Treatment using heat to destroy liver cancer (thermal ablation)

Ablation means to destroy. Doctors can use heat to destroy tumours that started in the liver (primary liver cancer).

The 2 types of thermal ablation for liver cancer are:

• radiofrequency ablation (RFA)
• microwave ablation (MWA)

What is radiofrequency ablation and microwave ablation?

Radiofrequency ablation (RFA) is a type of electrical energy.

You have RFA using one or more special needles called needle electrodes. The electrical current from the needle heats the cancer cells to high temperatures which destroy them. The heat only travels a short distance, so it doesn’t generally affect the rest of your liver tissue. You usually have the needles through your skin into the tumour. This is called percutaneous ablation. Some people might have this treatment as part of an operation. But this is more unusual.

You have microwave ablation (MWA) in a similar way to RFA. But MWA uses a different type of energy called microwave energy. 

When you might have thermal ablation

Your doctor might recommend RFA or MWA if you can’t have surgery to remove your cancer. This could be because:

• the position of the cancer makes surgery difficult (for example, if it is near a major blood vessel or near the gallbladder)
• you are not well enough to have the surgery

For a very small tumour in the liver you might have thermal ablation instead of surgery (liver resection).

These treatments generally work best on small cancers. For example, cancers that are smaller than 3cm. But doctors sometimes use ablation to treat larger tumours. Your doctor can explain whether this treatment is suitable for you.

You can have treatment several times. You might have RFA or MWA alone, or with other treatments.

Before your treatment

You have an appointment at the pre assessment clinic about a week before your treatment. This is to prepare you for the treatment and check you are well enough to have it.

You might need tests such as blood tests and an ECG to check your heart.

The nurse explains exactly what will happen on the day. Do use this time to ask any questions you might have.

Let them know if you have any allergies or are taking any medicines that change how your blood clots. These medicines include:

• aspirin
• clopidogrel
• arthritis medicines
• blood thinning medicines such as warfarin, rivaroxaban and dabigatran

How you have thermal ablation

You go into hospital on the day of your treatment or the evening before.

You have the treatment in the operating theatre or scanning (x-ray) department of the hospital. You can’t eat for at least 6 hours before you have it. But you can usually drink water up to 2 hours beforehand. Your appointment letter will tell you about this.

You might have RFA or MWA under general anaesthetic, which means you are asleep. Or you might have a drug that makes you sleepy (sedation) and a local anaesthetic to numb the skin above the liver. You will also have strong painkillers during treatment.

Your doctor (interventional radiologist) uses either an ultrasound scan or a CT scan to guide the needle through your skin into the tumour. The needle heats the tumour and destroys it. The time this takes varies. It can take anything from 30 minutes to a couple of hours in total. 

Nurses monitor you throughout the procedure. They check your blood pressure, pulse and oxygen levels.

Your doctor removes the needle when the treatment has finished and covers the area with a dressing.

After thermal ablation

You usually have to stay in bed for a few hours after the procedure. You can start eating and drinking once you are fully awake and feel up to it. You usually go home the next day. You should be back to doing your normal activities after about a week.

You usually have a scan about 4 to 6 weeks afterwards to check how well the treatment has worked.

Side effects

As with any medical procedure there are possible side effects or complications. Your doctor makes sure the benefit of the treatment outweighs these risks. Side effects include:

• discomfort or mild pain
• feeling unwell with a slightly raised temperature (flu-like symptoms) for a few days
• infection
• damage to the surrounding area
• bleeding

Discomfort or pain

You will probably have some discomfort or mild pain where the needles have gone into your skin. Treatment to the liver can also cause shoulder pain in some people. This is caused by pain travelling along a nerve near the liver, which is connected to nerves in the shoulder. It’s called referred pain.  

You will have painkillers to take home, although you may not need to use these. Contact your healthcare team if you are taking painkillers and they are not working. Also let them know if you have still have pain 1 or 2 weeks later, or if the pain is getting worse. 

Flu-like symptoms (post ablation syndrome)

Some people have flu-like symptoms that start about 3 to 5 days after treatment and can last up to a week. You feel generally unwell, have body aches and you may feel sick. This is due to a side effect called post ablation syndrome. Before you go home, your healthcare team will explain this syndrome. They will go through what medicines you can take to relieve your symptoms.

Contact your healthcare team if you feel unwell after this time or have a temperature above 38°C. You may have an infection that needs treatment. 

Damage to the surrounding area

During the procedure, there is a small risk of damaging structures near the liver. For example, damage to the bile ducts, bowel or gallbladder. But this is rare because the doctor uses scans to help guide the probe to the right place.

Bleeding

Another risk is bleeding caused by the needle going into the liver. This is also rare. Your doctor and nurses monitor you closely during and after treatment. So if this happens, they deal with it straight away. You might need to have a procedure, such as an angiogram, to stop the bleeding. You may also have a blood transfusion if you have lost a lot of blood.

Risk of your cancer coming back

There is a risk that thermal ablation does not completely get rid of the liver tumour. Or the tumour grows back (recurs). You may be able to have the area treated again. This can be done a few weeks after the first ablation.