A 55-year-old patient with hepatocellular carcinoma (single 4 cm lesion) undergoes transarterial chemoembolisation (TACE). What is the principle underlying selective tumour embolisation in HCC?

• A HCC receives equal supply from portal vein and hepatic artery, and TACE blocks both
• B HCC derives >90% of its blood supply from hepatic artery branches, while normal liver parenchyma receives 75% from portal vein, allowing selective arterial embolisation to deprive tumour while sparing liver ✓
• C TACE works by delivering chemotherapy directly into the tumour through the portal vein
• D HCC tumours have no blood supply and are treated by direct percutaneous injection

Explanation

The selectivity of TACE exploits the dual blood supply of the liver. Normal hepatocytes derive ~75% of blood flow from the portal vein and ~25% from the hepatic artery. In contrast, HCC is almost entirely supplied by hepatic artery branches (>90%), typically forming neovascular sinusoids via hepatic arterial tumour supply. TACE delivers a chemotherapy drug (doxorubicin/cisplatin) mixed with lipiodol (or drug-eluting beads) followed by embolic particles directly into the tumour-feeding artery, causing tumour ischaemia and concentrated drug delivery while sparing the portal vein-supplied normal parenchyma. TACE is indicated for Barcelona Clinic Liver Cancer (BCLC) stage B (multinodular, preserved liver function).

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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