Have you had TACE or SirSpheres radiation treatment? Please share

Dear sue_in_delaware,

I had the TACE procedure last Thursday (Nov. 12). Please feel free to ask me anything you want about the procedure and I will be happy to answer you/walk you through it. I am the gist patient mentioned above ^^.

Take care,
Laydeewinx

Hi @Laydeewinx. Thanks for joining us here on Connect. I love it when networks of connections intersect.

I'd like to ask you about the TACE (transarterial chemoembolization) procedure. Can you walk us through it? For example, were you sedated, general or local? How long did you stay in the hospital? What did it feel like? How are you feeling now?

That's a lot of questions. You don't have to answer them all 🙂

Thanks so much for replying. Colleen saw your reply before I got here, but my questions are much like hers for now so I won't repeat them as you probably see here questions above (or below?) Any info you can tell us will be helpful. I can't remember at the moment why my Interventional Radiologist told me to try Sir-Spheres first, and if that doesn't work, we'll do TACE later. Is yours a liver tumor or elsewhere? Thanks again.

Hi ladies,

I will try to answer as best I can, please keep in mind that I am an art historian so my "medicalese" is not really up to snuff 😉

A little bit of history: My primary tumour is in my duodenum and I have multiple mets in both sides of my liver. I also have a bleeding issue where my liver randomly decides to split open and bleed. There is no rhyme or reason to it, and no way to prevent it from happening. It has happened to me 4 times in 2.5 years so it makes treatment options where internal bleeding is a potential side effect a giant no-no for me, thus we have to find alternate solutions. I was supposed to have a liver resection in summer 2014, but when the surgeon got there he decided that my liver "felt funny" and that it would not be safe enough to resect, so they did an open RFA instead.

Fast forward to this fall: There was not really any advanced preparation to do in the weeks before TACE, other than to make sure that my liver was strong enough to withstand the procedure. The procedure was set for November 12 and I went through the usual pre-op "speed dating" session where you get your blood tested (there was an extra, special TACE related blood test that they had to do... ), meet a nurse, meet a doctor, etc... Then I was told they would call me the day before to confirm. They called me Wednesday afternoon to tell me they had a bed for me and that I should admit myself later that afternoon (which was a bit of a problem since no one told me about having to be there before... but my husband and I worked out the kinks and we got there around 8pm.)

The fist thing they make you do is take an antimicrobial shower and put on the gown and any pj pants/slippers etc... you amy have brought with you. Then they install (insert?) two IVs one on each arm, take blood pressure, temperature etc... and then they pretty much left me alone until 4:30am when they made me take another antimicrobial shower and then started the IV fluids. They said that they found that TACE works a lot better if your kidneys are functioning really well, so they keep you SUPER hydrated. They also inserted a foley catheter. I was also not allowed to eat/drink anything until MUCH later that day.

Around 8:45 they came to bring me to angio where there was a LOT of waiting around, bring a blanket and socks - it gets chilly. I forgot to wear socks and I regretted it, also bring easy to slip on footwear like crocs, or similar - just because after they remove the catheter you will be going to the washroom a LOT!!

Once I was finally in the actual procedure room, I climbed upon a really narrow table and they covered me until the prep person came. They had a lot of IV bags full of antibiotics, the chemo, anti-inflammatories, and morphene that they were prepping for later use. I asked about them all and they were super nice when they explained them all to me. So the prep person came and prepped the table of tools that they would be using and then prepped me. Be prepared to be shaved down *there* if you are not already. Then they put on disinfectant and a very large blue paper cloth that covered me from my neck to my ankles (I am also 5'8" so I imagine it would cover a less tall person completely.) The person who was doing the actual procedure came in and explained that they were going to give me a local anesthetic and that they were going to put a hole in my leg to my femoral artery where they were going to place a catheter that would go up to my liver, then they "park" the catheter and inject the chemo and the other IVs mentioned previously, directly into my liver. They said the longest part of the procedure was the actual infusion. There were moments when he was going up the artery that he asked me to hold my breath. I was not sedated per se, but I was experiencing some back pain so they gave me a little morphene to take the edge off which made me very compliant.

When the infusions were over they removed the catheter and bandaged me up (I have a 1/4" incision, not even enough for a stitch.) Afterwards, you are not allowed to move your leg for about 6.5 hours just in case you should open up the wound and start bleeding from the femoral artery - no bueno. They kept up with the anti-inflammtories, anti-nausea, and pain killers the whole time I was there so I felt pretty good, albeit sleep deprived. I was there from Wednesday 8pm until Friday around noon. The procedure itself didn't feel like anything. But there is a big concern about pain and nausea afterwards, so they take care of you very well to make sure none of those things happen.

Now, I still have some pain, but honestly I have not been sitting around resting either, I have been going out and doing stuff. As a Masters student, it is necessary to keep moving. I am not sure how I would feel if I took a few days to rest, maybe the same, maybe better. I am not sure.

Follow up includes, 4 blood tests at specific intervals and then a CT scan on January 7, 2016 to see how things are shrinking and then we will discuss doing the other side. They chose the left side this time because that is where my largest tumour is/was.

