QUESTIONS TO ASK
ABOUT TACE
The right questions at the right consultation can change your treatment plan — by revealing a missed technique option, identifying a contraindicated drug interaction, or prompting a second opinion that overturns an 'inoperable' judgement. This guide organises the essential TACE questions by consultation stage.
analyticsAt a Glance
- check_circleAsk about centre TACE volume before committing — low-volume centres have significantly higher complication rates
- check_circleConfirm your Child-Pugh score and BCLC stage in writing — and ask what would change if the staging is different at diagnostic laparoscopy
- check_circleAfter first-session imaging: ask for mRECIST assessment specifically — not RECIST 1.1
- check_circleAsk whether a systemic therapy combination (TACTICS protocol, EMERALD-1 approach) is appropriate alongside TACE for your case
Why the Right Questions Change Outcomes
Cancer treatment decisions are made in consultations that typically last 20–30 minutes. The questions you ask in those minutes determine whether you receive the most appropriate treatment for your specific situation, understand what to expect, and know what warning signs require urgent attention. Most patients leave TACE consultations with unanswered questions — not because clinicians are withholding information, but because patients don't know what they don't know.
“A patient who asks 'how many TACE procedures do you perform per year?' may receive a number that prompts them to seek a second opinion at a higher-volume centre — and that single question could meaningfully change their complication risk and survival.”
The Questions That Most Commonly Change Management
In our experience facilitating second opinions for HCC patients, three question clusters most commonly reveal information that changes the treatment plan: questions about centre TACE volume (which can prompt referral from a low-volume to a high-volume centre); questions about systemic therapy combination eligibility (which can prompt adding sorafenib or immunotherapy alongside TACE that the local team had not discussed); and questions about the post-TACE imaging protocol (which can reveal that a centre is using RECIST 1.1 rather than mRECIST, leading to incorrect 'progression' calls).
How to Use This Guide
Take this guide to your consultations. You do not need to ask every question — select those most relevant to your situation. Write down the answers. If an answer is unexpected or inconsistent with what you have read here, this is a signal for a second opinion rather than a reason to immediately distrust your treating team — there are legitimate reasons for clinical variation, and a good clinician will explain their reasoning clearly.
Questions to Ask Before Consenting to TACE
At the pre-TACE consultation — before signing consent — these are the most important questions to raise.
- 1
About Your Eligibility
What is my BCLC stage and Child-Pugh score? How were these determined — from imaging alone, or from diagnostic laparoscopy? Has my case been reviewed at a hepatobiliary MDT that includes interventional radiology, hepatology, and surgery? Are there any borderline eligibility factors in my case that might mean TACE carries higher risk than average?
- 2
About This Centre's TACE Programme
How many TACE procedures does your team perform per year? What is your published or audited 30-day complication rate and major adverse event rate? What is your procedure-related mortality rate? Is there a hepatobiliary MDT that reviews all cases together — including surgeons, transplant physicians, and oncologists?
- 3
About the Technique
Will I receive cTACE or DEB-TACE — and why? Will the procedure be superselective (targeting my tumour's specific feeding branch) or segmental/lobar? Which chemotherapy drug will be used and at what dose? What embolic material will be used?
- 4
About Combination Therapy
Given current evidence (TACTICS protocol, EMERALD-1 trial), am I a candidate for adding systemic therapy alongside TACE? If yes, which agent — sorafenib (sequential), lenvatinib, or durvalumab + bevacizumab? If not, why not — is it liver function, performance status, or another reason?
- 5
About the Goal of Treatment
What is the intended outcome of this TACE — control of existing disease, bridge to transplant, downstaging to transplant eligibility, or palliation? How many TACE sessions are planned, and what criteria will determine when to continue versus stop? What is the plan if TACE does not work?
Questions to Ask After Your First Post-TACE Imaging
After the 4–6 week post-TACE MRI or CT — these questions ensure you receive the correct assessment and the right management recommendation.
- 1
About the Imaging Assessment
Was the response assessed using mRECIST (measuring the arterially enhancing viable tumour) or RECIST 1.1 (measuring total lesion size)? If RECIST 1.1 was used: what is the mRECIST assessment? For cTACE: does the Lipiodol retention pattern on CT suggest complete or incomplete devascularisation?
- 2
About Residual Viable Tumour
Is there any arterially enhancing viable tumour remaining within the treated lesion? If yes: where is it (peripheral rim, central zone) and what size? Does the residual tumour require retreatment, and if so, will superselective targeting of the residual rim be used?
- 3
About New Lesions
Have any new HCC lesions appeared in the liver since the last imaging? If yes: are these within the same vascular territory (treatable with TACE) or in new segments? Have any extrahepatic lesions appeared — lymph nodes, lungs, bones — that would change the BCLC stage from B to C?
- 4
About Liver Function Trajectory
Has my Child-Pugh score changed since before TACE? What are my current liver function blood tests (ALT, bilirubin, albumin, INR) and AFP compared to pre-TACE? Based on the ART score — is my liver function showing signs that further TACE sessions carry increasing risk?
- 5
About the Next Step
Based on this imaging and blood test results, what is the plan — immediate retreatment, surveillance, addition of systemic therapy, or discussion of alternative strategies? What would change that plan, and when should the next imaging assessment be scheduled?
