Liver Tumour Ablation (Interventional Oncology Service)

Ablation is a technique that destroys tissue using needle probes which are carefully inserted into the body through the skin, guided by a scanner (e.g. CT or US). The probes deliver energy that destroys the tumour and a small amount of normal surrounding tissue, but sparing the rest of the organ.

In the liver, we generally use a microwave probe to deliver thermal energy (i.e. heat) to treat the area. We also sometimes use probes that deliver electrical pulses to disrupt tumour cells. Another older thermal technique called Radiofrequency ablation is very similar but is not normally used at UCLH.

Ablation is performed under general anaesthesia (you are asleep) so that any discomfort and movement of the liver can be controlled.

Ablation may be used in patients with a smaller number of liver tumours which have spread from other parts of the body (i.e. liver metastases). The aim of the ablation is to destroy the cancerous cells in these tumours.

This treatment can often be performed in patients who are unfit or unsuitable for other treatments such a surgery.

As there are few side effects, if necessary, the procedure can be repeated. Most people can resume normal activities within a few days.

All treatments and procedures have risks and we will talk to you about the risks of ablation. Thousands of ablations have been performed worldwide and there are unfortunately always risks involved but these will have been minimised by making sure the procedure is appropriate in your circumstance.

There are recognised complications of the procedure both generic and unique to the area being ablated. The risk of certain complications also varies with the size and position of the lesion, its proximity to other structures and the experience of the operator.

For most, ablation is a very successful method of focal tumour treatment and in skilled hands has a low and acceptable complication rate, with significant morbidity and mortality of less than 2-5% (2 in 100 people) and 0.5% (1 in 200 people) respectively.

Problems that may happen straight away

• Bleeding from the skin or liver at the needle insertion site.

Very occasionally, further procedures will have to be performed if your body does not stop bleeding by itself.

Problems that may happen later

• Post ablation syndrome, which occurs in about 1 in 4 patients. This is a flu-like illness that happens 3-5 days after treatment. This is caused by your body’s immune system in response to the treatment. Paracetamol may be required if there is a low-grade fever.

Problem that are rare

• Air leaking into the space around the lung, causing the lung to deflate (pneumothorax) if the liver tumour is adjacent to the lung.
• Infection at the treated site. This is very uncommon but may require antibiotics or further procedures such as drainage.

Your doctor will discuss with you the best course of treatment in your case and can outline any alternative treatments.

We will ask you to come for a pre-operative assessment appointment. At this appointment, we will ask you about your medical history. We will carry out any necessary clinical examinations and investigations to make sure you are well enough for the procedure to go ahead. You may need an electrocardiogram (ECG) and a blood test, where we will check the function of your liver.

We will also give you clear written information that tells you about eating and drinking before your procedure, what to bring with you, when you should arrive, and the need to have an escort home. You are usually expected to stay in the hospital for one night after this procedure, so please bring an overnight bag with you.

The nurse will ask you about any medicines or tablets that you are taking – either prescribed by a doctor or bought over the counter in a pharmacy. It helps us if you bring written details of your medicines with you to this appointment. We will tell you whether you need to stop taking any of your medicines before your procedure. When you come into the hospital for the procedure itself, please bring all your medicines with you.

Generally, the ablation procedure will take around 90 minutes, but on occasion it may take longer. This is variable depending on the complexity and size of tumour. You will then spend around an hour in recovery where we can make you comfortable after your anaesthetic.

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves. The Intervention Oncology (IO) doctor will have explained all the risks, benefits and alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please do not hesitate to speak with the IO doctor again.

University College London Hospital is one of the top academic centres in the world. As such, it is likely that you will be invited to participate in research. This may involve new treatment techniques or new ways of imaging or assessing tumours. Involvement in research is entirely voluntary, and you will be provided with full details of any trials for which you may be suitable.

You will be taken into the CT scanner room and will be met with the anaesthetic team and the radiographers. You may be asked to lie on a trolley. The anaesthetist will place a cannula into a vein in your arm, so that the anaesthetic and any painkillers can be administered. You may have monitoring devices attached to your chest and finger and may be given oxygen.

After you are anaesthetised, you will not be aware of the procedure. A dose of antibiotic is usually given before we begin.

