Ablation for Liver Cancer

Ablation is treatment that destroys (ablates) liver tumors without removing them.

When is ablation used for liver cancer?

Ablation techniques can be used for people with a few small liver tumors, especially when surgery is not a good option (because of poor health or reduced liver function). Ablation is best used for tumors no larger than 3 cm across (a little over an inch). For slightly larger tumors (1 to 2 inches, or 3 to 5 cm across), it may be used along with embolization .

These treatments are also sometimes used in people waiting for a liver transplant.

Because ablation often destroys some of the normal liver tissue around the tumor, it might not be a good choice for treating tumors near major blood vessels, the diaphragm, or major bile ducts.

How is ablation done?

People getting this type of treatment typically do not need to stay in a hospital.

Often, ablation can be done without surgery by inserting a needle or probe into the tumor through the skin. The area where the probe is inserted is numbed with local anesthesia. The needle or probe is then guided into place with ultrasound or a CT scan.

Sometimes, though, to be sure the treatment is aimed at the right place,  ablation is done in the operating room with either laparoscopy or a surgical incision (cut) in the skin over the belly, while the person is under general anesthesia (in a deep sleep).

Types of ablation used for liver cancer

Ablation is less likely to cure liver cancer than surgery, but it can still be very helpful for some people.

Radiofrequency ablation (RFA)

Radiofrequency ablation (RFA) uses high-energy radio waves to heat and destroy tumors. A thin, needle-like probe is placed through the skin and moved forward until the end is in the tumor. Ultrasound or CT scan is used to guide the probe into place. Once it is in place, an electric current is passed through the tip of the probe. This heats the tumor and destroys the cancer cells.

Microwave ablation (MWA)

Imaging tests are used to guide a needle-like probe (antenna) into the tumor. Electromagnetic microwaves are then created at the tip of the probe to heat to destroy the tumor.

Cryoablation (cryotherapy)

Cryoablation destroys a tumor by freezing it using a thin metal probe. The probe is guided into the tumor, and then very cold gasses are passed through the probe to freeze the tumor, which causes the cancer cells to die.

This technique is sometimes used along with surgery to remove part of the liver. It isn’t used as often by itself as RFA or MWA are, as it tends to be a more complex procedure.

Ethanol (alcohol) ablation

This is also known as percutaneous ethanol injection (PEI). Concentrated alcohol is injected directly into the tumor to damage cancer cells. Sometimes several treatments of alcohol ablation are needed.

This technique is used less often than RFA or MWA, although it might be helpful in some situations where it would be hard to use those other approaches.

Side effects of ablation therapy

Possible side effects after ablation therapy can include:

• Abdominal pain (especially with PEI)
• Bleeding
• Infection in the liver
• Fever
• Abnormal blood tests of liver function

Serious complications aren’t common, but they are possible.

Newer ablation techniques to treat liver cancer are also being studied.