Heat treatment for liver cancer (thermal ablation)

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

There are 2 types of thermal ablation used to treat liver cancer. These are:

• radiofrequency ablation (RFA) which uses a type of electrical energy

• microwave ablation (MWA) which uses microwave energy

Thermal ablation is a treatment for primary liver cancer. Primary liver cancer is different to cancer that spreads to your liver from somewhere else in your body. This is called secondary liver cancer or liver metastases.

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 the gallbladder)

• you are not well enough to have surgery

For a very small cancer in the liver you might have thermal ablation instead of surgery.

Thermal ablation is not a suitable treatment if the cancer is larger than 3cm. Or if it has spread into the blood vessels, lymph nodes or other parts of your body. You need to be generally healthy, and the rest of your liver must be working well.

You can have treatment several times. You might have RFA or MWA alone, or with other treatments. Some people have thermal ablation during liver resection surgery.

How do you have thermal ablation?

Preparing for treatment

You may 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.

Tell your doctor if you're having medicine that changes how your blood clots. This includes:

• aspirin
• clopidogrel
• arthritis medicines
• warfarin or heparin
• apixaban or rivaroxaban
• ticagrelor

Your doctor will tell you if you need to stop taking these or any other medicines for a while before your treatment.

You can't eat for 4 to 6 hours before the ablation but you might be able to drink sips of water up to 2 hours before your appointment. Your doctor or nurse gives you written instructions about this before.

Talk to your doctor if not eating could be a problem for you. For example, if you have diabetes.

Having treatment

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

A specialist doctor called an interventional radiologist carries out the procedure. Radiographers and nurses will also be with you in the room.

First you get changed into a hospital gown. You lie on your back on the x-ray table. Your doctor or nurse puts a small tube (cannula) into your arm or back of your hand. They use the cannula to give you any medicines you might need, such as antibiotics, sedation, or pain relief. Your nurse regularly checks your heart rate and blood pressure. You might have oxygen through a small plastic tube or sponge which sits just inside your nostril. 

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

Your radiologist uses either an ultrasound scan or a CT scan to guide a special needle through your skin into the cancer. Once it is in the correct place, the needle is heated using electrical or microwave energy. The needle heats the cancer cells and destroys them. 

The time your treatment takes can vary. It can take anything from 30 minutes to a couple of hours in total. 

After treatment

Your doctor removes the needle when the treatment has finished and covers the area with a dressing. You go back to the ward where your nurse will monitor you. Let them know if you feel sick or have any pain.

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 stay in hospital for the night. You should be back to doing your normal activities after about a week.

You usually have a scan about 4 to 6 weeks after ablation treatment to check how well it has worked.

What are the side effects of thermal ablation?

As with any medical procedure there are possible side effects or complications. Your doctor makes sure the benefit of the treatment outweighs these risks. Possible side effects of thermal ablation 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 went into your skin. Treatment to the liver can also cause shoulder pain. This is caused by pain travelling along a nerve near the liver, which connects to nerves in the shoulder. It’s called referred pain.  

You will have painkillers to take home, although you may not need to use them. Contact your healthcare team if your painkillers are not working. Also let them know if your pain isn't getting better, or if the pain gets worse. 

Flu-like symptoms (post ablation syndrome)

Some people have flu-like symptoms that start about 3 to 5 days after treatment. You feel tired, generally unwell, have body aches and you may feel sick. This might last 1 to 2 weeks.

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. This is rare because the doctor uses scans to help guide the probe to the right place. The heat only travels a short distance, so it doesn’t generally affect the rest of your liver tissue.

Bleeding

There is a risk of bleeding caused by the needle going into the liver. This is 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 cancer. Or that it grows back (recurs). You may be able to have the area treated again. This can be done a few weeks after the first ablation.