This booklet has been provided to help answer some of the questions you may have about RFA of liver tumours.

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1 This booklet has been provided to help answer some of the questions you may have about RFA of liver tumours. RFA of tumours is a minimally invasive procedure used to treat liver tumours (growth or mass in your liver). RFA works by passing a special RF needle into the tumour through the skin and into the body. The needle is connected to an electrical generator; and grounding pads are placed on the thighs to complete the electrical circuit allowing the process to work. The needle tip is heated through ionic frictional motion. The radiofrequency current produces a high level of heat within the tumour tissue near the needle tip and ablates or destroys it. The needle tip is left in place for about minutes. The Interventional Radiologist will choose the correct settings to ensure that the heat will destroy all the tumour tissue as well as 5-10mm of the surrounding normal tissue margin. This treatment is usually done under heavy sedation or under general anaesthetic (GA); you will be seen by an anaesthetist before the procedure. The interventional radiologist (specialist doctor) will use ultrasound guidance during this procedure. Ultrasound produces sound waves that are beamed into the body causing return echoes that are then converted into a picture called a sonogram. The ability to measure different echoes reflected from a variety of tissues allows a shadow picture to be constructed. Ultrasound imaging, allows physicians to get an inside view of soft tissues and body cavities, without using invasive techniques. Your doctor has recommended that you have radiofrequency ablation because you have a tumour that is suitable for this treatment. 1

2 The benefit of RFA is that it is a safe procedure which can treat liver tumours without the need for major surgery. RFA can be an effective treatment for primary liver cancer, or other cancers that have spread to the liver, or in some patients whose disease is unsuitable for surgical resection (when part of the liver is removed). In most studies, more than half the liver tumours treated by RFA have not recurred. It can also be used alongside other treatments such as chemotherapy. RFA may be used repeatedly to treat recurrent liver tumours. RFA is less invasive treatment takes less time than other options. Patients are able to resume their usual activities within a few days. Serious complications related to the treatment are uncommon. However, the risk of complications after RFA are: organ damage: there are rare reports of the organs that lie next to the liver (gallbladder, stomach and colon) becoming damaged by the heat generated during the procedure. less than 1% (1 in 100) risk of bleeding. less that 1% risk (1in 100) risk of infection. less than 1% (1 in 100) risk of skin burns at the site of the grounding pads used to provide the electrical circuit for the treatment. A blood test to check your blood clotting will be taken before the procedure and the use of ultrasound guidance will help the interventional radiologist (specialist doctor) minimize the risk of these complications. The interventional radiologist will also discuss the risk factors with you before starting the procedure and will be happy to answer any questions you may have. Your doctor will only have requested radiofrequency ablation if they feel that this is the best way to treat your condition. There are other types of local therapy available for liver tumours, these include: alcohol injection acetic acid injection cryotherapy chemoembolisation surgery to remove liver tumours. Your doctor will be happy to discuss it further with you before starting the procedure. If you cannot keep the appointment then please contact admissions or the ward. You will find the appropriate contact numbers on your appointment letter. 2

3 Please note you will need to be admitted to hospital usually the day before the procedure. The appointment letter will tell you what ward you are to go to. You will be asked not to have anything to eat or drink up to 6 hours before the procedure. Your doctor or nurse will advise you. If you are diabetic please tell the ward staff so that they are aware of your condition, please do not take your morning medication if you have been asked not to eat and drink as you may risk having a hypoglycemic episode. You can take all your medications as usual, except blood-thinning tablets (such as warfarin or aspirin or plavix or clopidogrel or dabigatran). If you take blood-thinning medications, it is very important that you inform your doctor, the ward staff or the imaging department staff before you come into hospital. You may be advised by your doctor to stop blood thinning drugs before your procedure. They will advise you how far in advance to stop these drugs. Please let us know if you are allergic to any medications before your appointment. It is very important that you have had your blood taken recently, as the results of these tests will tell us how well your blood clots. Please note that we will not do your radiofrequency ablation without having normal results from your blood tests. You are advised to travel, if possible, by public transport when visiting Hammersmith Hospital. Car parking is severely limited and you may find it difficult to find a place to park near the hospital. The nearest tube stations for Hammersmith Hospital are East Action and White City (both on the central line). Buses that stop outside the hospital are numbers 7, 70, 272 and 283. The nearest tube station for Charing Cross Hospital is Hammersmith station. Buses that stop outside the hospital are numbers 220, 190, 295, 211 The nearest tube station for St Mary s Hospital is Paddington, (District and Circle, Bakerloo, Hammersmith and City and Main Line Buses that stop outside the hospital are numbers 7,15,23,27,36,205,332 and 436 The ward staff will ask you to change into a hospital gown before going to theatre or imaging department. A cannula (fine plastic tube) will be inserted into a vein in your hand or arm. The Radiologist will see you on the ward to discuss the procedure and gain your consent. The Anaesthetist will also see you before the procedure. When you arrive in theatre, staff will check your name and date of birth and connect you to a monitor that will record your blood pressure, pulse and ECG (heart tracing). The anaesthetist will then give you some medication to make you sleepy before taking you into the procedure room. The grounding pads to prevent burning of other area will be placed on your thighs before the procedure. The area where the needle is to be inserted will be cleaned with antiseptic fluid and 3

4 covered with a sterile drape (towel) A contrast enhanced ultrasound scan is used to identify the tumour site(s) within the liver. A needle electrode is then positioned within the area to be treated. The needle is connected to the special generator and the electrical current is delivered into the tissue. The tip of the needle is an electrode and is positioned into the tumour. The heat generated from the current destroys the tumour cells. Radiofrequency ablation can take approximately minutes to complete but may take longer if more than one tumour needs treating. Once the interventional radiologist is satisfied that all the lesions have been treated, the needle will be removed. A simple dressing will be applied to the area. No stitches will be needed. You will then be taken to the recovery room and theatre or recovery staff will continue to monitor your pulse and blood pressure as well as check the puncture site regularly. Analgesia will be administered if required. If you feel unwell during this time you must inform staff immediately. You will remain in recovery until you are fully awake. Once you are fully awake you will return to your ward. The ward nurse will continue to monitor your observations if you feel unwell please let ward staff know. One in four patients may develop flu like symptoms (Post-ablation syndrome) three to four days after the procedure however if your temperature suddenly becomes higher or you feel unwell, please contact the doctors who looked after you on the ward, or alternatively, go to your nearest Accident and Emergency (A&E) Department. Most people can resume their usual activities within 10 days of having the treatment. Your doctor will give you further advice about this. Yes. You will need to have a US or CT or MRI scan after three to four weeks, your team of doctors involved in your continuing care will see you to discuss the results of the radiofrequency ablation with you. We aim to provide the best possible service and staff will be happy to answer any questions you may have. If you have any suggestions or comments about your visit, please either speak to a member of staff or contact the patient advice and liaison service (PALS) on or

5 The PALS team are able to listen to your concerns, suggestions or queries and are often able to help sort out problems on behalf of patients. Alternatively, you may wish to express your concerns in writing to: The Managing Director Imperial College Healthcare NHS Trust Trust Headquarters The Bays, South Wharf Road London W2 1NY Please do not hesitate to contact us if you have queries or concerns Imaging Department, Hammersmith Hospital, Du Cane Road, London W12 0HS Telephone: Cancer BACUP British Liver Trust Imaging Published: July 2014 Review date: July 2017 Reference number: 2467v1 Imperial College Healthcare NHS Trust 5