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A variety of ablative therapies are available, these include: CryoAblation Microwave Ablation, and RadioFreqquency Ablation. All of these procedures can be performed percutaneously (through the skin) by interventional radiologists (IR) or as an open surgical procedure by a surgeon who specializes in oncology. Ablation therapy consists of heating or cooling the liver tissue, or uses intense electric pulses, to achieve cancer cell death. A special probe is used to access the tumor and each specific method of treatment is delivered by the probe. Ablation is safe and is well tolerated.  It is an effective treatment for patients with inoperable metastatic tumors but is limited by the size and number of tumors present.  Medicare does provide coverage for these ablation procedures.

 

CryoAblation

Microwave Ablation

RadioFrequency Ablation

Cryoablation

 

What is Cryoablation?

 

Cryoablation uses extremely cold temperatures to destroy cancer cells.

 

How Does It Work?

 

Cryosurgery relies upon the process of producing extremely cold temperatures using liquid nitrogen or argon gas in order to destroy diseased or abnormal tissue. The freezing temperature results in the formation of ice crystals in the diseased tissue which causes abnormal cells to tear apart.

 

The Procedure

 

For external problems such as skin cancers, in particular, treatment is quick with usually few, if any, side effects. The liquid nitrogen is simply applied to the abnormal cells directly using either a swab or spraying device. In addition to smaller skin cancers and precancerous skin cells, it can also be used on things such as moles, warts and skin tags. The procedure deadens the skin which falls off later by itself.

 

Cryosurgery can also be used for internal abnormalities. These can include certain forms of liver tumors. For the liver, thre treatment is administered using an instrument which is inserted into the body to come into contact with the tumor. This is known as a cryoprobe.

 

It workds by cicrulating argon gas or liquid nitrogen which results in a ball of ice crystals forming around the probe which then freezes the affected cells. After cryoablation has been completed, then eventually the frozen tissue thaws and it is then absorbed ty the body.

 

Side Effects

 

Although you can experience side effects as the result of undergoing cryoablation, they tend to be far less severe than other more conventional treatments.

 

Side effects will also depend on where the tumor is located.

 

The Benefits

 

One of the key benefits of cryoablation is that it is far less invasive than other forms of treatments as well as producing fewer side effects. It is also far less expensive treatment to administer. Furthermore, it has started to gain increasing popularity for those whose medical conditions or a patient's age means that they are not suitable for other traditional forms of surgery or treatment.

 

 

Microwave Ablation

 

WHAT IS MICROWAVE ABLATION FOR LIVER TUMORS?

 

A microwave ablation system allows your doctor to destroy unresectable liver tumors in a minimally invasive way, using few or very small incisions. Your doctor will use ultrasound, CT, or MRI images to see your liver in real time while performing the ablation procedure. Guided by these images, your doctor will place the ablation antenna into the center of the non-resectable liver tumor. There, the antenna delivers thermal (heat) energy to destroy the non-resectable liver tumor(s) and some of the surrounding tissue.

 

Ablation can be combined with additional therapies (such as chemotherapy, radiation, or resection) so that you have another weapon in the battle for your liver.

 

HOW ABLATION WORKS

 

1.  Ablation targets the non-resectable liver tumor.

Guided by images of the liver, your doctor places the ablation antenna into the center of the non-resectable liver tumor.

2.  The tumor cells are destroyed.

The ablation antenna delivers thermal energy to destroy the tumor cells and some of the surrounding tissue.1

3.  Your tissues will heal.  The dead tumor cells are gradually replaced by scar tissue that shrinks over time.2

 

WHO IS A CANDIDATE FOR LIVER TUMOR ABLATION?

 

For some patients, ablation may used for non-resectable liver tumors in addition to chemotherapy, radiation, or other therapies. Studies have shown that ablation is a good alternative therapy when the tumor(s) cannot be removed surgically.3-5

Doctors generally make a decision to use ablation based on certain guidelines. For example, the non-resectable liver tumor and surrounding normal tissues need to be located where the doctor can reach them in a minimally invasive procedure.6 Also, ablation is generally more effective when used on non-resectable liver tumors that are less than 1.18 inches (3 centimeters) in size.6,7

Microwave ablation procedures are not recommended for pregnant patients, patients with cardiac pacemaker or other implanted electronic devices. Consult your health care professional and review the possibilities of risks.

 

WHAT TO EXPECT BEFORE YOUR ABLATION PROCEDURE

 

You may receive ablation as an outpatient procedure. It is performed in a hospital radiology suite or operating room. Here are some things to know before you have your ablation procedure:

 

 Ablation is typically performed under sedation or general anesthesia. Before your procedure, your healthcare team will determine the appropriate sedation for you.

 The length of the procedure varies from patient to patient.

 The doctors performing your procedure will use imaging scans to help them monitor the area of ablation.

 After the procedure, you will go to recovery where doctors will monitor you.

 Your doctor will discuss the results of the procedure with you. If necessary, your doctor will help you determine any further steps to take.

 The most common complication patients experience after an ablation procedure is some slight pain and discomfort.8

 Serious complications, such as bleeding and infection, are uncommon.7 Your doctor will discuss your risk for specific complications.

 Please consult with your doctor for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information about ablation.

 

What should I expect after the Microwave ablation?

 

• Often a one night stay in the hospital is required post procedure for observation and pain control.

• Pain post procedure may last up to 5-7 days, tapering in intensity. This usually does not require more than a few days of prescription pain medicine and many patients only use over the counter pain medication.

• Do not plan anything active or requiring your close attention for the first few days following discharge from the hospital. If you work, you may return as soon as you feel able. Most patients do not need more than 2-3 days away from work.

