Medical Oncologist
CION Cancer Clinics
Liver function before and after embolisation | CION Cancer Clinics
Liver function decides whether TACE or TARE is safe, because both treatments strain the healthy liver as well as the tumour. Teams usually grade it with the Child-Pugh class, A, B or C, from blood tests and an examination. Numbers often rise for a few days afterwards and then settle. This page explains the tests, what the class means and which changes need same-day care. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Why does liver function decide whether TACE or TARE is safe?
- What do the liver test results actually measure?
- What is checked before each session?
- What usually happens to the liver numbers afterwards?
- What do families often believe about the liver tests?
- What can the liver numbers not tell you?
- Common questions about liver function and embolisation
The short answer
Why does liver function decide whether TACE or TARE is safe?
TACE and TARE treat the tumour, but they also put some strain on the healthy liver around it. So your team only offers them when the rest of the liver is working well enough to cope, and they check it again after every session.
How the team measures it
Most teams use a simple grading called Child-Pugh. It combines a few blood results with two things the doctor looks for: fluid in the belly and confusion caused by the liver. The result is a class, A, B or C. Class A means the liver is coping well. Class C means it is struggling badly.
What the class usually means for treatment
People in class A are the group these procedures are mostly designed for. In class B the team looks harder, because some people cope and others are pushed into liver failure. In class C, the strain of TACE or TARE is usually judged greater than any benefit, and the focus moves to other care.
Why one report is not enough
Liver results move from week to week. An infection, a blocked bile duct, a missed hepatitis tablet or a few days of poor eating can all shift them. Your team looks at the trend across several reports, and may repeat a test before deciding, rather than acting on one number.
The class is a guide, not a verdict. Your team also weighs the scans, your general fitness and how much of the liver the tumour takes up.On your blood report
What do the liver test results actually measure?
- Bilirubin
- A yellow waste product the liver clears. When it builds up, the skin and eyes turn yellow, which is jaundice.
- Albumin
- A protein the liver makes. A low level suggests the liver is not keeping up with its work.
- INR or prothrombin time
- How quickly the blood clots. A damaged liver makes fewer clotting proteins, so the number rises.
- ALT and AST
- Enzymes released when liver cells are irritated. They often rise after embolisation and settle again.
- Ascites
- Fluid collecting in the belly, one sign the liver is struggling.
- ALBI grade
- Another grading, built only from albumin and bilirubin. Some teams use it beside Child-Pugh.
Not sure whether this applies to you?
Ask an oncologistBefore the procedure
What is checked before each session?
The checks are repeated before every session, not only the first. A liver that coped once may not cope the same way next time.
Blood tests
The liver panel, clotting, kidney function and blood counts. Kidney function matters because contrast dye is used during the procedure.
A recent scan
A CT or MRI shows the size and spread of the tumour, and whether the portal vein, the main vein into the liver, is open or blocked.
A blocked portal vein makes TACE riskier and is one reason TARE may be discussed instead.An examination
The doctor looks for jaundice, fluid in the belly and any confusion or drowsiness, and asks how active you are day to day.
The cause of the liver damage
Hepatitis B, hepatitis C, alcohol or fatty liver each need their own care alongside the cancer treatment.
You may be asked about
- Antiviral tablets for hepatitis
- Any alcohol, even occasional
After the procedure
What usually happens to the liver numbers afterwards?
-
The first few days
ALT and AST often jump, and bilirubin may rise a little. This is the treated tissue breaking down, and it is expected. Many people also have fever, pain and feeling sick, which is called post-embolisation syndrome.
-
The following weeks
In most people the numbers drift back towards where they started. Your team will ask for repeat blood tests, often in a local lab if you live outside Hyderabad.
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The follow-up scan
A scan checks how the tumour responded. Together with the blood results, it helps the team decide whether another session is needed.
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Before any repeat session
The whole assessment is done again. If the liver has worsened, the team may space sessions further apart, treat a smaller area, or stop.
