Ablation

What is ablation

Ablation is a medical procedure used to treat primary liver cancer by destroying cancerous tissue. Primary liver cancer is cancer that starts in the liver itself, not somewhere else in the body.

Ablation means to destroy. Doctors can use heat (such as microwave or radiofrequency ablation) or cold (cryoablation) to destroy cancers cells.

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Types of ablation

Microwave ablation (MWA)

Microwave ablation (MWA) is the most common type of ablation used in Australia. MWA is a procedure used to treat liver cancer by destroying tumour cells with heat generated from electromagnetic microwaves. During the procedure, a thin, needle-like probe is inserted through the skin and guided to the tumour using ultrasound or CT scan imaging. Once in the correct position, microwaves are then emitted which generate heat within the tumour that destroys cancer cells.

MWA is usually done under general anaesthesia, and patients may need an overnight stay in hospital following the procedure.

Radiofrequency ablation (RFA)

Radiofrequency ablation (RFA) is a procedure used to treat liver cancer using high-energy radio waves to heat and destroy cancer cells. A thin, needle-like probe is inserted through the skin and guided into the tumour using imaging such as ultrasound or CT scan. Once it is in place, an electric current is passed through the tip of the probe generating heat that destroys the cancer cells.

RFA is usually performed under general anaesthesia, and patients may need an overnight stay in hospital following the procedure.

Cryoablation (cryotherapy)

Cryoablation is a procedure used to treat liver cancer by destroying tumour cells with extreme cold. During the procedure, a thin, needle-like probe is inserted through the skin and guided into the tumour using ultrasound or CT scans. Once it’s positioned, extremely cold gases are passed through the probe. These freeze the tumour and cause the cancer cells to die. Cryoablation is typically performed under general anaesthesia, and patients may require a short hospital stay following the procedure.

This technique is sometimes used along with surgery to remove part of the liver. It is less common as a single treatment compared to RFA or MWA, as it tends to be a more complex procedure.

Ethanol (alcohol) ablation

This is also known as ‘percutaneous ethanol injection’ (PEI). It is a procedure used to treat liver cancer by injecting alcohol directly into the tumour. The alcohol causes cell death and scarring which makes the tumour shrink. This procedure is usually performed under local anaesthesia with ultrasound or CT scans to guide the needle into the tumour. Sometimes several treatments of alcohol ablation are needed to achieve complete tumour ablation. This technique is now used much less often than the other types of ablation as it is less effective.

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How do I prepare for ablation?

Ablation is generally more effective when used on liver tumours that are less than 3 cm in size and are not able to be surgically removed. Ablation is not a suitable treatment if the cancer has spread into the blood vessels, lymph nodes or other parts of your body. You need to be generally healthy, and the rest of your liver must be working well.

You may have an appointment at the pre assessment clinic before your treatment. This is to prepare you for the treatment and check you are well enough to have it. You might need tests such as blood tests and an ECG to check your heart.

Tell your doctor if you’re having medicine that changes how your blood clots. These include:

• aspirin

• clopidogrel/plavix

• arthritis medicines

• warfarin or heparin

• apixaban, rivaroxaban or dabigatran

• ticagrelor

You should also tell your doctor if you are taking some specific medications for diabetes such empagliflozin (in Jardiance, Jardiamet, Glyxambi) or dapagliflozin (in Forxiga, QTern, Sidapvia, Xigduo) as these need to be held prior to a general anaesthetic.

Your doctor will tell you if you need to stop taking these or any other medicines for a while before your treatment.

You can’t eat for 4 to 6 hours before the ablation, but you might be able to drink sips of water up to 2 hours before your procedure. Your doctor or nurse will give you instructions about this before.

Talk to your doctor if not eating could be a problem for you. For example, if you have diabetes.

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What happens during ablation? 

You will normally go into hospital on the day of your treatment or the evening before.

A specialist doctor called an interventional radiologist carries out the procedure. Radiographers and nurses will also be with you in the room.

