Chemoembolisation

Dr Suresh Babu
Dr Suresh Babu
Senior Consultant Vascular and Interventional Radiologist

Chemoembolisation is a minimally invasive procedure that delivers high doses of cancer-treating drugs directly to a tumour while blocking its blood supply. This targeted approach combines the effects of chemotherapy with embolisation, which cuts off blood flow to the tumour. The procedure involves guiding a catheter through blood vessels to reach the tumour site. Chemoembolisation is primarily used to treat liver tumours, including those that originate in the liver and those that have spread from other parts of the body.

Indications for Chemoembolisation

Chemoembolisation is often recommended for the following conditions:

Primary Liver Cancer (Hepatocellular Carcinoma)

This procedure is often used for patients with tumours confined to the liver who are not candidates for surgical removal or transplantation.

Liver Metastases

Chemoembolisation can be effective for cancer that has spread to the liver from other primary sites, such as colorectal cancer, neuroendocrine tumours, or ocular melanoma.

Multiple Tumours

When multiple tumours are present throughout the liver and surgery is not feasible, chemoembolisation can simultaneously target multiple tumour sites during a single session.

Inadequate Liver Function

Patients with compromised liver function who cannot tolerate surgical intervention may be candidates for chemoembolisation. The selective nature of the procedure preserves healthy liver tissue while treating the affected areas.

Bridge to Transplant

For patients awaiting liver transplantation, chemoembolisation can serve as a bridging therapy to prevent tumour progression during the waiting period, helping maintain eligibility for transplantation.

Benefits of Chemoembolisation

Chemoembolisation provides several advantages compared to other treatment options for liver tumours due to its targeted approach and minimally invasive nature.

The procedure delivers chemotherapy drugs directly to the tumour site, allowing for higher drug concentrations than systemic chemotherapy. This localised approach reduces systemic side effects while maximising treatment at the tumour location.

Chemoembolisation addresses cancer through two complementary methods: delivering high concentrations of chemotherapy agents directly to the tumour and cutting off the blood supply that feeds the tumour.

By targeting specific blood vessels feeding the tumour, chemoembolisation preserves healthy liver tissue, maintaining overall liver function.

Unlike surgical resection, chemoembolisation does not require large incisions or removal of liver tissue, resulting in shorter hospital stays and quicker recovery.

Chemoembolisation provides a treatment option for patients with tumours that cannot be surgically removed due to location, size, number, or underlying liver disease.

By delivering chemotherapy directly to the tumour rather than throughout the body, systemic side effects typically associated with chemotherapy are minimised.

Preparing for Chemoembolisation

  • Medical Evaluation: A comprehensive assessment determines suitability for the procedure, including blood tests and imaging studies such as CT scans, MRI, or angiography to map blood vessels and locate tumours.
  • Medication Adjustments: Certain medications may need to be temporarily stopped before the procedure. Blood thinners such as warfarin, clopidogrel, or direct oral anticoagulants typically need to be discontinued for a specific period. Metformin may need to be stopped temporarily due to the use of contrast agents.
  • Pre-procedure Imaging: Detailed imaging studies map the liver vasculature and tumour locations. CT or MRI with contrast enhancement helps identify the number, size, and location of tumours. A planning angiogram may be performed to study the blood supply to the liver and tumours, which helps determine the optimal approach for catheter placement.
  • Fasting Requirements: Refrain from eating or drinking for 6-8 hours before the procedure. Clear liquids may be permitted until a designated cutoff time. These fasting guidelines help reduce the risk of complications related to sedation or anaesthesia during the procedure.

Step-by-Step Procedure

Anaesthesia

The procedure begins with the administration of moderate sedation or general anaesthesia. Vital signs are continuously monitored throughout the procedure.

Vascular Access

A small nick is made in the skin, usually in the groin area, to access the femoral artery. A small needle is inserted into the artery, followed by a guide wire and then a vascular sheath. This provides a stable pathway for catheter insertion and manipulation throughout the procedure.

