Embolization for Liver Tumours

Why Embolization Works Well in the Liver

The liver has a unique dual blood supply:

• The portal vein, which primarily supplies healthy liver tissue
• The hepatic artery, which predominantly supplies liver tumours

This difference allows specialists to treat tumours selectively, minimising injury to surrounding liver parenchyma. In carefully selected patients, embolization can achieve effective tumour control with preservation of liver function.

Types of Embolization

Treatment is tailored to tumour type, stage, liver function, and overall treatment goals.

1. Transarterial Chemoembolization (TACE)
TACE combines local chemotherapy delivery with embolization.

A catheter is advanced into the artery supplying the tumour. Chemotherapy is delivered directly into the tumour, followed by embolic particles that block its blood supply.

This results in:

• High concentration of chemotherapy within the tumour
• Reduced systemic side effects compared to intravenous chemotherapy
• Prolonged exposure of tumour cells to the drug

TACE is commonly used in patients with Hepatocellular carcinoma and in selected patients with liver metastases.

2. Drug-Eluting Bead Chemoembolization (DEB-TACE)
DEB-TACE is an advanced form of TACE.
Microscopic beads are pre-loaded with chemotherapy before being delivered into the tumour-feeding arteries. These beads:

• Slowly release chemotherapy over time
• Provide sustained local drug delivery
• Further reduce systemic toxicity

This technique allows controlled, predictable dosing while simultaneously blocking blood flow.

3. Bland Embolization (TAE)
Also known as Transarterial Embolization (TAE), this approach blocks the tumour’s blood supply without chemotherapy.

It may be appropriate:

• When chemotherapy is not indicated
• In patients who may not tolerate chemotherapeutic agents
• In selected tumour types

Tumour control is achieved by depriving the lesion of oxygen and nutrients.

4. Transarterial Radioembolization (TARE / Y90)
TARE involves delivering microscopic radioactive beads (Yttrium-90) into the tumour’s arterial supply.

These beads emit targeted radiation within the tumour while limiting exposure to surrounding healthy liver tissue.
TARE may be recommended:

• In primary liver cancer
• In metastatic liver disease
• When tumours are large or multifocal
• When portal vein involvement is present (in selected cases)
• As a bridge to surgery or transplantation
• As a downstaging strategy

5. Percutaneous Trans-Hepatic Biliary Drainage (PTBD)
PTBD is a supportive image-guided intervention.

Liver tumours can sometimes obstruct bile ducts, leading to jaundice, infection, or impaired liver function. Under imaging guidance, a small catheter is inserted through the skin into the bile ducts to relieve obstruction and allow bile drainage.
PTBD may be required:

• Before embolization or systemic therapy
• To improve liver function
• To relieve symptoms of biliary obstruction

Restoring bile flow can improve safety and allow definitive cancer treatment to proceed.

Comparing The Types of Embolization

Which Treatment Is Right for You?

Treatment selection depends on multiple clinical factors. No single approach suits all patients.

TACE or DEB-TACE may be recommended when:

• You have Hepatocellular carcinoma at an intermediate stage
• The tumour is confined to the liver
• Liver function remains adequate
• A locoregional approach is preferred over systemic therapy

DEB-TACE may be chosen when controlled drug release and reduced systemic toxicity are priorities.

Bland Embolization may be considered when:

• Chemotherapy is not suitable
• The tumour type does not require drug delivery
• Minimising systemic side effects is essential

TARE (Y90) may be appropriate when:

• Tumours are large or multifocal
• Portal vein involvement is present (in selected cases)
• Previous embolization has not achieved desired control
• Downstaging is required before surgery or transplantation

PTBD may be required when:

• The tumour is causing bile duct obstruction
• Jaundice or infection is present
• Liver function needs optimisation before definitive treatment

A Personalised Decision

The right treatment is determined after careful assessment of:

• Tumour size, number, and location
• Liver function and reserve
• Presence of portal vein involvement
• Overall health status
• Treatment intent (curative, downstaging, or disease control)

At RIVEA, these decisions are made through multidisciplinary discussion to ensure that tumour control is balanced with preservation of liver function and long-term safety.

Who May Benefit from Embolization?

Embolization may be recommended for:

• Patients with primary liver cancer such as Hepatocellular carcinoma
• Patients with liver metastases (e.g., colorectal cancer)
• Tumours not suitable for surgical removal
• Patients awaiting liver transplantation (bridge therapy)
• Patients requiring tumour shrinkage before surgery (downstaging)

What to Expect

Before the Procedure
You will undergo blood tests and detailed imaging (CT or MRI). Liver function and clotting parameters are assessed. Certain medications may need to be adjusted.

During the Procedure
The procedure is performed under conscious sedation or general anaesthesia. A small catheter is inserted through the wrist or groin and guided into the liver arteries using real-time imaging. Treatment is delivered directly to the tumour.

Most procedures take 1–2 hours.

After the Procedure
You will be monitored for several hours. Many patients stay overnight. Temporary symptoms such as pain, fatigue, nausea, or low-grade fever (post-embolization syndrome) may occur for a few days.

Most patients resume normal activities within one to two weeks.

Why RIVEA

At RIVEA, embolization procedures are performed by dedicated interventional radiology specialists with expertise in complex vascular and oncologic interventions.
We offer:

• Advanced imaging infrastructure for high-precision treatment
• Multidisciplinary tumour board decision-making
• Expertise in managing patients with underlying liver disease
• Organ-preserving treatment strategies focused on long-term outcomes
• Structured follow-up and response assessment

Every case is evaluated individually. Our goal is not only tumour control, but preservation of liver function and quality of life.