First you get changed into a hospital gown. You lie on your back on the x-ray table. Your doctor or nurse puts a small tube (cannula) into a vein in your arm or back of your hand. They use the cannula to give you any medicines you might need, such as antibiotics, sedation, or pain relief. Your nurse regularly checks your heart rate and blood pressure. You might have oxygen through a small plastic tube or sponge which sits just inside your nostrils.

Mostly RFA or MWA is performed under general anaesthetic, which means you are unconscious. Or you will have a drug that makes you very sleepy (sedation) and a local anaesthetic to numb the skin above the liver. You will also have strong painkillers during treatment.

The time your treatment takes can vary. It can take anything from 30 minutes to a couple of hours in total.

In some cases, to be sure the treatment is aimed at the right place,  ablation is done in the operating room with either laparoscopy (keyhole surgery) or a surgical incision (cut) in the skin over the belly, while the person is under general anaesthesia.

Your doctor removes the needle when the treatment has finished and covers the area with a dressing. You go back to the ward where you will be monitored by nurses. It is important to tell them if you feel sick or have any pain.

You usually need to stay in bed for a few hours after the procedure. You can start eating and drinking once you are fully awake and feel up to it. You will probably have to stay in hospital overnight so that you can be monitored. Most patients can go back to doing their normal activities within about a week.

You usually have a scan about 4 to 6 weeks after ablation treatment to check how well it has worked.

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What are the side effects of ablation?

As with any medical procedure there are possible side effects or complications. Your doctor makes sure the benefit of the treatment outweighs these risks. Possible side effects of ablation include:

• Discomfort or mild pain

• Feeling unwell with a slightly raised temperature (flu-like symptoms) for a few days

• Infection

• Damage to the surrounding area

• Bleeding.

• Skin burn and nerve damage can occur with cryoablation, but this is rare.

Discomfort or pain

You will probably have some discomfort or mild pain where the needles went into your skin. Treatment to the liver can also cause shoulder pain. This is caused by pain travelling along a nerve near the liver, which connects to nerves in the shoulder. It’s called referred pain.

You will have painkillers to take home, although you may not need to use them. Contact your healthcare team if your pain isn’t getting better, or if the pain gets worse.

Flu-like symptoms (post ablation syndrome)

Some people have flu-like symptoms that start about 3 to 5 days after treatment. You might feel tired, generally unwell, have body aches and you may feel sick. This might last 1 to 2 weeks.

This is due to a side effect called post ablation syndrome. Before you go home, your healthcare team will explain this syndrome. They will go through what medicines you can take to relieve your symptoms.

Contact your healthcare team if you feel unwell after this time or have a temperature above 38°C. You may have an infection that needs treatment.

Damage to the surrounding area

During the procedure, there is a small risk of damaging structures near the liver. For example, damage to the bile ducts, bowel or gallbladder. This is rare because the doctor uses scans to help guide the probe to the right place. The heat or cold only travels a short distance, so it doesn’t generally affect the rest of your liver tissue.

Bleeding

There is a risk of bleeding caused by the needle going into the liver. This is rare. Your doctor and nurses monitor you closely during and after treatment. So if this happens, they deal with it straight away. You might need to have a procedure, such as an angiogram, to stop the bleeding. You may also have a blood transfusion if you have lost a lot of blood. But remember this is very uncommon.

Risk of your cancer coming back

There is a risk that ablation does not completely get rid of the cancer. Or that it grows back (recurs). Your team will monitor you regularly for this and have the area treated again if needed.

You will also be at risk of new cancers developing in a part of the liver away from the treated cancer. Because of the risk the treated tumour may grow back, or new tumours might develop, long term monitoring with 3-6 monthly scans of your liver will be recommended.

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How much does ablation cost? 

You will not pay anything for your ablation treatment if you are having it in a public hospital. If you are being treated in a private centre, you may have some or all of your costs covered by private health care (if you have it). You should talk to your doctor about the best option for you. 

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Resources

Liver Foundation Nurse Led Support Line: call 1800 841 118 or email support@liver.org.au to talk to a friendly, expert hepatology nurse. 

Reviewed Jan 2026