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Liver-directed treatment

Intra-Arterial and Regional — Chemotherapy for Liver Tumours

Most chemotherapy travels through the bloodstream to reach a tumour. Intra-arterial chemotherapy takes a more direct route — a catheter delivers the drug into the artery feeding the tumour itself, concentrating treatment where it is needed.

Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed September 2026

  • Catheter-based — A thin tube is guided by X-ray into the artery that supplies blood to the tumour.
  • Mainly used for the liver — TACE — the most common form — is used for liver tumours that cannot be removed by surgery.
  • Performed by a specialist — An interventional radiologist does the procedure, not a surgeon or oncologist.
  • Available at specialist centres in India — TACE is offered at major cancer and liver hospitals in Hyderabad and other cities, though not everywhere.
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Intra-arterial chemotherapy delivers drugs through a catheter placed directly into the artery that supplies a tumour, rather than through a vein. For liver cancer, the most common form is TACE — where drugs are loaded onto tiny beads that also block the artery. A trained interventional radiologist performs the procedure, usually under sedation.

How is intra-arterial chemotherapy given?

A thin flexible tube called a catheter is inserted through a small puncture in the groin artery. Under real-time X-ray guidance, the radiologist steers it until the tip sits in the artery supplying the tumour.

Chemotherapy is released directly at that site. In TACE, the drug is loaded onto tiny particles that also block the vessel — this traps the drug at the tumour and cuts off its blood supply simultaneously.

The procedure takes one to several hours inside an angiography suite, under sedation or light anaesthesia. This is a different kind of specialist facility — not a chemotherapy ward.

Which cancers is it used for?

  • Primary liver cancer (hepatocellular carcinoma) that cannot be removed by surgery
  • Colorectal cancer that has spread mainly to the liver, in selected cases
  • Cholangiocarcinoma (bile duct cancer) at some specialist centres
  • Other cancers with liver-dominant spread where a localised approach fits better than systemic treatment alone
  • Suitability depends on the tumour's blood supply, your liver function, and the overall plan — your oncologist and interventional radiologist assess this together

What will happen on the day?

You fast beforehand. A needle enters the artery in your groin, and a thin wire guides the catheter toward the liver. You will feel pressure but not usually pain.

You remain awake or lightly sedated while the team monitors you throughout. The procedure ends when all planned vessels have been treated.

Afterwards you stay in hospital for at least one night. Fever, nausea and right-sided abdominal discomfort are common in the first day or two — your team will prescribe medication to manage these before you go home.

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What do the terms TACE, HAI and embolisation mean?

TACE (Transarterial Chemoembolisation)
The most widely used liver-directed technique. Chemotherapy is loaded onto tiny beads that also block the artery, holding the drug at the tumour at a far higher concentration than a drip can deliver.
HAI (Hepatic Artery Infusion)
A small pump implanted near the liver delivers chemotherapy continuously into the hepatic artery. Less widely available in India; used in selected cases of colorectal cancer spread to the liver.
Embolisation
Deliberately blocking an artery with tiny particles or beads. When combined with chemotherapy it is called chemoembolisation; when done without a drug it is called bland embolisation.
Interventional radiologist
The specialist who performs catheter-based procedures using imaging guidance. A distinct subspecialty — separate from both surgical oncology and medical oncology.
Post-embolisation syndrome
Fever, nausea and localised pain in the one to two days after TACE. Common, expected, and managed with medicines your team prescribes before discharge.

Is intra-arterial chemotherapy available in India?

TACE is available at specialist cancer and liver centres in Hyderabad, Vijayawada and other major Indian cities. It requires an angiography suite and a trained interventional radiologist, so it is not offered at every hospital.

HAI pump implantation is performed at a smaller number of high-volume liver surgery units in India and is less widely available.

If you are a candidate, your medical oncologist will refer you to an interventional radiologist for assessment. Your CION care team can help coordinate that referral where specialist facilities are accessible in your area.

