A Look at Our Novel Cancer Treatments

If you or a loved one is suffering from cancer, you may have heard of radiofrequency ablation or transarterial chemoembolization (TACE) in Houston. These minimally invasive procedures can be effective in treating certain types of cancer.

Radiofrequency ablation is used most commonly for liver tumors. Using ultrasound guidance, an interventional radiologist places a needle electrode through the skin and into the tumor under local anesthesia and light sedation. An electrical current then passes through the electrodes and causes the tissues to heat up, destroying the cancerous tumor. This treatment can be used in patients who are unable to undergo surgery or who have small tumors.

Transarterial chemoembolization (TACE) is a minimally invasive procedure which decreases the blood supply to a cancerous tumor by delivering tiny beads which may also be laden with chemotherapy agents directly to the arteries feeding the tumor. This causes the tumor to eventually shrink and die. Like radiofrequency ablation for cancerous tumors, TACE is often used in liver cancers in patients unable to undergo surgical resection.

At Premier Vein & Vascular Center, our team of physicians are able to use this highly specialized form of vascular treatment to treat cancers in a minimally invasive way. Radiofrequency ablation works by targeting the cancerous tissue directly while TACE functions to attack the tumor by removing its blood supply.

These novel therapies can be used to treat liver cancer as well as kidney cancer, bone cancer, and lung cancer.

What Are Minimally Invasive Cancer Treatments?

Interventional oncology is the branch of interventional radiology that treats cancer using image guidance. Instead of opening the abdomen or chest, the interventional radiologist uses ultrasound, CT or live X-ray (fluoroscopy) to guide a thin needle or catheter directly to the tumor or to the artery that feeds it. Treatment is delivered exactly where it is needed, which spares much of the healthy tissue around it.

These treatments do not replace surgery, chemotherapy, immunotherapy or radiation therapy. They sit alongside them. In practice, decisions about treatments such as radiofrequency ablation and TACE are usually made by a team that includes the patient’s medical oncologist, surgeon, hepatologist or other specialist and the interventional radiologist. At Premier Vein & Vascular Center, Dr. Syed Raza brings fellowship training in interventional radiology and experience as a former Chief of Interventional Radiology at UTMB Galveston and Memorial Hermann Memorial City to that conversation. You can read an overview on our oncology treatment page.

Why the Liver Is So Often Treated With These Cancer Treatments

The liver has an unusual blood supply. Healthy liver tissue gets most of its blood from the portal vein, while liver tumors draw most of theirs from branches of the hepatic artery. That difference is what makes TACE possible: blocking the arteries that feed a tumor starves it while the healthy liver continues to be nourished by the portal vein.

The liver is also a common site for two kinds of cancer:

• Primary liver cancer, most often hepatocellular carcinoma (HCC), which usually develops in a liver already damaged by cirrhosis, hepatitis B or C, alcohol or fatty liver disease.
• Metastases, which are cancers that started elsewhere, such as the colon, and spread to the liver.

Many patients with liver tumors are not good candidates for surgery because of the size or position of the tumor, the health of the rest of the liver, or other medical conditions. For these patients, image-guided treatments can offer local tumor control with a shorter recovery.

How Radiofrequency Ablation Works, Step by Step

Radiofrequency ablation uses a high-frequency electrical current to heat tumor tissue until the cells die. Because the heat zone is limited, RFA is best suited to small tumors, typically up to around 3 centimeters, although the exact limit depends on location and the device used.

1. Preparation. Blood tests check clotting and liver function. Some blood thinners may need to be paused, but only on the advice of the prescribing doctor.
2. Anesthesia. The skin is numbed with local anesthetic and sedation or general anesthesia is given so you stay comfortable.
3. Needle placement. Using ultrasound or CT guidance, the radiologist passes a thin electrode through the skin into the center of the tumor.
4. Ablation. The current is switched on for several minutes, creating a zone of heat that covers the tumor plus a small margin of normal tissue.
5. Track ablation and removal. The needle track is often heated as it is withdrawn to reduce bleeding and the chance of seeding tumor cells.

Many patients go home the same day or after one night. Mild pain at the site, tiredness and a low-grade fever for a few days are common as the body clears the treated tissue. A follow-up CT or MRI, usually about a month later, shows whether the whole tumor has been treated.

Ablation outside the liver

The same principle can be used for selected tumors in the kidney, lung and bone. Small kidney tumors in older patients or those who cannot have surgery, small lung nodules in patients with limited lung function, and painful bone metastases are examples where ablation may be discussed.

How TACE Works, Step by Step

Transarterial chemoembolization combines two effects: a high local dose of chemotherapy, and blocking the tumor’s blood supply so the drug stays in place longer and the tumor is starved of oxygen.

1. Access. Through a small puncture in the artery at the wrist or groin, a thin catheter is threaded into the hepatic artery under X-ray guidance.
2. Mapping. Contrast dye shows the arteries feeding the tumor so the radiologist can avoid vessels that supply the stomach, bowel or gallbladder.
3. Delivery. A microcatheter is advanced as close to the tumor as possible, and chemotherapy, often loaded onto tiny drug-eluting beads, is injected.
4. Embolization. The beads lodge in the small tumor vessels and slow or stop the blood flow.
5. Closure. The catheter is removed and the puncture site is closed with pressure or a closure device.

