TACE: Delivering a 'one-two punch' to liver tumors

By Kristy Bleizeffer Nov 4, 2019

Before TACE treatment, Mr. Heady's tumor show up in images as a whitish blob on the top left of the liver (at right.) After treatment, the dead tumor shows up as a dark gray blob.

When doctors found a tumor in Gary Heady’s liver a couple of years ago, the Vietnam veteran drove seven hours from his home in Sheridan to the Veterans Affairs hospital in Denver. He underwent radioablation to treat the tumor, and then drove seven hours home.

Last fall, another spot appeared growing from the side of the same tumor. Mr. Heady didn’t want to make another 14-hour trip to Denver, so, his hepatology care team referred him to Charles Bowkley, M.D.,an interventional radiologist at Wyoming Medical Center, through the Veterans Choice Program.

In December, Mr. Heady drove two hours to Casper and underwent a Transarterial Chemoembolization of the liver.

“The experiences were night and day between Denver and Casper,” Mr. Heady said. “Denver is seven hours from my house. The VA is a teaching hospital, and I shared a room with several other people. There were several groups of people coming around to ask questions and do their rounds.”

In Casper, Mr. Heady spent less than 24 hours in the hospital and drove home the next day. Subsequent scans show that his liver tumor is successfully treated and gone!

How TACE works

Transarterial Chemoembolization of the liver, also known as TACE, is a localized therapy that cuts off the tumor’s blood supply while administering targeted chemotherapy. The majority of the normal liver receives its blood supply from the portal vein, the drainage system of the bowel. However, liver tumors are kept alive by the hepatic artery.

“By using this knowledge of tumor activity, we are able to use the tumors’ blood supply against the tumor directly,” said Dr. Bowkley.

The treatment acts in two ways:

  • Small spherical particles are injected through a small tube called a catheter directly into the arteries supplying the tumor. These block the arteries and prevent oxygen and nutrients from being delivered to the tumor.
  • The small particles also carry chemotherapy on their surface, which is slowly released into the tumor once the arteries are blocked.

“So it’s a one-two punch to the tumor that uses the tumor’s own supply mechanism to eradicate it,” Bowkley said.

The procedure requires no large incisions. Interventional radiologists access the femoral artery in your groin or the radial artery in your wrist and use real-time x-ray imaging to move the catheter through the blood vessels and to the liver.  Mr. Heady only required local anesthesia at the groin access site paired with an intravenous dose of pain medicine and anxiolytic to help him relax.

“I was awake through the whole procedure, and Dr. Bowkley was really good about informing me about what he was doing. He told me I was going to feel some pain, but I didn’t,” Mr. Heady said. “I just have nothing but good to say about the experience.”

Recovery

Recovery from TACE is typically very short, just 1 to 2 weeks. Many patients will experience a short period post-embolization syndrome – abdominal pain or cramping, nausea, mild body aches, and a mild fever.

“This is predictable and we provide outpatient oral medications to control these symptoms,” Dr. Bowkley said.

Other than his recurrent liver cancer, Mr. Heady was in good health and was a good candidate for the TACE procedure. The main advantages are that TACE is performed in a single session outpatient treatment without surgery, it is locally effective without systemic complications, and patients can expect a rapid recovery.

Mr. Heady’s doctors will continue to monitor his liver and watch for other tumors. But he has been encouraged by the effectiveness of the TACE treatment.

“It’s like a weight had been lifted from my shoulders,” Mr. Heady said.

Patients who want to learn more about TACE or other treatments for cancerous tumors should talk with their physicians.

“It’s important to understand that all cancer care in this day and age is multidisciplinary; meaning that multiple physicians should be involved in your care,” Dr. Bowkley said. “The common specialties that participate in a patient’s experience are Primary Care, Interventional Radiology, the specialty disciplines of Surgery, as well as Medical and Radiation Oncology.”

Charles Bowkley III M.D.

Dr. Bowkley is the only neurointerventional radiologist in Wyoming and Wyoming Medical Center’s 2017 Physician of the Year.  He is board certified in diagnostic and vascular / interventional radiology. He practices at Casper Medical Imaging in Casper. Call (307) 232-5054 for an appointment or referral.