Embolization of Liver Tumors

Embolization is a procedure that injects substances directly into an artery in the liver to block or reduce the blood flow to a tumor in the liver.

The liver is special in that it has 2 blood supplies. Most normal liver cells are fed by the portal vein, whereas a cancer in the liver is mainly fed by the hepatic artery. Blocking the part of the hepatic artery that feeds the tumor helps kill off the cancer cells, but it leaves most of the healthy liver cells unharmed because they get their blood supply from the portal vein.

Embolization is an option for some patients with tumors that cannot be removed by surgery. It can be used for people with tumors that are too large to be treated with ablation (usually larger than 5 cm across) and who also have adequate liver function. It can also be used with ablation. Embolization can reduce some of the blood supply to the normal liver tissue, so it may not be a good option for some patients whose liver has been damaged by diseases such as hepatitis or cirrhosis. It isn’t yet clear which type of embolization has a better long-term outcome.

People getting this type of treatment typically do not stay in the hospital overnight.

Trans-arterial embolization (TAE)

During trans-arterial embolization a catheter (a thin, flexible tube) is put into an artery in the inner thigh through a small cut and eased up into the hepatic artery in the liver. A dye is usually injected into the bloodstream to help the doctor watch the path of the catheter. Once the catheter is in place, small particles are injected into the artery to plug it up, blocking oxygen and key nutrients from the tumor.

Trans-arterial chemoembolization (TACE)

Trans-arterial chemoembolization is usually the first type of embolization used for large liver cancers that cannot be treated with surgery or ablation. It combines embolization with chemotherapy (chemo). Most often, this is done by giving chemotherapy through the catheter directly into the artery, then plugging up the artery, so the chemo can stay close to the tumor.

Drug-eluting bead chemoembolization (DEB-TACE)

Drug-eluting bead chemoembolization combines TACE embolization with drug-eluting beads (tiny beads that contain a chemotherapy drug). The procedure is essentially the same as TACE except that the artery is blocked after drug-eluting beads are injected. Because the chemo is physically close to the cancer and because the drug-eluting beads slowly release the chemo, the cancer cells are more likely to be damaged and die. The most common chemo drugs used for TACE or DEB-TACE are mitomycin C, cisplatin, and doxorubicin.

Radioembolization (RE)

Radioembolization combines embolization with radiation therapy. This is done by injecting small beads (called microspheres) that have a radioactive isotope (yttrium-90 or Y-90) attached to them into the hepatic artery. Once infused, the beads lodge in the blood vessels near the tumor, where they give off small amounts of radiation to the tumor site for several days. The radiation travels a very short distance, so its effects are limited mainly to the tumor.

Possible side effects of embolization

Possible complications after embolization include:

• Abdominal pain
• Fever
• Nausea
• Infection in the liver
• Blood clots in the main blood vessels of the liver

Sometimes, it can take 4-6 weeks to fully recover from the procedure. Because healthy liver tissue can be affected, there is a risk that liver function will get worse after embolization. This risk is higher if a large branch of the hepatic artery is embolized. Serious complications are not common, but they are possible.

Your Recovery

Tumour embolization, sometimes called transarterial chemoembolization (TACE), is a procedure to shrink a liver tumour by cutting off its blood supply. The doctor put a thin, flexible tube, called a catheter, into an artery in your groin or in your arm. The catheter was guided into the liver artery (the hepatic artery) that supplies blood to the tumour. The doctor sent small particles (like grains of sand) through the catheter into the hepatic artery. This mixture blocked the artery and will stop blood from getting to the liver tumour. Procedures also commonly done in Alberta include chemoembolization and radioembolization.

You may go home the same day. Or you might need to stay in the hospital overnight or longer. The area where the catheter was put through your skin into your artery (the puncture site) may be sore for a day or two after the procedure. You will probably have a bruise for at least a week.

