A 65-year-old male with unresectable hepatocellular carcinoma (HCC) confined to the liver (Barcelona Clinic Liver Cancer stage B — intermediate) is planned for transarterial chemoembolisation (TACE). The principle behind TACE is:

• A HCC derives its blood supply from the portal vein; portal vein embolisation is performed
• B HCC derives 80–90% of its blood supply from the hepatic artery; selective intra-arterial chemotherapy with embolic agents causes ischaemic and cytotoxic tumour necrosis while sparing the portal vein-supplied normal liver ✓
• C Microwave ablation is delivered through the hepatic artery catheter
• D Lipiodol alone is injected into the portal vein to embolise the tumour

Explanation

Normal hepatic parenchyma receives dual blood supply (70–75% portal vein, 25–30% hepatic artery), whereas HCC derives 80–90% of its blood supply exclusively from the hepatic artery (neoangiogenesis). TACE exploits this by selectively catheterising the hepatic artery branches feeding the tumour and injecting a chemotherapy-lipiodol emulsion followed by embolic particles (e.g., gelatin sponge, drug-eluting beads). This maximises drug delivery and ischaemia to the tumour while the normal liver continues to be nourished by the portal vein, allowing treatment of BCLC-B disease with improved survival.

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

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