Ablation for Liver Tumours

Advantages of Ablation

• Minimally invasive
• Potentially curative for small tumours
• Organ-preserving
• Short recovery time
• Can be repeated if required
• Can be combined with embolization or systemic therapy

Types of Ablation

Treatment choice depends on tumour size, location, proximity to vital structures, and overall liver function.

1. Radiofrequency Ablation (RFA)
RFA uses high-frequency electrical currents to generate heat within the tumour.
The heat destroys tumour cells by causing coagulative necrosis (thermal destruction).

Best suited for:

• Small tumours (typically under 3 cm)
• Patients with early-stage liver cancer
• Tumours located away from major bile ducts

RFA is widely used and has long-established safety and efficacy data.

2. Microwave Ablation (MWA)
MWA uses microwave energy to generate higher and more uniform heat within the tumour.

Compared to RFA, microwave ablation:

• Produces higher temperatures
• Creates larger ablation zones
• Is less affected by nearby blood vessels (reduced heat-sink effect)

MWA is often preferred for slightly larger tumours or those near blood vessels.

3. Cryoablation
Cryoablation destroys tumour cells by freezing them.

A probe delivers extremely cold temperatures into the tumour, forming an “ice ball” that can be monitored in real time on imaging.

Advantages include:

• Clear visualisation of the treatment zone
• Potentially reduced post-procedural pain
• Controlled ablation near sensitive structures

Cryoablation may be used in selected cases depending on tumour location.

4. Ethanol (Alcohol) Ablation
Also known as percutaneous ethanol injection (PEI), this technique involves injecting concentrated alcohol directly into the tumour.

The alcohol causes dehydration and chemical destruction of cancer cells.

Ethanol ablation may be considered:

• For very small tumours
• In patients where thermal ablation is not feasible
• When tumour location limits the use of heat-based methods

Although less commonly used today compared to thermal ablation, it remains an option in selected cases.

Role of Peripheral Interventions

In some patients, additional peripheral vascular interventions may be required to optimise treatment.

These may include:

• Angioplasty or stenting to improve arterial access
• Management of vascular narrowing affecting catheter navigation
• Optimisation of blood flow prior to or after tumour treatment

Addressing underlying vascular disease can enhance safety, access, and overall outcomes — particularly in patients with diabetes or peripheral arterial disease.

Comparison of Ablation Techniques for Liver Tumours

Key Clinical Considerations

• Tumour size: Thermal techniques (RFA/MWA) are preferred for most small tumours.
• Location: Cryoablation may be chosen when the tumour lies close to bile ducts or critical structures.
• Proximity to blood vessels: MWA is often more effective than RFA near larger vessels.
• Very small lesions: Ethanol ablation may remain an option in selected cases.
• Underlying liver disease: Liver reserve and cirrhosis influence technique selection.

All techniques are performed under image guidance and may be combined with embolization or systemic therapy depending on the overall treatment plan.

Who May Benefit from Ablation?

Ablation may be recommended for:

• Early-stage Hepatocellular carcinoma
• Limited liver metastases
• Patients unsuitable for surgery
• Patients awaiting liver transplantation (bridge therapy)
• Tumours requiring local control

Suitability depends on tumour size, number, location, and liver reserve.

What to Expect

Before the Procedure
You will undergo imaging (CT or MRI) and blood tests. Liver function and clotting profile are evaluated carefully.

During the Procedure
The procedure is performed under conscious sedation or general anaesthesia. Using imaging guidance, the ablation probe is inserted directly into the tumour. Treatment time varies but typically ranges from 30–90 minutes.

After the Procedure
Most patients are observed for several hours. Some may stay overnight. Mild discomfort or fatigue may occur for a few days.
Follow-up imaging is performed to confirm complete tumour destruction.

Which Ablation Technique Is Right for You?

Treatment selection is based on:

• Tumour size and number
• Proximity to bile ducts or major blood vessels
• Liver function and reserve
• Underlying liver disease
• Treatment intent

For example:

• RFA is often suitable for small, well-positioned tumours.
• MWA may be preferred for slightly larger tumours or those near vessels.
• Cryoablation may be selected for tumours near sensitive structures.
• Ethanol ablation may be considered when thermal options are not feasible.

These decisions are made through multidisciplinary discussion to ensure safety and long-term liver preservation.

Why RIVEA

At RIVEA, ablation procedures are performed by specialists trained in advanced image-guided oncology and complex vascular interventions.
We provide:

• High-resolution imaging for precise probe placement
• Expertise in treating tumours in challenging locations
• Integrated tumour board decision-making
• Combined embolization and ablation strategies when indicated
• Vascular optimisation through peripheral interventions when required
• Structured follow-up and response assessment

Our focus is not only on tumour destruction, but on preserving liver function, minimising risk, and maintaining quality of life.