You may feel like you have influenza (flu) and may feel tired and have a low fever and an upset stomach. You may not feel as hungry as you usually do. These symptoms are called post-embolization syndrome (PES), and they’re common side effects of the procedure. These symptoms usually get better in 1 to 2 weeks.

It may take a month or more to fully get your energy back.

You will have tests in the months after the procedure to check the liver tumour and see how well the treatment worked.

This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to feel better as quickly as possible.

How can you care for yourself at home?

Activity

Rest when you feel tired. Getting enough sleep will help you recover.

Do not do hard exercise, and do not lift, pull, or push anything heavy (more than 4.5 kg or 10 lb.) until your doctor says it is okay. This may be for a day or 2. You can walk around the house and do light activity, such as cooking.

Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation. If you feel unsteady, have someone walk with you.

If the catheter was placed in your groin, try not to use stairs for the first couple of days.

If the catheter was placed in your arm, be careful of activities that can keep the blood from flowing well in your arm:

For 24 hours after the procedure: Be careful of repetitive arm or wrist movements (including computer work), bending your arm, or having your blood pressure checked or an intravenous (IV) start on your arm.

For 5 days after the procedure: Be careful not to use this arm to help you get into and out of a chair or bed, and don’t use this arm for lifting, carrying, or pushing anything heavier than 2 kg (5 lb.).

Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, for at least 2 days or until your doctor says it is okay.

For 2 to 3 days, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.

Ask your doctor when you can drive again.

It may take a month or more to fully get your energy back.

Diet

You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Drink plenty of fluids (unless your doctor tells you not to).

Medicines

Your doctor will tell you if and when you can restart your medicines. Your doctor will also give you instructions about taking any new medicines.

If you take aspirin or some other blood thinner, ask your doctor if and when to start taking it again. Make sure that you understand exactly what your doctor wants you to do.

Be safe with medicines. Take pain medicines exactly as directed.

If the doctor gave you a prescription medicine for pain, take it as prescribed.

If you are not taking a prescription pain medicine, take an over-the-counter medicine that your doctor recommends. Read and follow all instructions on the label.

If you think your pain medicine is making you sick to your stomach:

Take your medicine after meals (unless your doctor has told you not to).

Ask your doctor for a different pain medicine.

If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Care of the puncture site

You will have dressing or bandage over the puncture site. A dressing helps the site heal and protects it.

Do not soak the puncture site in a bath, hot tub, or swimming pool until it is completely healed (no longer has a scab).

Watch for bleeding from the site. A small amount of blood (up to the size of a quarter) on the bandage can be normal.

If you start bleeding more than this or have a fast-growing, painful lump at the puncture site, call 194 and do the following:

Lie down and call a friend or family member for help.

Apply pressure using your fingers or fist at the puncture site. Hold this pressure for 20 minutes.

If the bleeding stops—lie still until emergency help arrives.

If the bleeding does not stop—keep firm pressure to the puncture site until emergency help arrives.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

When should you call for help?

Call 194 anytime you think you may need emergency care. For example, call if:

• You passed out (lost consciousness).
• You have severe trouble breathing.
• You have sudden chest pain and shortness of breath, or you cough up blood.
• You are bleeding from the area where the catheter was put in your artery.
• You have a fast-growing, painful lump at the puncture site.

Call your doctor or nurse advice line now or seek immediate medical care if:

• Your leg or arm looks blue or feels cold, numb, or tingly.
• Bright red blood has soaked through the bandage over your incision.
• You have signs of a blood clot in your leg (called a deep vein thrombosis), such as:
  • Pain in your calf, back of the knee, thigh, or groin.
  • Redness or swelling in your leg.
• You have signs of infection, such as:
  • Increased pain, swelling, warmth, or redness near the puncture site.
  • Red streaks leading from the puncture site.
  • Pus draining from the puncture site.
  • A fever.
• You have pain that does not get better after you take pain medicine.
• You are sick to your stomach or cannot drink fluids.
• You cannot pass stools or gas.