Radiofrequency ablation (RFA) is the latest technique to treat terminal liver cancer that is inoperable, as well as cancer that is spread from other organs to the liver.
RFA is a rather simple procedure with minimal side effects. The process starts by introducing a needle into the skin and directly inserting it into the liver. This procedure is performed through image guidance like computed tomography—CT, magnetic resonance imaging – MRI, or an ultrasound—US.
The inserted needle has an electrode attached to it and this electrode produces a high-intensity electrical current–also known as thermal ablation, in smaller areas in order to demolish the targeted tissues.
The equipment generally includes:
All types of radiofrequency ablation devices can be used for the RFA procedure. However, the designs of generators and needles can be different according to manufacturers.
The primary goal of radiofrequency ablation is to treat small liver tumors when the patient is unsuitable for surgical removal or transplantation. It includes hepatocellular carcinoma (HCC) —primary liver cancer and also tumor metastasized to the liver from other internal organs.
$17,000 to $19,000
The procedure is performed under local anesthesia given in the incision's area. However, sometimes it is performed with general anesthesia whereby a breathing tube is placed into the trachea through the mouth.
A tiny cut is made in the targeted area to introduce the needle into the liver.
There are 3 methods to carry out ablation in the liver:
This procedure requires medical imaging guidance to insert the needle electrodes inside the skin and reach the tumor site. After that, radiofrequency energy is generated. Multiple ablations may be required for a large tumor by relocating the needle electrodes in various parts of the tumor.
Then the needle electrode is taken out and a pressure bandage is applied to avoid any blood loss. Afterward, the incision is wrapped with a sterile dressing.
No stitches are required for this procedure.
A single ablation session takes about 10 to 30 minutes. If more than one ablation site is required, the whole procedure may take up to 1–3 hours.
A detailed medical exam including blood tests, kidney function, drug history, surgical history, and past medical history is conducted. Female patients must rule out any possibility of pregnancy, since medical imaging could expose the fetus to harmful radiation.
Inform the physician about any prior allergies, NSAIDs, or anticoagulant drugs you are taking. The doctor will discuss with you on the risks, complications, and side effects related to the procedure and anesthesia.
No food and drink are allowed prior to the procedure. Please make the necessary arrangements so that a family member or friend can send the patient back home after the procedure.
In local anesthesia, sedative agents are injected through IV to make sure the patient feels comfortable, sleepy, and well rested. Depending on the dosage determined by the doctor, some patients remain awake during the procedure while some are asleep.
In general anesthesia, a breathing tube is passed into the trachea through the mouth to avoid respiratory depression. Because of this reason, the patient may develop a painful sensation in the throat after the procedure.
Post ablation, the patient may experience some pain and soreness that can be managed by painkillers through the IV line. Later, oral pain management drugs can be prescribed in case of any discomfort. Nausea and dizziness may also be controlled through medications.
Until the patient is fully conscious, he will remain in the recovery room. When the doctor gives the all clear, the patient is then allowed to return home.
1 in 10 patients may experience pain and discomfort even after a week of ablation. The majority of patients can get back to their daily routines in a few days.
The radiofrequency ablation technique is usually well-tolerated with no serious complications. However, sometimes, it may cause:
What are the recommendations for travel after undergoing this procedure?
The patient is advised to stay at home or nearby the hospital for at least one-day after discharge, in case of any complications post-procedure.
What kinds of patients are eligible for this procedure?
Radiofrequency ablation is a treatment for patients who have primary liver cancer or liver tumor metastasized from other organs.
Patients with a maximum of 3 tumors and the tumor must be 5 cm in diameters or less. Each tumor site should be 1 cm under the surface of the liver, and at least 0.5 cm far from hepatic and portal veins.
Patients who need to shrink the their tumor size to make subsequent surgery possible.
Patients may also undergo this in combination with other types of cancer treatment procedures to achieve better treatment outcomes, for example; Transarterial Chemoembolization–TACE.
What kinds of patients are not eligible for this procedure?
Patients who have blood coagulation disorders.
When the tumor is too close to any vital organs (intestines, stomach, gallbladder, or the heart)
If the size of the tumor is more than 5 cm in diameter.
What tumor size can be treated by radiofrequency ablation?
There is no exact size of the tumor to be treated by RFA according to studies. But it is best recommended for tumors measuring no more than 5 cm in diameter. Tumors larger than 5 cm may require more than 1 ablation session. Please consult with your doctor.
What is the success rate of radiofrequency ablation therapy for the liver?
Due to fewer complications and less risk of adverse effects, the success rate for radiofrequency ablation is more than 85%. Tumors removed by this technique have less than 50% chance to reoccur. Moreover, chemotherapy can be resumed as soon as the procedure is completed. RFA may also be repeated if the tumor reoccurs in the future.