Lung Cancer: Radiofrequency Ablation

(RFA or RF Ablation)

Procedure overview

Radiofrequency ablation (RFA) is a technique that uses a small needle electrode to send an electrical current to heat and kill cancer cells. The heat also closes nearby blood vessels to limit bleeding. As you heal after the procedure, scar tissue replaces the tumor.

The needle electrode is guided with imaging scans, such as CT or MRI. These images tell the radiologist where to put the electrode.

This is minimally invasive surgery because it is an image-guided technique. It lets your doctor to get to the cancer through small cuts in the skin. Minimally invasive means less cutting and less blood loss. As a result, you may recover more quickly and have less pain related to the treatment.

RFA may be part of your overall cancer treatment. You may have it along with chemotherapy, radiation therapy, or both. You may not be able to have RFA if the tumor is close to important organs or tissues. Using RFA to reduce the tumor size may help some people live longer.

Reasons for the procedure

Lung cancer is the leading cause of cancer deaths in the U.S. But because many people are diagnosed when they have advanced lung cancer, they aren't able to have lung surgery. Lung surgery is the gold standard of treatment. The survival rate for radiation therapy is also disappointing. RFA offers a treatment choice for some people that can be done more than once if needed.

Your doctor may recommend this treatment to:

• Shrink tumors so they can be better treated with chemotherapy or radiation

• Treat some early-stage lung cancers if you can't or don't want to have surgery 

• Treat cancer that has spread to the lungs from elsewhere in the body

• Manage or ease pain from tumors

• Treat tumors that have returned to the same site

This procedure may also be recommended for people who are too old or sick for cancer treatments that are more invasive.

Risks of the procedure

As with any medical procedure, RFA carries certain risks. They include:

• Pneumothorax. This is a condition in which air collects in the chest cavity and causes part of the lung to collapse. It usually gets better on its own. But some people may need treatment.

• Bleeding

• Fluid pooling. The fluid may gather in the space between the lung and the lung's membrane. This can be treated by using a needle aspiration to take out the fluid.

• Infection

• Pain

• Worsening of lung disease symptoms

• Worsening of underlying lung disease, although this is rare

RFA may involve exposure to radiation, depending on the imaging test used for the procedure. But a small amount of radiation is used during the imaging tests, and the risks related to radiation exposure are quite low.

You may have other risks, depending upon your specific health condition. Be sure to discuss any concerns with your doctor before the procedure.

Before the procedure

Before RFA, you will likely need to:

• Complete any blood tests or other tests ordered by your doctor.

• Let your doctor know if you are or could be pregnant.

• Make sure you understand why the procedure was recommended.

• Tell your doctor about all the medicines, herbs, and supplements you are taking. He or she may recommend that you stop using some of these for a certain time before the procedure. These include blood thinners, aspirin, or other nonsteroidal anti-inflammatory medicines, such as ibuprofen.

• Ask your doctor when to stop eating and drinking or whether you should avoid certain foods before this test.

• Let your doctor know about any previous surgeries, or other health conditions, such as diabetes or kidney disease.

• Tell your doctor about any allergies, especially to iodine. Iodine may be used in the contrast dye during the imaging.

• If you will be discharged the same day, make sure you have someone who can drive you home.

During the procedure

The following steps explain what will likely occur during the procedure:

• You will be given a gown to wear.

• You will lie on an exam table.

• A nurse will start an IV to give you fluids and medicines.

• A CT scanner will be used to find the targeted tumor or tumors in your lungs. The areas on your chest will be marked so the doctor knows where to make the cut.

• After the skin is numbed, the doctor makes a small cut in the skin in order to put in the needle electrode. The radiologist will then guide the electrode into the tumor with CT scans. He or she will use radiofrequency waves to heat the electrode and kill the cancer cells.

• Once the doctor is satisfied that as much of the tumor as possible has been destroyed, he or she will remove the needle electrode.

• Pressure will be put on the small cut or cuts to stop the bleeding. The staff will put a bandage on the site and remove the IV.

After the procedure

You may feel some pain or nausea as a result of the procedure. You may get medicine to control these symptoms. Let your nurse or doctor know if they continue to be a problem. 

An X-ray will be taken about 2 hours after the procedure. This is to make sure that no section of your lung has collapsed or been harmed. Sometimes part of the lung collapses because of trapped air. In a few cases, patients will need a small tube put in the lung to remove the air. The tube may be removed after a day or two.

Make sure to go to all of your follow-up appointments. Let your doctor know right away if you have any signs of infection. These signs include redness or oozing at the incision, or fever and chills. Also let your doctor know if you have shortness of breath.