Questions families commonly ask

Is TACE the same as intra-arterial chemotherapy?

TACE is the most common form of liver-directed intra-arterial treatment, but the terms are not interchangeable. Intra-arterial chemotherapy also covers hepatic artery infusion pump therapy and other catheter-based approaches. When a specialist recommends this route, ask which specific technique they mean, why it fits your tumour, and how many sessions are planned.

Will I need general anaesthesia?

Most people receive conscious sedation — relaxed and comfortable, but breathing on their own throughout. Full anaesthesia is used when the procedure is expected to be lengthy or when sedation alone is not appropriate for your health. Your team will discuss this with you at the pre-procedure appointment, not on the day itself.

What medicines are used in TACE?

The drugs vary between centres and are chosen based on the cancer type and locally available formulations. Doxorubicin, cisplatin and mitomycin C are among the agents used in different protocols globally. The specific agent, bead type and combination are your interventional radiologist's decision — ask at your pre-procedure consultation rather than relying on what you read online.

How many sessions will I need?

The number depends on how many tumours are present, how the liver responds after the first session, and what the overall plan aims to achieve. Some people need a single session followed by monitoring; others need sessions spaced several weeks apart. Your radiologist will explain what they expect and how response will be assessed between treatments.

Does this replace my systemic chemotherapy?

Not always. For some people intra-arterial treatment works alongside systemic chemotherapy; for others it becomes the primary approach. The decision depends on whether cancer has spread beyond the liver and on your oncologist's overall plan. Never adjust or stop systemic medication without speaking to your team first.

What serious risks should I understand before consenting?

Fever, pain and nausea in the first couple of days are common and manageable. Less frequent but more serious risks include infection, unintended injury to nearby blood vessels or bile ducts, and worsening liver function in livers already significantly compromised. Your team will go through the risks specific to your case and your liver's reserve before asking you to consent — that conversation should happen before the procedure, not after.

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Common questions

Frequently asked questions

What is the difference between TACE and ordinary chemotherapy?

Ordinary chemotherapy travels through the entire bloodstream and reaches every organ in the body. TACE delivers the drug directly into the artery feeding the tumour, so the concentration at the tumour site is much higher while the amount circulating elsewhere is lower. This changes — but does not eliminate — side effects. TACE is a localised treatment and cannot address cancer that has already spread outside the liver.

Is the procedure painful?

During the procedure you should feel pressure at the groin site but not significant pain — you will be sedated. The discomfort most people describe comes in the one to two days afterwards: right-sided abdominal pain, fever and nausea as the treated area responds. Your team prescribes medication to manage this before you leave hospital, and it generally settles within a few days.

How long is the recovery after TACE?

Most people stay in hospital for one to two nights. At home, fatigue and some abdominal discomfort are common in the first week. Most people feel closer to their usual level within two weeks, though this varies. Your team will tell you what activities to avoid and when your follow-up imaging is scheduled.

Can TACE be done if my liver is already damaged?

Existing liver damage — from cirrhosis, hepatitis or previous treatment — affects whether the procedure is safe. Blood tests and imaging assess your liver's reserve before any recommendation is made. People with severely compromised liver function may not be suitable candidates. This assessment is part of the pre-procedure workup and is not a decision made on the day.

Is TACE available at CION?

TACE requires specialist interventional radiology facilities. CION's medical teams can assess whether you are a candidate and coordinate referral to interventional radiology units where this is available in your area. Raise it with your treating oncologist at your next appointment to understand what the pathway looks like for your specific situation.

What scans are needed before and after TACE?

Before the procedure your team will typically order a CT or MRI to map the tumour and plan the catheter route, alongside blood tests to assess liver function. After TACE, follow-up imaging — usually around four to six weeks later — shows how the tumour has responded and whether further sessions are needed. PET-CT may also be used at assessment points depending on your cancer type.

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