At a glance
Transarterial Chemoembolization (TACE) is a minimally invasive procedure that delivers chemotherapy (cancer-killing drugs) directly into the artery feeding a tumour while simultaneously blocking that blood supply, trapping the drugs inside the tumour for far longer than an intravenous drip would allow.
During TACE, a radiologist threads a thin flexible tube called a catheter through an artery in the groin or wrist and guides it, using live X-ray imaging, to the artery that feeds the tumour. A mixture of chemotherapy drugs and tiny blocking particles called embolic agents is then injected. The tumour loses its blood supply and is exposed to a concentrated dose of chemotherapy at the same time, while healthy surrounding tissue receives much less of the drug.
Medical Condition
TACE is used most often for liver tumours that cannot be removed by surgery, either because of their size, their position, or the patient's overall liver health. It may be the primary treatment or a bridge therapy, meaning it keeps the tumour under control while the patient waits for a liver transplant or becomes well enough for surgery.
- Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, in patients who are not surgical candidates
- Liver metastases (secondary tumours that have spread to the liver from cancers of the colon, breast, or other organs), in selected cases
- Cholangiocarcinoma (cancer of the bile ducts inside the liver), in some situations
- As a bridge treatment for patients awaiting liver transplantation, to slow tumour growth
- As a downstaging treatment, to shrink a tumour enough that surgery or transplant becomes possible
TACE is not suitable for everyone. Your oncologist and radiologist will review your scans and blood tests carefully before recommending it.
- Severe liver dysfunction (the liver is already too damaged to tolerate the procedure)
- Complete blockage of the main portal vein (the large vein bringing blood to the liver), because further reducing blood flow can cause acute liver failure
- Very large tumours occupying most of the liver
- Uncontrolled infection or bleeding
- Severely reduced kidney function, because the contrast dye used during imaging places extra stress on the kidneys
- Active tumour invasion into the bile ducts
Risks & Complications
TACE carries real risks, and the treating team will weigh them against the expected benefit for each individual patient.
- Post-embolization syndrome: fever, nausea, vomiting, and pain in the upper right abdomen in the days after the procedure; this is the most common side effect and usually managed with medication
- Liver injury: a temporary rise in liver enzyme levels (blood markers showing liver stress) that usually settles within a few weeks
- Non-target embolization: blocking arteries that feed healthy tissue rather than only the tumour, which can damage the gallbladder, stomach lining, or nearby bowel
- Liver abscess (a pocket of infection inside the liver), particularly in patients who have had previous biliary surgery
- Acute liver failure, especially if liver function is already compromised before the procedure
- Bile duct injury (biloma), causing bile to collect abnormally inside the abdomen
- Kidney injury from the contrast dye (iodinated contrast) used during imaging
- Bleeding or bruising at the catheter insertion site
- Infection at the insertion site or in the bloodstream
- Allergic reaction to the contrast dye or to the chemotherapy drugs used
Preparation & Procedure
Preparation for TACE usually begins several days before the procedure with blood tests and imaging, so the medical team can confirm the liver and kidneys are able to tolerate it. Your doctor will review all current medications and may pause blood thinners (anticoagulants) for a set number of days beforehand. Patients are usually asked to stop eating solid food at least six hours before the procedure and to stop drinking clear fluids at least two hours before, though your hospital may give slightly different instructions.
Smoking and alcohol are best avoided in the days leading up to TACE, because both affect the liver and recovery. If you take metformin for diabetes, the team may ask you to stop it a day or two before because of the way it interacts with contrast dye. Bring a complete list of all your medications, vitamins, and herbal supplements to your pre-procedure appointment.
Tests typically run before TACE include:
- Blood tests checking liver function (ALT, AST, bilirubin, albumin), kidney function (creatinine), blood clotting ability (INR/PT), and a full blood count
- Tumour marker blood test such as AFP (alpha-fetoprotein) for liver cancer
- CT scan or MRI of the liver and abdomen to map the tumour's blood supply and plan the catheter route
- Chest X-ray or CT to check for disease outside the liver
- Electrocardiogram (ECG) if heart monitoring is required before sedation
On the day of the procedure, the steps generally follow this order:
- 1. An intravenous (IV) line is placed in your arm for fluids and medications.
- 2. The groin or wrist area is shaved, cleaned, and numbed with a local anaesthetic (a numbing injection).
- 3. You are given sedation or, in some centres, a light general anaesthetic to keep you comfortable. You will be drowsy but usually able to respond to the team.
- 4. The radiologist makes a small puncture in the skin and inserts the catheter into the artery.
- 5. Using fluoroscopy (live X-ray) and contrast dye, the catheter is steered through the body's arterial network to the vessels feeding the tumour. This mapping is called a diagnostic angiogram.
- 6. The chemotherapy and embolic agents are injected through the catheter into the tumour's blood supply. The radiologist may reposition the catheter several times to treat all parts of the tumour.
- 7. A final angiogram is performed to confirm the tumour's blood supply has been adequately blocked.
- 8. The catheter is removed, and firm pressure or a closure device is applied to the puncture site to stop bleeding.
