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This information is about radiofrequency ablation (RFA). RFA is a new treatment that’s used for some types of cancer. It describes the treatment used, how and when it’s given and some of the possible side effects.
If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment or speak to one of our cancer support service nurses.
RFA uses heat to destroy cancer cells. It involves using a probe, called an electrode, to apply an electrical current (radiofrequency) to a tumour. The electrical current heats the cancer cells to high temperatures, which completely destroys (ablates) them. The cancer cells die and the area which has been treated gradually shrinks and eventually becomes scar tissue.
RFA does not always manage to destroy all the cancer cells. Some people may need to have it done more than once. RFA can be repeated if the tumour starts to grow again.
RFA can be given:
On the day of treatment you’ll have been asked not to eat anything for several hours beforehand. If you take any medicines you’ll usually be able to take them as normal. If you take drugs that can thin your blood such as aspirin or warfarin, your doctor will have given you instructions about when to stop taking these.
The treatment usually takes place in the operating theatre or hospital scanning department and takes from about 1–3 hours depending on the size and number of tumours being treated. It’s possible to have it done as an outpatient but most people will have an overnight stay in hospital. If you’re having the treatment as an outpatient you’ll need to arrange for someone to take you home as you won’t be able to drive for 24 hours afterwards.
Before the treatment you’ll see a doctor who will explain to you about the procedure. This is a good time to ask any questions about anything that you’re unsure about. You will then be asked to sign a form to say you agree (consent) to the treatment.
A nurse will give you a hospital gown to change into and a doctor or nurse will place a fine tube (cannula) into a vein in your arm or on the back of your hand. You may also have blood samples taken to check your general health and blood clotting.
RFA can be given with a local anaesthetic to numb the area and a sedative to make you drowsy. If you need to have a larger area treated, RFA is usually done under a general anaesthetic.
Once you’re in position on the treatment couch and have had the anaesthetic, you’ll have an ultrasound scan (uses sound waves to look inside the body) or a CT scan (takes x-rays which give a 3-D picture of inside the body). This helps the doctor to guide the electrode into the right position and it’s also used to keep a close eye on what’s happening during your treatment.
Once it’s in the right position the electrical current is passed through the electrode to the tip. How long the current is applied for will depend on the size of the tumours.
An area of healthy tissue around the tumour is usually also treated as there may be cancer cells around the tumour that can’t be seen. The treated tissue is not removed, but it slowly shrinks and heals over time.
If you have a larger tumour, or more than one tumour, the doctor may need to use a number of electrodes.
RFA can be used to try to cure a cancer, to reduce its size, or to relieve symptoms (palliative treatment). It can be given alone, or along with other cancer treatments.
RFA can be used as a treatment for both primary and secondary liver cancer.
RFA treatment is most suitable for tumours smaller than 5cm/2inch. Larger tumours can be treated, but may need repeated RFA treatments.
RFA is suitable for people who already have liver disease, such as cirrhosis (scarring of the liver which stops it working properly) and who cannot have surgery. However, if a person’s liver is very damaged, then treatment with RFA may not be possible.
Occasionally, a treatment called chemoembolisation may be done before RFA. Chemoembolisation involves mixing chemotherapy drugs with an oily liquid called lipiodol. This is injected into the liver through a tube, which has been inserted into the main blood vessel carrying blood to the liver (hepatic artery). You can read more about chemoembolisation in our section on primary liver cancer.
RFA is most commonly used to treat cancers that have spread to the liver from the bowel or breast.
Neuroendocrine cancers (rare tumours which can release hormones into the blood stream) which have spread to the liver can also be treated. People with other cancers may also be suitable for treatment with RFA, but first doctors need to make sure that the cancer is contained within the liver or is well controlled.
It usually works best for tumours that are smaller than 5cm/2inch.
Sometimes chemotherapy is given before RFA to try to shrink the tumours and help RFA work better.
RFA can be used as a treatment for both primary and secondary lung cancer.
RFA can be given to people with early lung cancer who can’t have or choose not to have surgery. It works best in tumours that are close to the outside of the lung and are smaller than 3.5cm/1¼inch. RFA may be given alone or in combination with radiotherapy treatment.
RFA can be used for tumours that are smaller than 3.5cm/1¼inch and close to the outside of the lung. A small number of tumours, usually up to five per lung, may be treated.
Tumours within the centre of the lung or larger than 3.5cm/1¼inch may also be treated. However, there is a higher risk of these tumours coming back. A general anaesthetic is usually used if a person has larger tumours or more than three smaller ones. One lung is usually treated at a time.
Surgery is the main treatment for kidney cancer. However, some people aren’t fit enough for an operation to remove the kidney, so, RFA may be used. It may also be used for people who have only one kidney or when it’s important to keep both kidneys for some other reason.
It can be used to treat tumours of up to 5cm/2inch. But it works best for tumours that are smaller than 3cm/1inch and close to the outside of the kidney.
The risk of complications with RFA is low. These are the main complications that can occur:
Bleeding from the site There is usually very little bleeding during the treatment. Occasionally, some people have more serious bleeding during or immediately after the procedure. You’ll be closely monitored for bleeding during the treatment and for a few hours after so that if it occurs it can be dealt with straightaway.
Infection Some people develop an infection at the site of the treatment. You may be given antibiotics to prevent this happening. If infection develops it may show up as redness or discharge, as pain at the treatment site that doesn’t go away after a few days, or you may feel generally unwell. If you think you might have an infection contact your doctor for advice.
Collapsed lung (pneumothorax) A part or, sometimes, all of the lung may collapse. The lung can collapse when treating liver or upper kidney cancer although this is very rare, and it‘s most likely to happen when a tumour in the lung is treated with RFA. A collapsed lung can cause breathlessness. Although this may sound frightening it’s usually not serious, and the lung will get better on its own over a few days. Most people don’t need any treatment for a collapsed lung other than painkillers. Some people may need to have a tube placed into their lung, for a short time, to help their lung to expand back to its full size.
Damage to organs close to the area being treated This is rare as the doctor uses scans to guide the electrodes into place. However, some people are at greater risk because of the size or location of the tumours. In a few cases people having treatment to the liver have had damage to their bile ducts – causing jaundice (yellowing of the skin) – or to their bowel. RFA to the kidney can sometimes damage the tube that carries urine from the kidney to the bladder (ureter). Sometimes further treatment is needed to repair damage if it occurs.
These are some of the side effects you may have for a few days after your treatment:
Pain or discomfort Your doctor will prescribe you painkillers to take regularly for a few days as you will probably have some pain or discomfort at the site of the treatment. Sometimes people have some pain in their shoulder after treatment in the liver or lung. Some people may have pain in their hip after treatment to their kidney.
For most people any pain or discomfort lasts for less than a week. If you have pain after this time, or if the pain isn’t controlled with painkillers, contact your doctor for advice.
Feeling unwell with a raised temperature You might feel a little unwell for the first few days and have a slightly raised temperature. You’ll probably feel tired as well. People who have treatment for larger tumours or to several tumours are most likely to be affected. This is a normal reaction and is caused by your body clearing away the cells that have been destroyed by the treatment. Drinking plenty of fluids will help. It’s a good idea to take it easy for a few days, but you should be able to get back to your usual activities after about a week. If your temperature doesn’t return to normal or if it goes above 38°C contact your doctor as this may be due to infection.
Blood in the urine This may occur after RFA to a kidney. It should disappear after a few days.
You will usually be given an appointment to have a repeat scan after your RFA to see how well the treatment has worked.
This section has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography.
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