individual is diagnosed with liver cancer, we recommend that they consider consulting a qualified interventional doctor to determine whether TACE is suitable for them, thus taking proactive control of their health