Liver tumour ablation

Author: Prof. Roberto Iezzi

Liver tumour ablation is a procedure used to treat liver cancer or tumours by destroying the tumour using heat, cold, or other energy sources.

There are several types of ablation. The most common are:
🔹 radiofrequency ablation (RFA)
🔹 microwave ablation (MWA)
🔹 cryoablation

Each method works by targeting the tumour with energy that either heats or freezes the cells, causing them to die.

Micro pulses of electricity can also be used to create:
🔸 permanent pores in cell membranes (IRE – irreversible electroporation) to destroy the cells, or
🔸 temporary pores (ECT – reversible electrochemotherapy) to allow drugs to enter the cells.

The procedure is minimally invasive, meaning it is done through a small incision or with a needle through the skin, under local anaesthesia and deep sedation. It is usually guided by imaging like ultrasound or CT scans to ensure accuracy.

Ablation is often used:
🔹 for smaller tumours (up to 3 cm in size), with the goal of curing the cancer, or
🔹 for larger cancerous tumours (up to 5 cm in size) that cannot be removed with surgery.

Liver ablation is generally a safe procedure, but like any medical treatment, it has some risks. Most side effects are mild and go away on their own, but serious complications can sometimes happen.

▪️ Pain: Up to 50% of patients feel mild to moderate pain at the treatment site, which can be managed with pain medicine.

▪️ Bleeding: Bleeding is rare, happening in about 1–2% of cases, especially in patients with liver cirrhosis, where blood does not clot as well.

▪️ Infection: Infection is another possible risk, but thanks to preventive antibiotics, it happens in less than 1% of cases.

▪️ Post-ablation syndrome: Around 20–30% of patients experience post-ablation syndrome, which causes flu-like symptoms such as fever, tiredness, and discomfort, but these usually go away within a few days.

▪️ Death: Death is extremely rare, occurring in up to 1 in 1000 people.

The treatment for liver cancer depends on factors like the size and location of the tumour, your overall health, and whether the cancer has spread. You might need one or more of these treatments:

▫️ Alternative 1 Surgery: This could mean either removing part of the liver (partial hepatectomy) or replacing the liver with a healthy one from a donor (liver transplant). Not everyone will be able to have surgery.

▫️ Alternative 2 Transarterial Chemoembolisation (TACE) or Transarterial Radioembolisation (TARE): Minimally invasive procedures that deliver chemotherapy or tiny radioactive beads directly into the tumour’s blood supply to shrink it. These treatments are used for larger or multiple tumours.

▫️ Alternative 3 Radiation Therapy – External Beam Radiation Therapy (EBRT): A series of treatments that use radiation beams from outside the body to destroy the tumour.

▫️ Alternative 4 Systemic Therapies: Targeted therapy, immunotherapy (helping the immune system fight cancer) and chemotherapy. If the cancer has spread, these treatments help control the disease throughout the body.

1. Pre-procedural preparation
The doctor uses imaging such as CT or ultrasound to find the tumour. The patient receives either local or general anaesthesia to prevent pain. The patient is positioned to give the best access to the liver.

2. Needle insertion
Using image guidance, a thin probe or electrode is inserted through the skin and directed into the tumour.

3. Ablation process
The wand is turned on to heat or freeze the tumour, which kills the tumour cells.

4. Post-procedural monitoring
The probe is removed, and the puncture site is covered. Imaging is done again to make sure the tumour has been effectively treated.

After the ablation procedure, you will be monitored in a recovery area to ensure there are no immediate complications. If you experience any pain or nausea, medications will be given to help you feel more comfortable. . Most patients can return home within 24-48 hours, depending on their condition and how they respond to the procedure.

Follow up:

• A few weeks after treatment, your doctor will do blood tests to check how your liver and kidneys are working.
• 1 to 3 months later, a CT or MRI scan will show how well the treatment worked.
• Your doctor will go over the results with you and talk about the next steps based on your progress.

Regular follow-ups are important to make sure that the tumor has been effectively treated and to monitor for any signs of recurrence.

❗Contact your doctor immediately if you have:

• Bleeding, swelling, redness or darkness at the treatment site
• Significant shortness of breath
• Uncontrollable pain
• Fever of 38°C (100.4°F) or higher.