Radiofrequency ablation (RFA)
Radiofrequency ablation (RFA) is a treatment that is used for some types of cancer. It is a type of thermal ablation. This means using heat to destroy (ablate) cancer cells.
RFA uses a probe called an electrode to apply an electrical current (radiofrequency) to a tumour. The electrical current makes the cancer cells vibrate rapidly, causing friction. The heat created from the friction destroys the cancer cells. The area that has been treated gradually gets smaller and becomes scar tissue.
RFA does not always manage to destroy all the cancer cells. You may need to be treated more than once. RFA can be repeated if the tumour starts to grow again.
Other types of thermal ablation
RFA is the most widely used thermal ablation treatment. Other thermal ablation treatments include:
- microwave ablation (MWA)
- laser therapy
- high-intensity focused ultrasound (HIFU)
- cryotherapy or cryosurgery.
RFA can be used to try to cure a cancer, reduce its size or relieve pain (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 are not fit enough to have a major operation.
RFA is mainly used to treat:
- liver cancer that has started in the liver (primary liver cancer) 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 lung cancer) or a cancer that has spread to the lung from another part of the body (secondary lung cancer)
- kidney cancer.
We have more information about treatment for your type of cancer.
RFA can be given in several ways:
- Placing one or more needle-like electrodes through the skin (percutaneously) into the tumour, guided by an ultrasound or CT scan. This is the most common method.
- 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 other tumours.
The way RFA is given will depend on the type of tumour and its position in the body. Your doctor or specialist nurse will explain how the RFA will be given.
You will be asked not to eat anything for several hours before your treatment. If you take any medicines, you will usually be asked to take them as normal. If you take medicines that can thin your blood, such as aspirin or warfarin, your doctor will give you instructions about when to stop taking these.
Before the treatment, you'll see a doctor who will explain the procedure. This is a good time to ask questions if you are 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. A doctor or nurse will then place a fine tube (cannula) into a vein in your arm or on the back of your hand. They may also take blood samples to check your general health.
You usually have RFA in the operating theatre or hospital scanning department. Treatment takes around one to three hours, depending on the size and number of tumours being treated. It is possible to have treatment as an outpatient, but most people will stay overnight in hospital.
If you are having the treatment as an outpatient you will need to arrange for someone to take you home, as you should not drive for 24 hours after your treatment.
Most hospitals will use a general anaesthetic for RFA. It can also be given with a local anaesthetic to numb the area and a sedative to make you drowsy.
Once you have had the anaesthetic, you will have an ultrasound or CT scan. These scans help the doctor guide the electrode into the right position. They also help the doctor monitor what is happening during your treatment.
Once the electrode is in the right position, an electrical current is passed through to the tip. How long treatment lasts for will depend on the size of the tumour, and whether you have more than one tumour. An area of healthy tissue around the tumour is usually also treated, as it may contain cancer cells.
If you have a larger tumour or more than one tumour, the doctor may need to reposition the electrode before repeating the treatment. Or they may use a number of electrodes.
The risk of complications is low. These are the main complications that can occur.
Bleeding from the site
There is usually very little bleeding during the treatment. Sometimes people have more serious bleeding during or straight after the procedure. You will be closely monitored for bleeding during the treatment and for a few hours afterwards, so that if it occurs it can be dealt with straight away.
Some people develop an infection at the treatment site. You may be given antibiotics to reduce the risk of this happening. Symptoms of an infection include:
- redness or discharge
- pain at the treatment site that doesn't go away after a few days
- feeling generally unwell.
Contact your doctor for advice if you think you have an infection.
Collapsed lung (pneumothorax)
A part of the lung, or the whole lung, may collapse. This is most likely to happen when a tumour in the lung is treated with RFA. The lung can collapse when treating liver or upper kidney cancer, but this is very rare. A collapsed lung can cause breathlessness. This may sound frightening but it is not usually serious. The lung will get better on its own over a few days. Most people do not 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 will use scans to guide the electrodes into place during RFA treatment. But some people are at a greater risk because of the size or location of their tumours:
- RFA treatment to the liver may sometimes damage the bile ducts, causing yellowing of the skin (jaundice). Rarely, it may also cause damage to the bowel.
- RFA to the kidney can sometimes damage the tube that carries urine from the kidney to the bladder (ureter). Further treatment may be needed to repair any damage.
These are some of the side effects you may have for a few days after RFA:
Pain or discomfort
You will probably have some pain or discomfort at the treatment site. Your doctor will prescribe painkillers for you to take regularly for a few days. Sometimes people have pain in their shoulder after treatment to the liver or lung. Others may have pain in their hip after treatment to the kidney. For most people, any pain or discomfort lasts for less than a week. If you feel pain for longer than a week, or the pain is not controlled with painkillers, contact your doctor for advice.
We have more information about managing pain, which you might find 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 will probably be tired as well. People who have treatment for larger tumours, or for a number of 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 is a good idea to get plenty of rest for a few days, but you should be able to get back to your usual activities after around a week. If your temperature does not 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.