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Signs that cannot wait until the next appointment
If, after going home, the skin or eyes turn yellow, the belly swells quickly, the person becomes confused or unusually sleepy, vomits blood or passes black stools, go to the nearest emergency department the same day. Tell them about the recent embolisation and take the discharge summary. Do not wait to see if it settles overnight.
Commonly believed
What do families often believe about the liver tests?
"The liver numbers went up, so the treatment has failed."
A short rise after embolisation is expected, because the treated tissue releases enzymes as it breaks down. Whether the treatment worked is judged from the follow-up scan, not from one blood report.
"Child-Pugh B means nothing more can be done."
Some people in class B are still offered a procedure, often to a smaller area. Others are offered medicines or supportive care. The class opens a discussion rather than ending one.
"A liver tonic or herbal powder will protect the liver during treatment."
Some herbal products strain the liver further, and their contents are often unknown. Tell your team about everything you take, including powders and home remedies, before you start them.
"A little alcohol at a function will not matter now."
A liver already under strain handles alcohol badly, and alcohol can tip the grading into a worse class. Most teams advise none at all.
Being straight with you
What can the liver numbers not tell you?
A blood report on its own cannot tell you whether you should have another session, or how the cancer will behave. It is one piece of a picture your team reads with the scans and the examination.
Who these procedures do not suit
They are generally not offered when the liver is failing, with persistent jaundice, fluid in the belly that keeps coming back or confusion caused by the liver. They are also used with great caution when the tumour has spread widely outside the liver. In these situations, the treatment can do more harm than good.
Questions worth asking
Ask what class your liver is in today and whether it has changed. Ask which result worries the team most, and what would make them stop treatment. Ask which blood tests to repeat at home and who reads them. Bring every past report, so the trend can be seen rather than a single number.
If you live outside Hyderabad
Many repeat blood tests can be done at a good lab near home. Send the results to your team the same day, and keep copies in one folder. Ask who to call if a result comes back very different from the last one.
Questions we are asked
Common questions about liver function and embolisation
My father's bilirubin is high. Can he still have TACE?
It depends on how high, why it is high, and the rest of the picture. A raised bilirubin from a blocked bile duct may be treated first and then rechecked. A high bilirubin because the liver is failing usually makes TACE unsafe. Ask the team which of these applies to him.
How soon after TACE are blood tests repeated?
Usually within the first days in hospital, then again at a follow-up visit, and before any further session. The exact timing varies between teams. Ask for a written schedule at discharge, and ask whether the tests can be done at a lab near your home.
Is TARE gentler on the liver than TACE?
They strain the liver in different ways. TARE causes less of the short-term reaction for many people, but radiation damage to healthy liver can appear later. Neither is simply gentler. The choice depends on the tumour, the veins and the liver function your team sees.
Can Child-Pugh class improve?
Sometimes. Treating hepatitis, stopping alcohol, treating fluid in the belly or improving nutrition can move the result. It can also worsen as the disease progresses or after treatment. That is why it is measured fresh before every decision.
Should I stop my hepatitis tablets before the procedure?
Do not stop them on your own. Antiviral tablets for hepatitis B are often continued throughout, because stopping can cause a flare that damages the liver. Tell both the liver doctor and the radiologist what you take, and follow what they agree together.
What diet helps the liver around treatment?
Enough protein and enough food overall matter more than any special item. People with liver disease often lose muscle without noticing. If there is fluid in the belly, you may be told to limit salt. A dietitian can plan meals that suit your home cooking.
The report says "correlate clinically". What does that mean?
It means the test result alone cannot settle the question, and your treating doctor must read it alongside your examination, symptoms and scans. It is standard wording and is not a hidden warning. Ask your doctor to explain it at your next visit.
Does a normal liver report mean the cancer is gone?
No. Liver function tests show how the liver is working, not whether the tumour is present. Someone can have normal numbers and active cancer, or raised numbers and a good response. The scan and, where used, tumour markers answer that question.
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Sources
- American Cancer Society — Embolization therapy for liver cancer
- National Cancer Institute — Liver cancer treatment (PDQ), patient version
- Cancer Research UK — Treatment for liver cancer
- NHS — Liver function tests
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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