Liver Ablation - Ablation for liver cancer – Tumour ablation for liver cancer
What is Liver Ablation?
Liver ablation is a minimally invasive procedure used to destroy liver tumours or lesions, most commonly using heat-based technology like Microwave Ablation (MWA).
Unlike surgery, it does not involve removing part of the liver, but instead precisely targets and eliminates cancerous cells while preserving healthy surrounding tissue.
Key Facts About Liver Ablation
- It is a keyhole or needle-based technique, often avoiding major surgery.
- It is frequently used for patients who are not candidates for traditional surgery or have small, hard-to-reach tumours.
- For small, favourably located tumours, ablation can offer outcomes equivalent to surgical resection.
- Advantages include shorter recovery times, fewer complications, and maximal preservation of healthy liver tissue.
Liver Ablation Procedure: How It Works
Microwave Ablation (MWA)
MWA is the most common modern ablation technique. It uses microwave energy to generate intense heat, effectively destroying cancer cells.
- Imaging Guidance: Using live CT or ultrasound imaging, a radiologist or surgeon guides a thin, needle-like probe directly into the tumour.
- Energy Delivery: Microwave energy is emitted from the tip of the probe, creating a small, targeted sphere of heat that cooks and destroys the tumour.
- Approach: The probe can be inserted:
- Percutaneously: Through a tiny incision in the skin (most common).
- Laparoscopically/Robotically: Through small keyhole incisions during a minimally invasive operation.
- Via Open Surgery: During a traditional operation, if needed.
Combination Therapy
Ablation is often used in combination with surgery (resection) to treat all tumours in the liver, especially when they are in different lobes.
Common Liver Issues That May Require Ablation
Liver ablation is primarily used to treat tumours within the liver. Common issues include:
- Primary Liver Cancer: Most commonly Hepatocellular Carcinoma (HCC), often arising from underlying liver disease like cirrhosis or hepatitis.
- Metastatic Liver Cancer: Cancer that has spread to the liver from other organs, such as colorectal cancer, neuroendocrine tumours, or breast cancer.
- Benign Liver Tumours: Such as symptomatic hepatic adenomas, which may be treated with ablation to prevent rupture or alleviate symptoms.
When is Liver Ablation Required?
Ablation is not suitable for every patient or every tumour. It is typically recommended in these scenarios:
- Small Tumours (< 3-5 cm): Most effective for tumours that are small and localized.
- Non-Surgical Candidates: For patients who cannot undergo major surgery due to poor overall health, advanced age, or insufficient liver function.
- Tumour Location: To treat tumours in surgically challenging locations.
- Bridge to Transplant: To keep patients within transplant criteria while they wait for a donor liver.
- Recurrent Tumours: To treat new tumours that appear after previous liver surgery.
- Multimodal Treatment: In combination with other therapies like surgery, chemotherapy, or embolization to comprehensively treat all liver disease.
Your multidisciplinary care team will determine if ablation is the right choice for you.
Risks and Complications of Liver Ablation
While generally very safe, liver ablation carries potential risks, including:
- Pain or Discomfort: Mild pain at the probe insertion site is common and manageable.
- Infection: A small risk of infection at the insertion site (rare).
- Injury to Nearby Structures: Minimal risk of damage to nearby organs (e.g., intestines, gallbladder) or bile ducts.
- Incomplete Ablation: There is a chance the tumour is not fully destroyed, which could lead to recurrence.
- Liver Damage: Though designed to spare healthy tissue, some surrounding liver cells can be affected.
Recovery and Post-Procedural Care
Recovery is significantly faster than from major surgery.
- Post-Procedure: You will be monitored for a few hours before often going home the same day (for percutaneous ablation) or after a short hospital stay.
- Pain Management: Any discomfort is typically managed with over-the-counter or prescribed pain medication.
- Activity: Most patients resume normal, non-strenuous activities within a few days. Strenuous exercise and heavy lifting should be avoided for 1-2 weeks.
- Follow-up Instructions: It is crucial to follow all instructions regarding wound care, activity, and medications.
Follow-up Care After Liver Ablation
Long-term monitoring is essential to ensure the treatment’s success and check for recurrence.
- Regular Imaging Scans: You will have periodic CT or MRI scans (e.g., every 3-6 months initially) to confirm the tumour is destroyed and monitor for new lesions.
- Blood Tests: Liver function tests and tumour markers (like AFP for HCC or CEA for colorectal mets) are tracked over time.
- Ongoing Specialist Visits: You will have regular appointments with your hepatologist, oncologist, and surgeon to manage your overall liver health and cancer care.
Frequently Asked Questions (FAQs) About Liver Ablation
Is liver ablation a major surgery?
No. Percutaneous ablation is not surgery. It is a minimally invasive, image-guided procedure that usually only requires a needle puncture.
How long does the ablation procedure take?
The actual ablation time is very short (often ~10-30 minutes). The entire process, including setup and imaging, usually takes 1-2 hours.
Will I be awake during the procedure?
You will likely be under moderate sedation or general anaesthesia, meaning you will be comfortable and not feel pain during the procedure.
Is ablation a cure for liver cancer?
For small, early-stage tumours, ablation can be potentially curative. For larger or more numerous tumours, it is an excellent tool for local control and prolonging life.
What is the difference between ablation and surgery?
Surgery (resection) removes the tumour and a margin of liver tissue. Ablation destroys the tumour in place without removing it. Ablation is less invasive but may not be suitable for all tumours.
How soon can I go home after the procedure?
Many patients who undergo percutaneous ablation can go home the same day after a short observation period.
What does "incomplete ablation" mean?
It means that not all the cancer cells were destroyed. This is why precise imaging and expert technique are critical, and why close follow-up is needed to catch and retreat any residual disease.
Can my liver tumour come back after ablation?
Yes, there is a risk of recurrence, either at the same site (if not fully ablated) or in a new location in the liver. This is why lifelong monitoring is important.
Can ablation be repeated if new tumours appear?
Yes. One of the key advantages of ablation is that it can often be repeated to treat new tumours as they arise, while preserving liver function.
Does ablation affect my eligibility for a liver transplant later?
No, it often does not. In fact, it is frequently used as a “bridge to transplant” to keep the cancer under control while waiting for a donor organ.