- 9. You are moved to a recovery or observation area.
Aftercare
Most patients stay in hospital for one to three nights after TACE so the team can monitor for post-embolization syndrome, check liver and kidney function through blood tests, and manage pain and nausea, which are expected and treatable side effects in the first few days.
- The puncture site in the groin or wrist should be kept dry and watched for swelling, bruising, or any new bleeding for at least 24 hours after discharge.
- Strenuous physical activity is usually restricted for about a week, and heavy lifting should be avoided for longer. Your medical team will give you a specific timeline based on how you recover.
- Fatigue is common for one to four weeks after the procedure and is a normal part of recovery, not a sign that something has gone wrong.
- Staying well hydrated helps the kidneys clear the contrast dye used during the procedure.
- A follow-up CT scan or MRI is usually arranged four to six weeks later to assess how the tumour has responded. This imaging guides the decision about whether a repeat session of TACE or a different treatment is needed.
- Liver function blood tests are typically repeated at regular intervals after discharge to catch any delayed changes early.
- Alcohol should be avoided completely during the recovery period, as the liver is under extra stress.
- Fever above 38.5 degrees Celsius, worsening abdominal pain, yellowing of the skin or eyes (jaundice), or any bleeding at the catheter site are reasons to contact the treating hospital promptly.
- If the procedure is part of a bridge-to-transplant plan, your oncology team will continue coordinating with the transplant team throughout your recovery.
Cost & What Determines It
The cost of TACE varies widely from one hospital to another and from one country to another, because the procedure involves specialised interventional radiology equipment, a multidisciplinary team, and materials that differ significantly in price depending on which type of TACE is performed and how complex the case is.
- Tumour complexity: a single, well-defined tumour requires less catheter work and fewer materials than multiple tumours or a tumour with an unusual blood supply.
- Type of TACE: conventional TACE uses an oil-based carrier mixed with chemotherapy drugs, while drug-eluting bead TACE (DEB-TACE) uses specialised beads that release the drug slowly. The beads cost considerably more than the oil-based approach.
- Hospital class and country: a university hospital in a high-income country typically charges more than a comparable centre in Southeast Asia or Eastern Europe, even for the same technique.
- Operating room and imaging time: longer or more complex procedures require more fluoroscopy time, more contrast dye, and more staff.
- Length of stay: one night versus three nights in hospital changes the bill noticeably.
- Anaesthesia type: sedation is generally less expensive than full general anaesthesia, and not all centres use the same approach.
- Pre-procedure imaging: a dedicated planning CT or MRI angiogram may be billed separately from the procedure itself.
- Post-procedure imaging: the follow-up CT or MRI scan four to six weeks later is usually a separate charge.
- Medications: anti-nausea drugs, pain management, and antibiotics administered during the hospital stay add to the overall cost.
- Repeat sessions: TACE is often performed more than once over the course of treatment, so the total cost must account for multiple sessions.
A hospital package for TACE typically covers the procedure room fees, the catheter and embolic materials, the chemotherapy drugs used during the session, the anaesthesia or sedation fee, and the hospital stay. Items that are often billed separately include the pre-procedure consultation, pre-procedure blood tests and imaging, the follow-up scan, outpatient medications for managing symptoms at home, and any complications that require additional treatment.
BPJS Kesehatan does not cover treatment abroad, and most Indonesian private insurance policies also exclude overseas care. Patients who travel for TACE generally pay out of pocket or through an international private health insurance plan that explicitly includes medical travel. Before booking travel, ask the hospital for a written itemised cost estimate that separates the package from any likely add-ons. This document protects you from unexpected invoices on discharge.
Frequently Asked Questions
How many TACE sessions will I need?
Most patients need more than one session, but the exact number depends on how the tumor responds after each treatment. Your doctor will usually repeat imaging, such as a CT or MRI scan, between sessions to check whether the tumor has shrunk and to decide if another round is needed. Some people have two or three sessions spread over several months, while others may need more.
What does TACE feel like, and is it painful?
During the procedure most patients feel little to no pain because a local anaesthetic is used at the entry point, usually in the groin or wrist, where a thin tube called a catheter is inserted into the artery. Afterward, it is common to feel tired, have a mild fever, and experience aching in the abdomen for a few days, a reaction doctors call post-embolization syndrome. Pain relief is typically given to keep you comfortable during this recovery period.
How soon will TACE start working?
The chemotherapy medication and the blocking of blood supply to the tumor both act from the moment of the procedure, but visible shrinkage takes time to show up on scans. Doctors usually wait four to six weeks before doing follow-up imaging to assess the response, because the body needs time to break down treated tissue. How well and how quickly the tumor responds varies from person to person.
How much does TACE cost?
The cost varies depending on the number of sessions required, the type of embolic agent (the tiny particles used to block the artery) chosen, the complexity of the tumor's blood supply, and the class of hospital where it is performed. A longer hospital stay or additional imaging between sessions will also affect the total. Requesting a written cost estimate directly from the hospital gives you the most accurate figure for your specific situation.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
