A 65-year-old with inoperable hepatocellular carcinoma (HCC) and Child-Pugh A cirrhosis undergoes transarterial chemoembolisation (TACE). The procedure involves selective catheterisation of the hepatic artery supplying the tumour and injection of a chemotherapeutic-Lipiodol mixture followed by embolic material. The therapeutic principle exploiting HCC's unique blood supply is:

• A HCC has a portal blood supply that is blocked by embolisation
• B Lipiodol is taken up by normal liver but rejected by HCC
• C HCC derives >90% of its blood supply from the hepatic artery (neoangiogenesis), whereas normal hepatic parenchyma receives 75% portal and 25% arterial blood — arterial embolisation selectively starves the tumour ✓
• D Chemoembolisation disrupts the bile duct supply to the tumour

Explanation

Normal hepatic parenchyma receives a dual blood supply: ~75% portal venous and ~25% hepatic arterial. HCC, however, generates new arteries (angiogenesis) and derives >90% of its supply from branches of the hepatic artery. This dual supply is exploited by TACE: selective hepatic arterial catheterisation and embolisation starves the tumour (cuts its dominant supply) while the surrounding parenchyma survives on the portal supply. Lipiodol selectively retained in HCC serves as a carrier for chemotherapy and an embolic depot.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.