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Ablation therapies for liver cancer
Ablation therapies are procedures that destroy liver cancer cells while preserving as much of the surrounding liver tissue as possible.
The 2 types of ablation therapy used for liver cancer are radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI). These procedures are usually done in the radiology department in a hospital. Doctors use an ultrasound or CT scan to create images of the liver and the tumour to guide them during these procedures. They may need to do the procedure several times to shrink or destroy the tumour. You will have a CT scan after the procedure, so the healthcare team can see if the liver tumour has shrunk or if you need more treatment.
RFA is the most commonly used ablation therapy for liver cancer. You may be offered RFA if you can’t have surgery. You may also be offered RFA if you are waiting for a liver transplant. It is used to keep a tumour small enough to meet the transplant eligibility criteria (called “bridging” therapy).
RFA works best for liver tumours that are 2.5 cm or less in size and when there are no more than 3 tumours. RFA may also be offered to people who have tumours up to 4 cm in size or who have more than 3 tumours. When the tumours are larger, there is a greater chance that RFA will not completely destroy them.
Liver tumours that are near blood vessels are harder to treat with RFA. The blood flowing through them cools the tissue, so the heat does not work as well to destroy the cancer cells.
RFA uses a high-frequency electrical current to create heat to destroy cancer cells. The electrical current is delivered directly into the tumour by a thin needle. The needle may be placed in several different places in the tumour in order to treat the whole area. You may be given a local or general anesthetic before you have RFA.
Percutaneous RFA is the most common way of doing this procedure. The doctor guides the needle directly into the liver tumour through the skin and muscle of the abdomen.
Laparoscopic RFA is done through a narrow cut in the abdomen. The doctor uses special instruments passed through the cut to guide the needle into the tumour. Doctors use laparoscopic RFA to protect other organs that are close to the liver tumour or to give them better access to a tumour.
Percutaneous ethanol injection
PEI is a type of ablation therapy that uses concentrated alcohol. The doctor uses a needle to inject the ethanol alcohol directly into 1 or more liver tumours. Alcohol works by drawing water out of, or dehydrating, the cancer cells, which causes them to die.
You may be offered PEI if you can’t have surgery to treat your liver cancer. It may be used to treat tumours near blood vessels where RFA can’t be used. PEI works best on tumours that are smaller than 2 cm.
PEI is not as effective as RFA, so it is not used as often. Sometimes PEI may be used together with RFA or transarterial chemoembolization (TACE).
Side effects can happen with any type of treatment for liver cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.
Side effects can develop any time during, immediately after or a few days or weeks after ablation therapy. Sometimes late side effects develop months or years after ablation therapy. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.
Side effects of ablation will depend mainly on the type of ablation therapy, the number of tumours being treated, how much the liver is affected by cirrhosis and your overall health.
Ablation therapy for liver cancer may cause these side effects:
- damage to nearby organs (such as the bile duct)
- a collection of pus in the area where the tumour was removed (called a liver abscess)
- changes to liver function or liver failure
- tumour lysis syndrome
Tell your healthcare team if you have these side effects or others you think might be from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.
An imaging technique that uses high-frequency sound waves to produce images of structures and organs inside the body.
The image produced is called a sonogram.
Also called ultrasonography or sonography.
See computed tomography (CT) scan.
A drug that causes anesthesia (the loss of some or all feeling or awareness).
General anesthetics put a person to sleep. Regional anesthetics cause a loss of feeling in a part of the body, such as an arm or leg, but the person does not lose awareness. Local anesthetics numb only a small area of the body.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
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