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Treatment using heat to destroy liver cancer (thermal ablation)

Ablation means to destroy. Doctors can use heat to destroy tumours that started in the liver (primary liver cancer).

The 2 types of thermal ablation for liver cancer are:

  • radiofrequency ablation (RFA)
  • microwave ablation (MWA)

What is radiofrequency ablation and microwave ablation?

Radiofrequency ablation (RFA) uses an electric current to heat tumour cells in the liver and destroy them.

You have RFA using one or more probes (electrodes) that usually go through your skin into the tumour. The electrical current from the probe heats the cancer cells to high temperatures which destroys them. The heat only travels a short distance, so it doesn’t affect the rest of your liver tissue.

You have microwave ablation (MWA) in a similar way to RFA, but it uses a different type of energy to destroy the liver tumours. It is a newer treatment than RFA but is increasingly being used in some hospitals.

When you might have thermal ablation

Your doctor might recommend RFA or MWA if you can’t have surgery to remove your cancer. This could be because:

  • the position of the cancer makes surgery difficult (for example, if it is near a major blood vessel or near the gallbladder)
  • you’re not well enough to have the surgery

For a very small tumour in the liver you might have RFA instead of surgery (liver resection).

These treatments generally work best on small cancers, usually those smaller than 5cm across. You can have treatment several times.

You might have RFA or MWA alone, or 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 and gives you the opportunity to ask questions.

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
  • warfarin (Coumadin)

How you have thermal ablation

You go into hospital on the day of your treatment or the evening before.

You have the treatment in the operating theatre or scanning (x-ray) department of the hospital. You can’t eat for at least 6 hours before you have it, but you can usually drink water up to 2 hours beforehand. Your appointment letter will tell you about this.

You might have RFA or MWA under general anaesthetic, which means you are asleep. Or you might have a drug that makes you sleepy (sedation) and a local anaesthetic to numb the skin above the liver.

Your doctor (interventional radiologist) uses either an ultrasound scan or a CT scan to guide a special needle or probe through your skin into the tumour. The probe heats the tumour and destroys it.

Nurses monitor you throughout the procedure. They check your blood pressure, pulse and oxygen levels.

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

The treatment takes around an hour or more.

After thermal ablation

You usually have to stay in bed for a few hours after the procedure. You can start eating and drinking once you are fully awake and feel up to it. You usually go home the next day. You should be back to doing your normal activities after about a week.

You usually have a scan about 4 to 6 weeks afterwards to check how well the treatment has worked.

Side effects

As with any medical procedure there are possible side effects or complications. Your doctor makes sure the benefit of the treatment outweighs these risks.

Side effects include:

  • discomfort or mild pain – you’ll have painkillers to take home with you
  • feeling unwell with a slightly raised temperature (flu-like symptoms) for a few days
  • infection, but this is rare

Some people have flu-like symptoms that start about 3 to 5 days after treatment and can last up to a week. Contact your doctor if you feel unwell after this time or have a temperature above 38C, as you may have an infection. 

There’s a small risk of damaging the bile ducts or other structures near the liver such as the bowel or gallbladder during the procedure. But this is rare because the doctor uses scans to help guide the probe in place.

Another risk is bleeding caused by the probe going into the liver. 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.

Last reviewed: 
19 Nov 2018
  • EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma
    European Association for the Study of the Liver
    Journal of Hepatology, 2018. Volume 69, Pages 182-236

  • Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up
    A Vogel and others
    Annals of Oncology, 2018. Volume 29, Supplement 4, Pages 238-255