Transarterial Embolisation (TAE) of a liver tumour- A guide for patients

Introduction

This leaflet is designed for patients who have been advised to have a transarterial embolisation (TAE) procedure as part of the treatment for liver cancer.

What is a TAE?

• A TAE is a procedure where the arteries supplying a liver cancer are blocked-off, which starves the cancer of nutrients and oxygen. This may cause the cancer to stop growing, and in some cases shrink. However, it does not remove the cancer entirely.
• Normally arteries do not show up on an ordinary x-ray so a dye, called contrast medium, is injected into the arteries through a fine plastic tube called a catheter to make them visible.
• X-rays are taken during the procedure. These images will assist the doctors in performing the procedure.

Why do I need this procedure?

• Patients are referred for TAE when they have cancers growing in the liver. Usually this is hepatocellular carcinoma (HCC), but occasionally other tumours are treated this way too.
• TAE is usually performed when the cancer is not suitable for removal by other forms of surgery.
• In some people, TAE is used to keep a cancer from growing while awaiting a liver transplant.
• It is common to need more than one TAE procedure to get the best result.

Who has made the decision for me to have this procedure?

The consultant in charge of your case and the radiologist performing the TAE will have discussed your case and come to the conclusion that this is the best way of treating your condition.

You will have the opportunity for your opinion to be taken into account, and if after discussion with your doctors, you do not want the procedure carried out, you can decide against it.

Who will be performing the procedure and other staff you are likely to meet?

• A specially trained doctor called an Interventional Radiologist will be performing your procedure.
• Radiologists have special expertise in using x-ray equipment and in interpreting the images produced, as well as performing minimally invasive procedures.
• They will look at these images whilst carrying out the procedure.
• The Interventional Radiologist will be assisted by a radiographer and nurses and/or other Radiology doctors or trainees.

Where will the procedure take place?

You will be taken to the Interventional Radiology Department.

What happens before my procedure?

• For most first TAE treatments you will be admitted to the hospital the night before, or day of the procedure.
• Some patients for follow-up treatments may attend the Radiology Day Unit.
• A doctor will take a medical history from you.
• You may have a small needle put into a vein in your arm for painkillers to be given if necessary.
• Standard blood tests may be carried out.
• You may eat a light meal.
• You will be given oral antibiotics before the procedure.
• If you have any allergies you must let your doctor know and a red allergy band will be attached to your wrist.
• If you take any medications to thin the blood (anticoagulants or antiplatelets) please let us know beforehand, as these will need to be stopped a certain length of time before the procedure.
• If you have previously reacted to intravenous contrast medium (the dye used for CT scans), you must also tell your doctor about this.

What happens during the procedure?

• You will get dressed into a hospital gown.
• You will lie on the x-ray table, generally flat on your back.
• You will have a monitoring device attached to your finger, and will have a blood pressure cuff placed around your arm.
• The procedure is performed under sterile conditions and the radiologist and scrub nurse will wear sterile theatre gowns and operating gloves.
• Most often an artery in the groin is used, but occasionally an arm or wrist artery will be chosen. Your doctor will tell you beforehand which artery will be used. Your skin will be cleaned and local anaesthetic given to numb the area, and prevent any pain. A small tube is then placed into the artery.
• Small catheters (plastic tubes) will then be guided into the liver arteries using x-ray guidance.
• When pictures need to be taken you will be asked to hold your breath for a short time at these points.
• Once the catheter is in the right place, the artery will be blocked. Usually tiny plastic beads are injected to block the artery.
• Sometimes several arteries must be blocked, depending on how complicated the blood supply to the tumour is.
• After the arteries have been blocked you will move back onto the hospital bed. The tube in the artery will then be removed, and pressure applied on the site for several minutes.

Will the procedure hurt?

• Some discomfort may be felt in the skin and deeper tissues during injection of the local anaesthetic.
• You may feel a warm sensation for a few seconds when the x-ray dye is injected and some people report a metallic taste in the mouth. You may also feel like you are passing urine; this is normal.
• There will be a nurse, or another member of the clinical staff, in the room looking after you.
• If the procedure does become uncomfortable, please let a member of staff know.
• Following the procedure you may develop abdominal or shoulder pain, sickness and temperatures. If you experience any of these symptoms let the nursing staff know, so treatment can be given.

How long does the procedure take?

Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Generally, the procedure will last approximately 1 to 2 hours.

What happens after the procedure?