Red Flag Answers: When to Seek a Second Opinion
The following answers to your questions should prompt consideration of a specialist second opinion — not necessarily because your treating team is wrong, but because these answers indicate either lower-quality practices or complex situations where specialist review is standard of care.
| Question Asked | Red Flag Answer | Why It Matters |
|---|---|---|
| How many TACE procedures does your team perform per year? | Fewer than 20–30 per year | Volume-outcome evidence is clear — complication rates are substantially higher at low-volume centres; consider referral to a higher-volume programme |
| Was my response assessed with mRECIST? | 'We used standard RECIST' / 'We measured the total size' | RECIST 1.1 systematically misclassifies TACE response — a 'progressive disease' call on RECIST may be complete response on mRECIST; insist on mRECIST assessment |
| Has my case been reviewed at an MDT? | 'No, my gastroenterologist makes the decision' / 'We discuss it informally' | All complex HCC cases should be formally reviewed at a dedicated hepatobiliary MDT — informal decision-making in a single specialty misses important inputs |
| Am I a candidate for systemic therapy alongside TACE? | 'TACE alone is fine; we don't do combinations here' | If you are Child-Pugh A and ECOG 0, the evidence for TACE + sorafenib (TACTICS) or TACE + immunotherapy (EMERALD-1) is established — a centre not familiar with these combinations should prompt specialist review |
| What is the plan if TACE doesn't work? | 'We'll cross that bridge when we come to it' | A competent TACE programme has a clear downstream plan — Y-90, systemic therapy, transplant evaluation — articulated before treatment starts; vague answers suggest limited programme scope |
| Is my BCLC stage confirmed by MDT? | 'I think you're BCLC B based on the CT' | Staging from CT alone misclassifies 30–40% of HCC patients — formal MDT staging with radiologist, hepatologist, and surgeon is the standard; single-physician CT-based staging is insufficient |
The Impact of Asking the Right Questions
Evidence-based figures on what appropriate questioning and second opinion-seeking achieves.
- 30–40%Of 'inoperable' patients reassessed as eligible at specialist hepatobiliary MDTThe most impactful second-opinion statistic in hepatic oncology — asking 'can a specialist MDT review my case?' leads to management change in nearly one-third of patients.
- 2–3×Higher complication rates at low-volume vs high-volume TACE centresThe direct clinical consequence of not asking 'how many TACE procedures do you perform per year?' — a question that may redirect a patient to a safer, higher-volume programme.
- mRECISTCorrect response assessment framework after TACE — not RECIST 1.1Patients who ask for mRECIST assessment after TACE avoid the systematic misclassification that causes correct responses to be called 'progression' under standard RECIST.
- 5 daysCancerFax turnaround for preliminary eligibility second opinionFor patients who want to verify a 'not eligible for TACE' judgement — CancerFax provides a specialist preliminary assessment within 5 working days of record submission.
More from the TACE Resource Library
Continue exploring TACE — from the basics through to access, costs, and follow-up guidance.
- Accessing TACE Through CancerFax: Patient Navigation Guide
- mRECIST Response Assessment for TACE: How Response Is Measured
- Repeat TACE: When to Retreat and When to Stop
- TACE Patient Selection: BCLC Staging and Child-Pugh Score
- TACE Cost Comparison: China vs India vs Western Countries
- TACE Therapy — Complete Treatment Guide
Frequently Asked Questions
Common questions from patients preparing to advocate for themselves in TACE consultations.
About Asking Questions
My doctor seems bothered when I ask too many questions — should I still ask them?
Yes — unequivocally. A clinician who is bothered by informed questions is not the right clinician for a complex treatment like TACE. You are being asked to consent to a procedure that carries real risks, will significantly affect your quality of life in the recovery period, and is one component of a multi-year treatment strategy for a life-threatening condition. Asking about complication rates, technique selection, systemic therapy eligibility, and response assessment criteria are not difficult questions — they are the questions any responsible patient should ask. If you find that a particular clinician discourages questions, seek a second opinion at a specialist hepatobiliary MDT where patient engagement in treatment planning is standard practice.
I have already had two TACE sessions — is it too late to get a second opinion?
No — a second opinion is appropriate at any point in the TACE treatment course, not only before the first session. Common points where second opinions change management mid-course: after the first imaging shows an unexpected response pattern (possible mRECIST vs RECIST misclassification); when liver function has deteriorated and the treating team is still proposing further TACE sessions; when the treating team has not discussed systemic therapy combination and you have read about TACTICS or EMERALD-1; or when you are uncertain whether TACE is still the right strategy versus transitioning to systemic therapy. CancerFax can arrange a mid-course specialist review — provide your treatment history, all imaging from before and after TACE, current blood tests, and AFP trajectory for the assessment.
How CancerFax Helps
CancerFax is a specialist cancer access and patient-navigation platform. We help patients and families understand their options, organise medical records, coordinate hospital communication, and support cross-border treatment planning where appropriate.
We help collect and organise reports, scans, pathology, biomarker results, and treatment history for structured case review.
We communicate with hospitals or trial teams to assess whether a case may be suitable for further screening.
We support appointment coordination, document submission, translation, and direct communication with international departments.
For international patients, we help with practical coordination — travel planning, hospital admission guidance, and local support.
If this option is not suitable, we help explore other relevant treatments, clinical trials, or advanced care pathways.
From inquiry through to follow-up, our coordinators provide a single point of contact for the family.
CancerFax does not guarantee treatment access, eligibility, or clinical outcome. Our role is to help patients access accurate information, structured review, and appropriate specialist pathways.
Want a Second Opinion Before Committing to TACE?
CancerFax can arrange a specialist hepatobiliary second opinion from high-volume TACE centres in China and India — reviewing your staging, eligibility, and proposed treatment plan before you make any decision. This service is provided at no charge to the patient.
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified oncologist before making treatment decisions.