• There are no dietary restrictions specifically due to this procedure. If you had restrictions prior due to other treatments or diseases such as diabetes, cardiovascular disease, or renal disease, continue with these. Bathing & Wound Care:

• It is okay to shower 24 hours after the procedure. Gently wash the catheter insertion site with soap and water, do not scrub only after 3 days post procedure. Do not bathe or soak in water for 3 days following the procedure.

 

Follow-up visit information:

 

Call your primary doctor after discharge for a follow-up appointment if you don’t already have one. Follow up with Interventional Radiology is not routinely necessary with follow up imaging depending on the targeted region. Occasionally, a situation will require prompt attention and an emergency room visit is necessary:

 

       • Your treatment site starts bleeding and will not stop after 10 minutes of firm pressure

       • You have shaking chills or a temperature over 102°F

       • Sudden shortness of breath

       • Severe, worsening abdominal pain

       • Jaundice (yellowing eyes and skin)

 

If you received Conscious Sedation (IV sedation) or General Anesthesia:

 

• You must have someone drive you home when you leave the hospital if it is less than 24 hours    post procedure.

• For 24 hours after your procedure, do not do anything where you need to be mentally alert. This includes making important decisions, operating machinery, signing important papers, etc.

• Eat light for the first 24 hours, and then start eating more as you are able. Drink plenty of fluids.

• Sore throat or mild “hang over” type feeling for a day or two from the general anesthesia. This   may include mild nausea.

 

 If you are taking pain medications:

 

 Take as directed

 Do not drink alcohol while taking narcotic pain medication

 Do not drive

 If you are constipated, drink more fluids and eat more fiber. You can also use an overthe-counter stool softener.

 

 

 

Radiofrequency Ablation

 

 

What is RFA?

 

Radiofrequency ablation (RFA) is a minimally invasive procedure that destroys cancerous tumors. Pulses of radiofrequency energy are sent through a catheter (a long, thin tube) to heat and destroy diseased tissue. Currently, RFA is a standard treatment for patients with inoperable liver tumors. It is being increasingly used for other cancers, such as lung cancers, kidney (renal), and certain benign and malignant bone tumors, and is being tested for other types of cancer. RFA does not cure cancer, but it can effectively destroy cancer cells, possibly in a similar way to surgical removal, relieve pain and suffering, and may prolong life.

 

Radiofrequency ablation (RFA) is a local treatment for cancer that delivers radiation directly to a tumor.

 

Radiofrequency energy comes from electric and magnetic energy and is absorbed by the body as heat. In RFA, the physician inserts a metal probe through the skin into a tumor. This heat destroys the cancerous cells but spares healthy tissue.

 

RFA may increase longevity and relieve pain, but it does not cure cancer.

 

RFA has fewer complications, is less risky, and causes fewer side effects than surgery to remove a tumor.

 

RFA may be used with other interventional cancer therapies, such as chemoembolization, and traditional cancer treatments, for example, chemotherapy.

 

WHEN IS IT INDICATED?

 

RFA is indicated in patients who have liver cancer for whom surgery is not possible. RFA may also be used to shrink large liver tumors before surgery.

 

Before treating cancer, the physician will order tests to determine the location, type, and severity of the cancer. These tests include:

 

Liver function test;

Biopsy;

Blood tests;

Computed tomography (CT) scan;

Spiral CT scan; and

Magnetic resonance imaging (MRI).

The night before the procedure, the patient is not allowed to eat. However, water is usually allowed up to 2 hours before the procedure.

 

WHO IS ELIGIBLE?

 

Eligible patients have liver cancer or cancer that has spread to the liver. Additionally, patients with small kidney tumors, lung tumors, or bone cancer may be eligible.

 

Patients with large or multiple liver tumors may be ineligible for RFA. RFA may not be as successful for liver metastases as for primary liver tumors.

 

WHAT TO EXPECT

 

RFA is frequently performed as an outpatient procedure by an interventional radiologist. In most cases, only a mild sedative and a local anesthetic are needed.

 

Interventional procedures are generally painless. Because there are no nerve endings inside the arteries, people cannot feel the catheters (long, thin tubes) as they move through their body.

 

The interventional radiologist will locate the tumor using imaging tests and choose an insertion point above a blood vessel for the catheter. Through this catheter, the physician inserts a probe with electrodes that transmit radiofrequency energy.

 

The interventional radiologist guides the probe to the site of the tumor while watching real-time images on a monitor. The patient may need to lie still or hold his or her breath as the probe is placed into the tumor. A generator sends radiofrequency energy through the probe. Heat kills the cancer cells surrounding the probe. This portion of the procedure typically takes 10 to 30 minutes.

 

When treatment is complete, the physician slowly removes the probe and places a small bandage over the site of the insertion. The entire procedure takes 1 to 3 hours.

 

POST-TREATMENT GUIDELINES AND CARE

 

The physician takes CT or MR images to ensure that the treatment has destroyed the tumor. If necessary, the procedure may be repeated.

 

For the first 2 to 3 hours after the procedure, the patient is placed on bed rest and his or her vital signs are monitored. Painkillers may be given. Patients stay in the hospital overnight.

 

For 24 hours following the procedure, the patient should avoid driving a car, exercising strenuously, or making important decisions if they have been given sedatives. Otherwise, patients can resume normal activities immediately.

 

Patients receiving RFA return for follow-up imaging tests. If the tumors have not shrunk, some patients may need additional treatments.

 

POSSIBLE SIDE EFFECTS

 

In general, RFA is safe and has a low rate of minor side effects, including:

 

Low-grade fever;

Bruising;

Bleeding;

Pain; and

Infection.

 

If a tumor in the liver or upper kidney is being treated, there is a small risk of lung collapse during the insertion of the probe.

 

Recurrence rates of liver tumors treated with RFA range from 1.8 percent to 28 percent. Long-term results of the procedure are not yet known.

 

 

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