Patients usually stay in the hospital overnight. TACE may be repeated over several sessions depending on the response seen on follow-up imaging.

RFA vs TACE vs Surgery: How the Options Compare

The right treatment depends on the number, size and location of tumors, liver function and overall health. This table is a general guide only.

Sometimes the treatments are combined. For example, TACE may be used first to shrink a tumor, followed by ablation, or as a bridge to keep a cancer under control while a patient waits for a liver transplant.

Who Is a Candidate for Ablation or TACE?

Every case is individual, but these treatments are commonly considered when:

• The cancer is mostly confined to the liver or the organ being treated
• Surgery is not possible or not the best option because of tumor location, liver health or other illnesses
• The patient’s liver function is good enough to tolerate treatment
• The goal is to control the tumor, relieve symptoms, bridge to transplant or work alongside systemic therapy

These treatments are usually not recommended when the cancer has spread widely throughout the body, when liver function is severely impaired, or when certain blockages of the portal vein are present. Your team will explain how these factors apply to you.

What Recovery Feels Like and Possible Side Effects

After TACE, many patients have what is called post-embolization syndrome: fatigue, nausea, mild fever and pain in the upper right abdomen for several days as the tumor tissue breaks down. This is expected and is usually managed with medication. Hair loss and the whole-body side effects of standard chemotherapy are much less common because most of the drug stays in the liver.

After ablation, discomfort is usually mild. Less common risks of either procedure include bleeding, infection or abscess in the treated area, injury to nearby structures and, rarely, worsening liver function. We review these risks in detail before any procedure.

Supportive Procedures for Patients With Cancer

Interventional radiology also makes cancer care easier day to day. Many patients receiving chemotherapy need reliable venous access for repeated infusions and blood draws. A port-a-cath placement places a small device under the skin of the chest that connects to a large vein, so treatment can be given without repeated needle sticks in the arm. Other forms of venous access are also available depending on the treatment plan. Image-guided biopsies are another common way interventional radiologists help confirm a diagnosis.

Questions to Ask Your Care Team Before Treatment

Patients and families often tell us they did not know what to ask. These questions help make sure everyone understands the plan:

• What is the goal of this treatment for me: cure, control, symptom relief or a bridge to transplant?
• Why is ablation or TACE recommended over surgery or other options in my case?
• How many sessions are likely, and how will we know whether it worked?
• Which of my medications, especially blood thinners or diabetes medicines, need to be adjusted beforehand?
• How long will I be in the hospital, and when can I return to work or drive?
• Who should I call if I have fever, pain or other problems after I go home?
• How will this treatment fit with my chemotherapy, immunotherapy or radiation schedule?

It helps to bring a family member and a written list to the consultation. We would rather spend extra time answering questions than have you leave unsure about what comes next.

How We Evaluate Patients for Image-Guided Cancer Treatment

1. Records review. We review your diagnosis, pathology, prior treatments and the plan from your oncologist or referring physician.
2. Imaging. Recent CT or MRI scans are studied to measure the tumors, map their blood supply and check the health of the surrounding organ.
3. Blood tests. Liver and kidney function, blood counts and clotting are checked to make sure treatment is safe.
4. Consultation. Dr. Raza explains which procedure fits your situation, what it involves, expected recovery and alternatives.
5. Coordinated plan. Scheduling and follow-up imaging are coordinated with your oncology team so every specialist is working from the same plan.

Minimally Invasive Cancer Treatment in Houston

If you or a family member has been diagnosed with a liver tumor or another cancer and you want to know whether an image-guided option could be part of the plan, ask your oncologist about a referral or contact us directly. Our interventional radiology and vein clinic in Houston works closely with referring physicians across Houston and Katy. Same-week consultations are usually available, and most insurance plans, including Medicare, are accepted.

Frequently Asked Questions

Is radiofrequency ablation painful?

The procedure is done under sedation or general anesthesia, so most patients feel little during treatment. Afterward, mild pain at the site and tiredness for a few days are common and are usually managed with simple pain medication.

How long does TACE take?

The procedure itself usually takes one to two hours, depending on the number of tumors and the anatomy of the arteries. Most patients stay in the hospital overnight for observation and pain control.

Can TACE cure liver cancer?

TACE is most often used to control liver tumors, slow their growth, relieve symptoms or keep a cancer in check while waiting for a transplant. In selected small tumors, combinations with ablation may achieve complete local response. Your team will explain the realistic goal in your specific case.

What is post-embolization syndrome?

It is a common, expected reaction after TACE that includes fatigue, nausea, low-grade fever and upper abdominal pain for several days. It happens as the treated tumor tissue breaks down and usually improves with rest and medication.

Do I still need chemotherapy if I have ablation or TACE?

That depends on the type and stage of your cancer. Some patients need only local treatment, while others receive it alongside systemic chemotherapy, immunotherapy or targeted drugs. The decision is made with your oncologist.

How do I know if I am a candidate for image-guided cancer treatment?

Candidacy depends on the number, size and location of tumors, your liver or organ function and your overall health. A review of your recent CT or MRI scans, blood tests and treatment history by an interventional radiologist is the best way to find out.