• You will be taken back to your ward for overnight observation (if a ward admission). For repeat TAE where you are on the Radiology Day Unit you will go home after the bed-rest period has been completed.
• If your procedure is planned as a day case and you do not feel well enough to go home, then you will need overnight admission.
• Nursing staff may carry out routine observations including taking your pulse and blood pressure and will also check the treatment site.
• If you experience pain or sickness let the nursing staff know.
• You will need to stay in bed for 4-6 hours, including a 2-hour period of lying flat.
• You will continue the oral antibiotics for 24-48 hours following the procedure.
• You will need someone to pick you up and take you home.
• You must not drive or use public transport to get home.
• You will need a responsible adult at home with you for the night following the procedure (if a day-case procedure).
• After the TAE, you will need a follow-up scan of the liver 6-8 weeks later, to assess the response to the treatment. Further treatment may be recommended depending on the scan results.

What are the benefits and possible risks of the procedure?

Benefits

• The purpose of the TAE is to reduce the size or rate of growth of the liver tumour, and to improve survival from the tumour.
• TAE is not intended to provide a cure for the tumour.

Risks

TAE is generally a safe procedure, but as with any procedure there are risks.

• Bruising at the artery puncture site is a relatively common problem. Rarely significant bleeding or artery damage may need to be treated with an operation.
• Most patients will feel tired following the procedure, often with flu-like symptoms. This is known as post embolisation syndrome. These symptoms should settle over 1-2 weeks. If you are getting worsening fevers you should contact the hepatology specialist nurses, as it may indicate an infection within the liver.
• There is a small risk of injury to the arteries.
• A small risk of the injected beads moving to locations not intended. Most commonly this is within the liver, and does not cause any problems. Very rarely this may be to other organs, which may be serious depending on which organ is affected.
• The liver function may be affected by the TAE. Usually this is not significant, but in rare situations worsening liver failure can occur, which may be serious.
• Your kidney function may rarely be affected by the contrast dye injected, though this usually recovers.

Radiation

• You have been referred for an Interventional Radiology procedure to help deliver your treatment. A specialist in radiology agrees that this is the best procedure to treat your clinical condition and that the benefit of the examination is greater than the risk.
• The x-ray involves a dose of ionising radiation equivalent to a few months or years of natural background radiation which we are all exposed to every day.
• Ionising radiation can cause cell damage that may turn cancerous, however the risk of this happening from your examination is considered low.
• Depending on the length of the procedure there may also be a small risk of an excess radiation dose to the skin leading to short term and long-term effects (e.g. reddening of the skin and burns).
• If this happens as a result of this procedure, you will receive further advice following the procedure. The dose delivered will be kept as low as is practicable.
• For further information please see the information on our webpage.

Accessibility requirements

If you require support for your appointment, e.g. if you find it hard to hear, see or be understood by others, please let the receptionist or healthcare professional know on arrival, email CUH Accessibility or telephone: 01223 256998.

Pregnancy status

We have a legal responsibility to enquire if you are pregnant. Any patient aged between 12-55 years will be asked if there is a possibility they could be pregnant. This is important for us to know before you have your examination involving ionising radiation.

You can discuss this with a healthcare professional in private if you wish.

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP.

Can I bring someone with me?

Those accompanying you may be required to stay out of the examination room during the procedure and remain in the waiting area.

Childcare whilst in the department

Staff are unable to look after or supervise children whilst your procedure is taking place. Please make alternative arrangements for the care of your children whilst you attend for your procedure. If you attend an appointment with children with no one to look after them whilst you have your procedure, then your appointment will unfortunately have to be cancelled and rescheduled.

Personal belongings

Patients are advised to bring minimal belongings and not to bring valuable items. Any valuable belongings (mobile phone, wallet etc.) will go with the patient while having their procedure and can be secured in a locked box/safe.

How, when and by whom will my results be communicated?

Imaging examinations are reported in order of clinical priority to ensure those with the highest urgency are reported first.

Your referring team or clinician will be responsible for communicating reports back to you.

Test results are made available via MyChart but there is 3-week delay from when an examination has been reported to when it is available on MyChart, in order to allow time for your clinical team to be able to see and action the results prior to them being released to the individual patient.

Contacts/Further information

Please call the Radiology Day Unit and speak to the Imaging Nurses, on telephone number 01223 254639 if you have any questions or concerns about this procedure.

Some of your questions about the procedure should have been answered by this leaflet, but remember this is only a starting point for discussion about your treatment with the doctors looking after you and you will be able to discuss any questions you have with them.

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Question, concern or complaint?

Firstly speak to your nurse, doctor or other staff member as soon as you can so they can do their best to put things right straightaway.

If you don’t feel able to speak directly to the people caring for you, contact the patient advice and liaison service (PALS). Please call 01223 216756 9am to 4pm Monday to Friday, email CUH PALS or via a form available via link on the CUH PALS webpage.

PALS is open every weekday, and you can leave a message in the evenings and weekends.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device.

More information is available on the MyChart section on our website.

This document has been adapted from one prepared by the British Society of Interventional Radiology (BSIR).