What is tumor ablation?

Ablation uses energy delivered through a thin needle inside the tumor itself to destroy the tumor cells. The choice of energy depends on the tumor’s location and the tissue around it. Four modalities are in routine use:

• Microwave ablation (MWA) — fast, hot ablation zone. Especially well-suited to liver and kidney tumors.
• Radiofrequency ablation (RFA) — gentler heating; the original modality, still widely used in the liver.
• Cryoablation — extreme cold delivered through gas-cooled probes, forming a visible ice ball that engulfs the tumor. Particularly suited to kidney tumors.
• Irreversible electroporation (IRE / NanoKnife) — non-thermal. Brief electrical pulses disrupt cancer cell membranes — preferred near critical structures such as bile ducts, ureters, or major blood vessels.

All four are delivered through a small puncture in the skin under live CT, ultrasound, or MRI guidance.

Kidney tumors

For small kidney tumors — particularly T1a renal cell carcinoma (RCC), generally up to about 4 cm — ablation is well-established alongside surgery. Long-term outcomes for ablation in this setting compare favorably to partial nephrectomy in published series, with the advantages of preserving more functional kidney tissue, often avoiding general anesthesia, and going home the same day.¹ Ablation is especially valuable for patients with a solitary kidney, bilateral renal masses, hereditary syndromes (von Hippel-Lindau, Birt-Hogg-Dubé, hereditary leiomyomatosis-RCC), reduced kidney function, or who are not surgical candidates. Cryoablation and microwave ablation are the most commonly used modalities for kidney tumors at FIS.

Liver tumors

For hepatocellular carcinoma (HCC) — particularly BCLC stage 0 and stage A — image-guided ablation is one of the curative-intent options recommended by international guidelines, alongside resection and transplant.² Ablation can be definitive treatment, a bridge to liver transplant while patients wait, or downstaging to bring patients within transplant criteria. For liver metastases — colorectal, neuroendocrine, breast, melanoma, sarcoma, and other oligometastatic disease — ablation is increasingly part of the plan, often combined with surgery, chemotherapy, or radioembolization to clear all visible disease.³ The decision is made jointly with hepatology, hepatobiliary surgery, transplant surgery, and medical oncology — and at TGH, with the Center for Liver Disease and Transplant.

Ablation, surgery, and radiation

Surgery removes the tumor and a margin of surrounding tissue, sometimes including a whole organ or lobe. Radiation — particularly SBRT (stereotactic body radiation therapy) — delivers energy from outside the body across a course of treatments. Ablation destroys the tumor in a single session through one or two small needle punctures, usually with same-day discharge. For many liver and kidney tumors, all three are reasonable options. The decision is made jointly by the multidisciplinary tumor board after weighing the tumor itself, the surrounding anatomy, and your overall health.

What the day looks like

You’ll come to the hospital interventional suite. Depending on the site, you’ll be under conscious sedation or general anesthesia. Live imaging guides one or more thin needles through a small puncture in the skin and into the tumor. The targeted energy is delivered, sometimes in multiple overlapping ablation zones to ensure an adequate safety margin. The procedure takes 60 to 180 minutes. Most patients are discharged the same day or the next morning. Follow-up imaging at 1, 3, 6, and 12 months — and annually thereafter — confirms complete ablation and surveils for recurrence.

Who is a good candidate?

Candidacy is decided jointly — by medical oncology, by your urologist (kidney) or hepatologist and hepatobiliary surgeon (liver), and at TGH by the Center for Liver Disease and Transplant for HCC patients. Tumor size, location, prior treatments, and overall health all factor in. Tissue diagnosis is established before ablation when not already known.

References

1. Pierorazio PM, Johnson MH, Patel HD, et al. Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis. J Urol. 2016;196(4):989–999.
2. Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 2022;76(3):681–693.
3. Crocetti L, de Baère T, Pereira PL, Tarantino FP. CIRSE Standards of Practice on Thermal Ablation of Liver Tumours. Cardiovasc Intervent Radiol. 2020;43(7):951–962.
4. Palussière J, Catena V, Buy X. Percutaneous thermal ablation of lung tumors — Radiofrequency, microwave and cryotherapy: Where are we going? Diagn Interv Imaging. 2017;98(9):619–625.

Frequently asked questions

What is tumor ablation?

Tumor ablation is an image-guided, non-surgical procedure that destroys a tumor in place using extreme heat (radiofrequency or microwave energy), extreme cold (cryoablation), or non-thermal electrical pulses (irreversible electroporation, also known as NanoKnife). One or more thin needles are advanced through a small puncture in the skin into the tumor under live imaging, the energy is delivered, and the tumor is left to be reabsorbed by the body over the following months.

How is ablation different from kidney or liver surgery?

Surgery — partial nephrectomy for kidney, liver resection for liver — removes the tumor and a margin of surrounding tissue and remains the right answer for many patients. Ablation destroys the tumor in place through a small needle puncture and preserves more healthy organ. For appropriately selected small tumors — particularly T1a renal cell carcinoma and very early hepatocellular carcinoma — ablation outcomes compare favorably to surgical resection in published series, with shorter recovery and same-day discharge.

How is ablation different from SBRT?

SBRT (stereotactic body radiation therapy) delivers focused radiation from outside the body, usually across a course of treatments. Ablation destroys the tumor in a single session through one or two small needle punctures. Both are reasonable options for many liver and kidney tumors. The choice is made jointly by the multidisciplinary tumor board based on the tumor, the surrounding anatomy, prior treatments, and patient preference.

Can ablation be a cure?

For appropriately selected small tumors — for example, T1a renal cell carcinoma and very early hepatocellular carcinoma (BCLC 0/A) — ablation can be curative, with outcomes that compare favorably to surgical resection in published series. For liver metastases and other situations, ablation is most often used as part of a multidisciplinary plan to treat oligometastatic burden, control progression, or bridge to transplant. Long-term imaging surveillance is part of every plan.

Why are patients referred to FIS for liver and kidney ablation?

Patients are referred to Florida Interventional Specialists by medical oncologists, urologists, hepatologists, hepatobiliary surgeons, and transplant teams across Florida and beyond. The reasons include the depth of our experience with all four modalities — microwave, RFA, cryoablation, and NanoKnife — the integration of our care with the Tampa General Hospital cancer programs, including the Center for Liver Disease and Transplant, and the multidisciplinary tumor-board pathway that makes ablation decisions in the context of the rest of your cancer care.

Who performs tumor ablation?

Tumor ablation is performed by interventional radiologists. The procedure is delivered as part of a coordinated multidisciplinary plan with medical oncology, surgical oncology, and the relevant organ-specialty team — urology for kidney tumors and hepatology, hepatobiliary surgery, and transplant surgery for liver tumors.