Radiofrequency Ablation (RFA) of Liver Tumors

What is radiofrequency ablation (RFA) of liver tumors?

Radiofrequency ablation (RFA) is 1 type of thermal ablation, a way to destroy tissue in the body using heat. It can be used as a treatment for cancer. RFA uses a high-energy electric current sent into a tumor using a thin needle electrode. The electric current creates heat around the electrode. It is put in the tumor to heat and kill the cancer cells. The heat also seals nearby blood vessels to limit bleeding. As you heal after the procedure, scar tissue replaces the tumor.

An imaging scan, such as a computerized tomography (CT) scan, ultrasound, or even magnetic resonance imaging (MRI), is used to see where to put the needle in your liver. The needle can be put in the liver through the skin or through small cuts (incisions) made in the skin over the tumor. Because usually only small cuts are needed, you may recover faster and have less pain than with surgery.

Why might I need RFA of liver tumors?

RFA is often used to treat cancer in the liver when surgery isn’t a good option. It's mostly used to treat small liver tumors.

RFA may be used if you have either of these:

• Hepatocellular carcinoma, a cancer that starts in the liver

• Another kind of cancer that has spread (metastasized) to the liver (colon, gallbladder, pancreas, and lung cancers tend to spread to the liver)

RFA may be used instead of surgery to remove the tumors when:

• Surgery would be high risk because of other health issues

• The liver tumor is small (less than or equal to 3 centimeters or a little more than an inch across)

• There are many small tumors spread across the liver

• The tumor is in a place that makes it hard to reach with surgery

• Surgery to remove the tumor(s) would destroy too much of the liver

• You have liver tumors that aren't responding to chemotherapy or come back after surgery

This treatment may not be a cure. But outcomes from RFA may be just as good as those in people who had surgery to remove small tumors.

RFA for liver tumors may not be advised if you have either of the below:

• A large tumor. This is a tumor that is more than 5 centimeters or about 2 inches across.

• A tumor close to other abdominal organs, major blood vessels, major bile ducts, or your diaphragm. RFA may cause damage to these key tissues.

What are the risks of RFA of liver tumors? 

All procedures have some risks. The risks of RFA of liver tumors include:

• Infection at the cut in the skin

• Injury to tissues, organs near the liver, and bile ducts can cause pain, organ inflammation, pus-filled tissue (abscess), and infection

• Extreme pain (rare)

• Flu-like symptoms that start 3 to 5 days later and last about a week (called post-ablation syndrome)

• Bleeding

• Damage to blood vessels

• Problems may occur due to medicines or anesthesia used during the ablation

Your own risks depend on your age, your general health, and the reason RFA is being done. Talk with your healthcare provider to find out more about your risks.

How do I get ready for RFA of liver tumors?

Talk with your healthcare provider about how to prepare for your RFA procedure. Tell your provider about all the medicines you take. This includes over-the-counter medicines, vitamins, herbs, and other supplements. It also includes marijuana or illegal drugs. You may need to stop taking some medicines before the procedure, such as blood thinners, nonsteroidal anti-inflammatory drugs (NSAIDs), and aspirin. If you smoke, you may need to stop before your procedure. Smoking can delay healing. Talk with your healthcare provider if you need help to stop smoking.

Blood tests may be needed before the procedure. These may be done to see how your kidneys and liver are working and make sure your blood clots well.

Tell your healthcare provider if you:

• Have had any recent changes in your health, such as an infection or fever

• Are sensitive or allergic to any medicines, contrast, latex, tape, and anesthesia medicines (both local and general)

• Have a history of bleeding disorders

• Are taking any blood-thinning (anticoagulant) medicines, aspirin, NSAIDs like ibuprofen, or other medicines that affect blood clotting

• Are pregnant or think you may be pregnant

Also make sure to:

• Ask your healthcare provider if you will receive local numbing medicines in the skin, sedation, or general anesthesia before the RFA procedure starts. Talk about the best choice for you.

• Have a family member or friend ready to take you home from the hospital. You can’t drive yourself if you're given sedation during the procedure.

• Follow any directions you're given for not eating, drinking, or taking medicines before RFA.

• Follow all other instructions from your healthcare provider.

You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully. Ask questions if anything isn't clear.

What happens during RFA of liver tumors?

A special healthcare provider called an interventional radiologist often performs RFA. The procedure is performed usually in an outpatient area. RFA of liver tumors may take a few hours. The amount of time depends on the number of ablations needed. The procedure will likely follow these basic steps:

• You’ll lie on an exam table. An IV (intravenous) line will be put in your hand or arm. Your healthcare team will give you medicine through this tube.

• Your healthcare team will connect you to a monitor to track your oxygen level, blood pressure, heart rate, and pulse.

• Pads to ground electricity will be put on your back or thighs.

• Your skin is cleaned and covered with a sterile drape.

• RFA may be done while you’re awake, sedated, or under general anesthesia. If you’re awake or sedated, your healthcare provider will numb the place on your body where the procedure is done with medicine given through a needle. You may feel a short burning sensation or sting before the numbing medicine works.

• Your healthcare provider will make a small cut in your skin. This is where the needle electrode will be put in. An imaging scan, such as a CT scan, MRI, or ultrasound, will help guide the needle electrode into the liver tumor.

• An electrical current will pass through the electrode to destroy the tumor. The electrode may need to be moved around to other parts of the tumor to reach all of it. If you are awake, you may feel pressure.

• For a large tumor, multiple ablations may be needed. This may require placement of more than 1 needle electrode to treat all of the tumor.

• Once the procedure is done, your healthcare provider will take out the electrode. Pressure may be applied on the site to stop bleeding. A bandage will be put over the site. Stitches aren't needed.

• You will be observed until you are ready to go home. You will be disconnected from the monitor. The IV line will be removed before you leave.

What happens after RFA of liver tumors?

You may have pain and nausea after RFA. These side effects are often mild and can be controlled with medicines. You should be able to go home a few hours after the procedure.

Within about a week, you should feel back to normal and be able to return to your daily activities. You may be told to not lift heavy objects for a few days after RFA. Follow all instructions from your healthcare provider. Call your healthcare provider if you have any problems after the procedure. Your provider will tell you about tests needed to see how well RFA worked.

Next steps

Before you agree to the test or the procedure, you should know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• If sedation or general anesthesia will be used

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure