Liver Cancer

Condition

What is liver cancer?
Primary liver cancer begins in the cells of the liver itself. Although many cancers are declining in the United States, new cases of primary liver cancer are increasing. Liver cancer is the fifth most common cancer in the world.

Treatment

What type of treatment is available for liver cancer?
The standard method for treating cancer of the liver is either surgery or chemotherapy. Recently, advances in minimally invasive techniques have been developed which can assist in treating these lesions. Radiofrequency Ablation (RFA) is a procedure that destroys tumor cells by heating them using a needle electrode and high frequency electrical currents. Ultrasound or CT Imaging may be used to help the radiologist guide the needle into the tumor.

While there are other methods of heating tumors, RFA, to date, is the most common of all thermal treatment methods. Over the last few years, developments in tumor ablation have allowed large volume tissue ablation to be performed safely on patients with either primary or metastatic liver disease. While other minimally invasive methods of tumor ablation have been used, at this point in time, RFA has been the most commonly used method.

When should I consider RFA?
At Massachusetts General Hospital, we believe that you should have all possible treatment options available and reviewed. To achieve this, we employ the team approach. This means that all patients will have the option of seeing a medical and surgical specialist in addition to the radiologist who performs the procedure.

RFA has proven most successful in the treatment of primary liver tumors (hepatoma, hepatocellular carcinoma). In Italy, where this technique originated, RFA has replaced surgery as the treatment of choice. Because liver tumors are slow growing and often encapsulated, patients treated with RFA have shown excellent survival results.

Indications include patients who are potential candidates for RFA of the liver include those:

with tumors 5 cm in size or less (larger tumors can and have been treated, but these may require additional therapies)
with 3 or fewer tumors per patient (If there are more than 3 tumors, treatment with RFA can be performed, but it is less successful)
elderly patients in whom surgery or post surgery recovery would be difficult
patients who are waiting for a liver transplantation who have a liver tumor

The world literature suggests that RFA is a safe and effective local treatment for neoplastic disease with a very low complication rate. Reported preliminary survival curves for hepatomas (< 3 - 4cm) are encouraging. Recent reports indicate that RFA results in complete necrosis of over 95 % of hepatomas of this size. In patients in whom there is some residual tumor, this area can be retreated.

What should I expect BEFORE RFA?
RFA is an outpatient procedure. For questions before the procedure please call our Nurse Coordinator in the Interventional Radiology Tumor Ablation Clinic at 617-724-2239.

You should be NPO (no food or drink) after midnight.
You should report to the Ellison 2 nursing area at 7:30am the day of the procedure.
You will have an I.V. placed to give some fluids and drugs for sedation during the procedure.
You will be taken either to Ultrasound or CT (depending on which imaging method has been chosen) for the procedure.

Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy because radiation can be harmful to the fetus. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby.

What should I expect DURING RFA?
RFA is usually performed under intravenous (conscious) sedation and the patient is usually awake and given standard drugs (midazolam, fentanyl, meperidine) to relax during the procedure. These are the same types of drugs that are given for any biopsy procedure. Most patients are comfortable during the procedure and require no pain medication or at the most, over- the-counter analgesics when at home.

The RFA procedure will take about 1- 2 hours. Much of this time is spent setting up the equipment and making the patient comfortable. The actual heating time is about 15 minutes. Patients may have several sessions (heating times) in one visit. This is determined based on the findings at the time of the procedure.

A small needle is inserted into the lesion using ultrasound or CT image guidance. The needle has an insulated portion and a variable length, and an uninsulated portion, which is the heating element of the needle. A machine generates energy, which is transmitted to the tip of the needle. The energy at the tip of the needle causes ionic agitation and frictional heat in the tissues surrounding the tip. In turn, these tissues can reach temperatures that cause cell death and coagulative necrosis. This usually occurs at temperatures above 50 degrees centigrade. The treatment can be repeated several times to kill more tissue. Each treatment takes about 15 minutes. Typically, RFA can create a kill area of 3-4 cm in size. The killed cells are not removed, but slowly are absorbed and digested by the natural "immune" system of the body, and a scar appears in the treated area.

What should I expect AFTER RFA?
For questions after RFA please call our Nurse Coordinator in the Interventional Radiology Tumor Ablation Clinic at 617-724-2239.

You will be taken to the recovery area to be monitored by radiology nurses after the procedure. You will remain there until you are completely awake and ready to return home.

Your doctor will decide what follow-up care is needed. Usually CTs or MRIs are ordered as follow-up imaging studies as they are the best methods to determine if the tumor has been completely treated.

Pain immediately following RFA can be controlled by pain medication given through your IV or by injection. Afterward any mild discomfort you experience can be controlled by oral pain medications. A few patients feel nauseous, but this can also be relieved by medication. Only about two percent of patients will still have pain a week following RFA.

You should be able to resume your usual activities within a few days.

Our Service

The Division of Abdominal Imaging & Intervention provides a full range of diagnostic and image-guided interventional studies of the GI and GU tract. This Division consists of nineteen full-time radiologists, all of whom are board certified in general radiology and fellowship trained with additional specialization in GI and GU procedures. In addition, each has extensive training in the use of x-ray equipment, x-ray dye and image interpretation.

Please see below for our abdominal imaging radiologists who specialize in performing RFA of the liver.

Debra A. Gervais, MD

Where is RFA of the liver performed?

Massachusetts General Hospital
Division of Abdominal Imaging & Intervention
55 Fruit Street, White 2
Boston, MA 02114

How to schedule RFA of the liver
A referral from a physician is necessary to schedule RFA of the liver.

Phone: 617-724-2239

To assist with scheduling please have the following information ready when calling:

Name and phone number of the physician ordering the RFA of the liver
Indication for RFA of the liver
Patient Medical Record Number (MRN)

Additional Information and Resources

MGH Radiology Rounds E-Newsletter

MGH Collaborative Care

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