Radiofrequency ablation

Radiofrequency ablation (RFA) uses heat to kill cancer cells. You can have it to get rid of your cancer, to control its growth or to control symptoms. You might have it alone or with other treatments. 

What is radiofrequency ablation (RFA)?

Radiofrequency ablation (RFA) uses heat made by radio waves to kill cancer cells. Radiofrequency is a type of electrical energy. Ablation means destroying completely.

You have RFA using one or more special needles called needle electrodes. An electrical current passes through the needle to heat the cancer cells to high temperatures which destroys them. You usually have the needles through your skin into the tumour.

Who can have RFA?

RFA is not usually the main treatment for cancer. You might have RFA alone, or in combination with other treatments, if you have:

• primary liver cancer
• secondary cancer in the liver
• primary lung cancer
• secondary cancer in the lung
• kidney cancer
• secondary cancer in the bones

Your doctors might recommend RFA if you can’t have surgery to treat your cancer. This could be because:

• you have several tumours
• the position of the cancer makes surgery difficult (for example, if it is near a major blood vessel)
• you can’t have a general anaesthetic

Researchers have found that RFA works best on small cancers, usually those smaller than 3cm across. But doctors sometimes use RFA to treat larger tumours. You can have RFA treatment several times.

You may have RFA for secondary bone cancer to relieve symptoms, such as pain. You would have this at specialist centres, so may need to travel for treatment.

Barrett's oesophagus

Barrett’s oesophagus is a change in the cells lining the food pipe (oesophagus). Your doctor may suggest you have RFA if you have high grade Barrett's oesophagus. High grade means that the cells look very abnormal under a microscope. You have RFA either on its own or in combination 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 RFA

Before the treatment starts you have either:

• a general anaesthetic
• a drug to make you sleepy (sedative) and a local anaesthetic, to numb the area

You will also have strong painkillers during treatment.

You can have RFA in different ways. The most common way is through your skin (percutaneously). You can also have it during surgery. During an operation, the surgeon would treat your cancer using the needle electrodes through the cut or incision. 

After an anaesthetic, you have a CT scan or an ultrasound scan. Your surgeon or radiologist uses the scan to guide a 1 to 2 millimetre wide needle through your skin into the tumour. Your surgeon might need to use several RFA needles if you have a large tumour or more than one tumour.

Your surgeon can vary the heat depending on the size of your cancer. 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. You can have more pain relief if you feel pain.

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

You usually need to stay in hospital overnight. But it’s sometimes possible to have your treatment as an outpatient and go home the same day.

Side effects of RFA

Most people have a few mild side effects after RFA. These include:

• discomfort or mild pain
• generally feeling unwell with a 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. This is 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 can 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.

Bleeding 
Another risk is bleeding caused by the needle or needles. This is also rare. Your doctor and nurses monitor you closely during and after the procedure. So if this does happen, they can deal with it straight away. You might need to have a procedure, such 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 RFA does not completely get rid of the cancer. Or the cancer grows back (recurs). You may be able to have the area treated again. This can be done a few weeks after the first treatment.

Follow-up

You normally have a CT scan or an MRI scan a few weeks after RFA to see how well the treatment has worked.

Your doctor will talk to you about the results and if they think you need any further treatment.

Clinical trials

Although RFA is a routine treatment for some cancers, doctors continue to look at this treatment in trials. For example researchers:

• want to find out how well it works in other cancers and conditions
• how well it works in combination with other treatment such as targeted drugs 
• more about the side effects