You will initially have a CT and/or US scan to plan the procedure, and the IO doctor will use this to identify the tumour. The needle is guided into the tumour and images are acquired to ensure the tumour is correctly targeted. The ablation is undertaken and then a completion scan is performed.

Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be, but it will usually take between 1 to 2 hours.

After the procedure, you will be transported into the recovery area. The nurse will check your observations regularly. Once you are comfortable and your observations are stable, you will be transferred to the ward and will stay overnight.

You will have a small dressing on your abdomen at the site the needles were placed. There are small puncture marks on the skin but no cuts or stitches.

You will have an intravenous drip in your arm throughout your stay so that we can give you fluids or medications if needed. In recovery, you will slowly be allowed to drink water. If you can tolerate this, then on the ward you will be given something light to eat.

To be able to go home, we will need to ensure you are safe on your feet. When you get out of bed for the first time, you will have a nurse with you in case you feel faint or dizzy.

The IO doctor and clinical nurse specialist will then see you on the ward and will discharge you home if you are comfortable to do so. This commonly takes place on or before midday the following day. You will be given a discharge summary.

Normally, you will be able to go home the day after your procedure. Before you go home, we will discuss your follow-up treatment with you. You should expect to be off work for one week after treatment.

You will have an appointment to come back to the clinic 4 weeks after the procedure for a repeat scan and to check that you have made a good recovery.

Signs to look out for:

• worsening shortness of breath or pain on breathing in
• bleeding from the needle insertion site
• pain that is not controlled by regular painkillers (e.g. paracetamol)
• increasing fever or pain more than 1 week after the procedure.

If you have cause for concern for concern following discharge, please contact our Clinical Nurse Specialist on 0790 467 4635.

If you are unable to contact our team out of hours, please contact the UCH 24-hour nurse led helpline on 0794 795 9020.

We will update your GP after your discharge, but immediately after the procedure they may not be aware of the details. If you see your GP after the treatment, please take your post discharge instructions with you.

Macmillan Cancer Information Centre

Ground Floor, Rosenheim Building, 25 Grafton Way, London, WC1E 6AU

Tel: 020 3447 8663

Email: cancerinfo@uclh.nhs.uk

Macmillan Cancer Backup

Telephone: 0808 808 00 00 (Monday to Friday 9am-8pm)

Website: http://www.macmillan.org.uk

UCH cannot accept responsibility for information gained from external organisations.

Tel Number: Interventional Oncology Clinical Nurse Specialist:

0790 467 4635 or 07970 699 321

UCH Switchboard: 020 3456 7890

Address:

Interventional Radiology Imaging Department, University College Hospital, 2nd Floor, Euston Road, London, NW1 2BU,

Interventional Oncology Service email: uclh.ios@nhs.net

Radiology Admin enquiries phoneline: 020 3447 3267

Website: www.uclh.nhs.uk

Hospital Transport Services: 020 3456 7010

Procedures

The Imaging Department, Level 2 Podium in the main University College Hospital building with the entrance on Euston Road (see map below).

Travelling to the hospital

No car parking is available at the hospital. Street parking is limited and restricted to a maximum of 2 hours.

Please note the University College Hospital lies outside, but very close to the Central London Congestion Charging Zone.

Tube

The nearest tube stations, which are within 2 minutes’ walk, are:

• Warren Street (Northern and Victoria lines)
• Euston Square (Hammersmith & City, Circle and Metropolitan lines)

Overground trains

Euston, King Cross & St Pancras and Kings Cross Thames link railway stations are within 10-15 minutes’ walk.

Bus

Further travel information can be obtained from http://www.tfl.gov.uk or by calling 020 3054 4040 14

Hospital transport service

If you need (and are eligible for) transport, please call:

020 3456 7010 (Mon to Fri 8am-8pm) to speak to a member of the Transport Assessment Booking Team.

If you have a clinical condition or mobility problem that is unlikely to improve you will be exempt from the assessment process. However, you will still need to contact the assessment team so that your transport can be booked. If your appointment is cancelled by the hospital or you cannot attend it, please call 020 7380 9757 to cancel your transport.

University College Hospital Area Map