Laydeewinx

Dear Laydeewinx,

Thanks so much for your detailed description of the TACE procedure. (So sorry about your duodenum and bleeding liver!) Your "medicalese" is just fine and as I was reading your story I felt like I was right there with you.

I'll come back after my Sir-Spheres microspheres procedure and hope I can give as good a description as you did with your treatment because I believe that these (on this and other forums) help so many people in many ways.

Please keep us posted as you progress.

Thanks again,
Sue

I had the SIRT procedure on Tues. Nov 24th at the University of Pennsylvania Hospital in Philadelphia (some call it Y-90 or SIR-Spheres but same thing.) I arrived at around 10am and they had me undress and put me in a gown. (No catheter, but in hindsight, it would have been a good idea, because when I came back to the recovery room I had to pee and ask for the bed pan 3 times. Each time it as a mess and they had to change my sheets and gown, sheesh! ) They accessed my chemo port catheter for the IV solutions. (This was the first time I ever let anyone other than the chemo nurses mess with my port, but this particular nurse had experience with them, she said.)

By 10:30 I was wheeled to the radiology room. They gave me sedation but it was just enough to stay awake yet not feel pain for the incision to my femoral artery. No antimicrobial shower like Laydeewinx had, just a quick shave and a scrub down in the groin area. The "awake sedation" must be a tricky business. I suppose as they watch you start to nod off, they know they can start the procedure. I could tell they had made the cut but it didn't hurt. Then at one point they told me to "take a deep breath, exhale ... STOP breathing, hold-it, hold-it, don't breathe, don't breathe.......OK breathe." That happened about 3 times. There were several times when I felt a sort of jam or pushing sensation in my abdomen and I jumped but in a split second they pushed more sedative through the IV and I relaxed again.

It was done in about 60 minutes (or less) and I was sent back to the recovery room and told not to move my right leg and lay still for 4 hours. They disconnected the IV fluids bags. Within a few minutes I had to pee and they brought the bed pan, but as I said above, what a mess that was. Each time they go to take the bed pan away it sloshes all over the place. ugh.

They gave me water and crackers. I had a crushing headache and awful stomach pain so they put Dilaudid in my IV and gave me an Rx to get some at home. The Dilaudid did help my headache but made me very dizzy and did not much help the stomach pain. I felt as if I had been pummeled by a boxing champion and my insides were in excruciating pain. They gave me an Rx for Prilosec 20mg to help with heartburn and an Rx for a 6-day 21 pill-pack of steroids.

Once at home, I laid around a couple days and took a few steroids and a couple Dilaudid, however, I didn't like being dizzy and not being able to walk around without falling over, so I stopped the Dilaudid and used Tylenol. I had nausea and didn't feel like eating for a few days. I took my anti nausea meds from when I was having chemo. I was constipated for 5 days (even though taking stool softeners and Miralax, so ended up trying a Fleet Enema which gave some relief.)

It's been a week now and I'm starting to feel normal again. I go back in a few months for scans to observe for shrinkage. They'll do regular blood tests in the meantime to check liver function. Last night I resumed my Xeloda pills and have an appointment on Friday with my regular Oncologist at the chemo center here in Delaware. She's the one prescribing the Xeloda and will help with dosage or adjustments if I have severe side effects etc.

So now we wait and see!

Hi Sue! Thank you for coming back to share your experience. Your post along with @Laydeewinx's about TACE will surely help the next person who searches for information comparing these 2 treatments. It's the specific things about what to wear, how to prepare, bed pans, catheters and pain that people can't read in pamphlets. Thanks for both of you.

Sue glad to hear you're starting to feel normal again. Do you tolerate Xeloda well?

@Laydeewinx how are you doing?

I was on Xeloda (3000mg a day --1500 mg taken after morning meal and again after evening meal) for 2 weeks. By about the 10th day into it the only annoying side effect was itching, peeling skin with some blisters forming on my feet and toes. (They had turned a dark color, almost purple looking.) Then the 3rd week was my one week "off" and the toes and feet issues cleared up. It will be interesting to see if the foot syndrome is cumulative and gets worse, or, if it just starts to get bad by the 10th day and then clears up on the next week off. I have heard that some people had to reduce their dose to 2000mg a day (or less) for debilitating hand/foot syndrome, so we shall see!

@sue_in_delaware It sounds like you might be experiencing hand-foot skin reaction which can be a side effect of some oral chemotherapy treatments like Xeloda. For more about this skin reaction, see this link:
http://www.mayoclinic.org/diseases-conditions/cancer/expert-blog/oral-chemotherapy/bgp-20056402
and also this link: http://www.mayoclinic.org/diseases-conditions/cancer/expert-blog/hand-foot-syndrome/bgp-20056309

Thanks for those links smness. They give good suggestions on how to deal with side effects. I had a visit with my Oncology doc who is prescribing the Xeloda last Friday. She says to let her know if the symptoms become unbearable and she'll switch me to one week on and one off. So far it's not that bad though. Now if only the fatigue would stop, which is probably the hardest thing for me to deal with. I never used to have to take a nap in the middle of the day and the all-day long "sluggish" feeling, ugh. (I have read where the radiation procedure causes fatigue too, so maybe I got a double-whammy with these lol.)