Radiofrequency ablation (RFA)
Radiofrequency ablation (RFA) is a treatment that is used for some types of cancer. This information describes the treatment, how and when it's given and some of the possible side effects.
We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having your treatment.
RFA uses heat to destroy cancer cells. It uses 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) the cells. The cancer cells die and the area that's been treated gradually shrinks and becomes scar tissue.
RFA doesn't always manage to destroy all the cancer cells. Some people may need to be treated more than once. RFA can be repeated if the tumour starts to grow again.
RFA can be given:
by placing one or more needle-like electrodes through the skin (percutaneously) into the tumour - this is the most common method
by passing the electrodes through the skin, guided by a mini-telescope (laparoscope) that is placed into the tummy area
at the same time as an operation to remove some of the tumour.
What usually happens
You'll be asked not to eat anything for several hours before your treatment. If you take any medicines, you'll usually be asked to take them as normal. If you take drugs that can thin your blood, such as aspirin or warfarin, your doctor will give you instructions about when to stop taking these.
The treatment usually takes place in the operating theatre or hospital scanning department. Treatment takes about 1-3 hours, depending on the size and number of tumours being treated. It's possible to have treatment as an outpatient, but most people will stay overnight 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 the procedure. This is a good time to ask questions if you're unsure about anything. You will then be asked to sign a form to say that 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 that give a 3D picture of the inside of the body). These scans help the doctor guide the electrode into the right position, and 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, the doctor may need to use a number of electrodes.
RFA can be used to try to cure a cancer, reduce its size, or relieve symptoms (palliative treatment). It can be given alone, or with other cancer treatments.
RFA may be used instead of surgery when someone has other medical conditions, which means they're not fit enough to have a general anaesthetic.
RFA is mainly used to treat:
liver cancer that has started in the liver (primary) or a cancer that has spread to the liver from another part of the body (secondary liver cancer)
lung cancer that has started in the lung (primary) or a cancer that has spread to the lung from another part of the body (secondary lung cancer)
RFA treatment for liver cancer
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RFA can be used as a treatment for both primary and secondary liver cancer.
Primary liver cancer
RFA is most suitable for tumours smaller than 5cm (2in). 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) and who can't 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 your liver (hepatic artery).
Secondary 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 that can release hormones into the bloodstream) that have spread to the liver can also be treated with RFA. 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 (2in).
RFA treatment for lung cancer
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RFA can be used as a treatment for both primary and secondary lung cancer.
Primary lung cancer
RFA can be given to people with early lung cancer who can't have surgery or choose not to have it. It works best in tumours that are close to the outside of the lung and are smaller than 3.5cm (1¼in). RFA may be given alone or in combination with radiotherapy treatment.
Secondary lung cancer
RFA can be used for tumours that are smaller than 3.5cm (1¼in) and close to the outside of the lung. A small number of tumours may be treated – usually up to five per lung.
Tumours within the centre of the lung, or larger than 3.5cm (1¼in), 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. The lungs are usually treated one at a time.
RFA treatment for kidney cancer
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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 another reason.
It can be used to treat tumours of up to 5cm (2in), but it works best for tumours that are smaller than 3cm (1in) and close to the outside of the kidney.
Possible complications with RFA
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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 afterwards, so that if it occurs it can be dealt with straightaway.
Some people develop an infection at the treatment site. You may be given antibiotics to reduce the risk of this happening. If infection develops, you may notice redness or discharge, feel pain at the treatment site that doesn't go away after a few days, or you may feel generally unwell. Contact your doctor for advice if you think you have an infection.
Collapsed lung (pneumothorax)
A part or all of the lung may collapse. The lung can collapse when treating liver or upper kidney cancer, but this is very rare. It's most likely to happen when a tumour in the lung is treated with RFA.
A collapsed lung can cause breathlessness. This may sound frightening but it's not usually 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 it expand back to full size.
Damage to the organs close to the area being treated
This is rare because the doctor uses scans to guide the electrodes into place. However, some people are at a greater risk because of the size or location of their tumours. In a few cases, treatment to the liver has damaged the bile ducts - causing yellowing of the skin (jaundice) - or the 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 any damage.
These are some of the side effects you may have for a few days after RFA:
Pain or discomfort
Your doctor will prescribe painkillers for you to take regularly for a few days, as you will probably have some pain or discomfort at the treatment site. Sometimes people have pain in their shoulder after treatment in the liver or lung. Others 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 it persists after this time or isn't controlled with painkillers, contact your doctor for advice.
We have more information about controlling cancer pain, which might be helpful.
Feeling unwell with a raised temperature
You may feel a little unwell for the first few days and have a slightly raised temperature. You'll probably be 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 (100.4°F), contact your doctor as this may be due to infection.
Blood in the urine
This may occur after RFA to the kidney. It should disappear after a few days.
You will usually be given an appointment to have a repeat scan after your RFA. This will show how well the treatment has worked.
This information has been compiled using a number of reliable sources, including:
Curley S. New Approaches to the Treatment of Hepatic Malignancies Radiofrequency Ablation of Malignant Liver Tumours. Annals of Surgical Oncology. 2003. 10: 338-347.
Radiofrequency Ablation for the Treatment of Colorectal Liver Metastases. 2009. National Institute for Health and Clinical Excellence (NICE).
Radiofrequency Ablation for the Treatment of Colorectal Metastases in the Liver: Information for People who Use NHS services. 2009. National Institute for Health and Clinical Excellence (NICE).
With thanks to: Professor O' Dwyer, Professor of Surgery; and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.