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A variety of ablative therapies are available, these include: Cryotherapy, NanoKnife, 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.







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.







NanoKnife is a minimally invasive cancer treatment that uses a targeted approach to treating hard to reach tumors at the cellular level.  It relies on the body's natural healing ability to replace cancer cells once they are destroyed, so it leaves almost no scarring.


NanoKnife works by applying electrical energy directly into tumors.  This opens the cell walls of the tumor; the cancer cells die; and healthy tissue remains unharmed.  NanoKnife serves as an alternative to thermal ablation which kills cells with extreme heat or cold.




NanoKnife is FDA approved for use on all soft-tissue organs.


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


Liver function test;


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.




NanoKnife offers an effective treatment option for small tumors - usually less than five centimeters - which are considered inoperable.  It can be used for primary liver tumors or tumors that have spread to the liver from other parts of the body.




You will be placed under general anesthesia, and with the use of a CT scan or ultrasound guidance, your interventional radiologist will insert the electrodes on or near the tumor.  Once the electrodes are placed, the NanoKnife generator sends a series of short and intense electric pulses directly to the tumor.




Physicians can destroy tumors that may not be treatable with surgery or radiation therapy.

Patients undergo general anesthesia and experience little pain following the procedure.

Treatment requires only a brief hospital stay - some patients  can go home the same day.

Because it causes few side effects or scarring, NanoKnife treatments can be repeated if new lesions develop.


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.




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;


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.




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.




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.




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.




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


Low-grade fever;



Pain; and



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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