Catheter Navigation

Using real-time X-ray guidance (fluoroscopy), the catheter is navigated through the arterial system to the hepatic artery and smaller branches that supply blood directly to the tumour.

Angiographic Mapping

Contrast material is injected to create detailed images of the liver blood vessels, identifying specific vessels feeding the tumour and determining optimal positions for treatment delivery.

Drug-Embolic Mixture Delivery

After identifying the target vessels, the chemotherapy-embolic mixture is slowly injected through the catheter, flowing directly to the tumour.

Embolisation Confirmation

Additional angiography confirms blockage of the target blood vessels while preserving flow to normal liver tissue. Additional embolic material may be administered if needed.

Catheter Removal and Closure

Once complete, the catheter and vascular sheath are removed. Pressure or a closure device seals the arterial puncture, with a small dressing applied over the access site.

Post-Procedure Care and Recovery

  • Initial Recovery: You will be monitored for several hours after the procedure with bed rest for 4-6 hours. Most patients experience post-embolisation syndrome (abdominal pain, nausea, fever, and fatigue), which typically peaks at 24-72 hours and resolves within 1-2 weeks. A hospital stay of 1-3 days is typical, with discharge once pain is under control and oral intake is adequate.
  • Activity and Lifestyle Adjustments: Limit physical activity for 7-10 days, avoiding strenuous exercise and heavy lifting. Follow a low-fat, easily digestible diet in small, frequent meals, and drink plenty of water throughout the day to stay well-hydrated. Avoid alcohol for at least one month after the procedure.
  • Follow-up: A follow-up appointment 2-4 weeks after the procedure assesses recovery, with imaging studies at 4-8 weeks to evaluate treatment response. Long-term monitoring includes imaging every 2-3 months, as well as blood tests to assess liver function and tumour markers.

Potential Risks and Complications

Chemoembolisation carries certain risks and potential complications. Most patients experience post-embolisation syndrome (fever, nausea, vomiting, pain, and fatigue), which typically lasts several days. Less common complications include liver abscess formation, access site bleeding, and allergic reactions to contrast material. In patients with advanced cirrhosis, complications such as blood flow blockage to other organs, liver or kidney damage, or acute liver failure are possible but rare. With proper patient selection, the procedure is generally safe, and most complications can be effectively managed with prompt intervention.

Dr Suresh Babu

Dr Suresh Babu

Senior Consultant Vascular and Interventional Radiologist

Dr Suresh is one of the leading specialists in vascular and non-vascular radiological interventions, interventional oncology, pain relief in interventional radiology and neuro interventional procedures in Singapore and Southeast Asia.

  • MBBS (Madras)
  • DMRD (Liverpool)
  • FRCP (Dublin)
  • FRCR (London)
  • FCIRSE (Europe)
  • EBIR (Europe)
  • MBA (Birmingham)

His training includes comprehensive programmes in Radiology and Interventional Radiology in the UK and Canada, equipping him with the skills to manage even the most complex procedures.

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    Chemoembolisation

    Frequently Asked
    Questions

    How many chemoembolisation sessions will I need?

    The number varies based on tumour size, number, location, and response to treatment. Most patients require 2-4 sessions spaced 4-8 weeks apart. Your treatment plan will be individualised based on imaging studies after each procedure.

    Will chemoembolisation cure my liver cancer?

    Chemoembolisation typically does not cure liver cancer but helps control the disease by shrinking tumours, slowing growth, extending survival, and improving quality of life. For some patients with small, localised tumours, chemoembolisation may achieve complete tumour necrosis, though regular monitoring remains necessary.

    How soon can I know if the treatment was effective?

    Initial assessment occurs through follow-up imaging, typically performed 4-8 weeks after the procedure. Complete response may take several months to become apparent. Blood tests for tumour markers, when applicable, can provide earlier indications of response.