Williams Cancer Institute

Let’s talk ablation.

The first thing we must define is the ablation term itself. According to the NCI (National Cancer Institute), ablation in the field of medicine is the process or procedure by which the removal or destruction of a part of the body or tissue or its function is achieved. Ablation can be done through surgery, hormonal therapies, the use of medications, radiofrequency, heat, freezing, or other methods. 1

Percutaneous ablation encompasses a set of techniques that destroy pathological tissue using needles inserted through the skin. Sometimes liquid agents will be used (such as absolute alcohol) and in other physical agents, which can transfer heat (radiofrequency and microwave thermoablation) or cold (cryoablation) to the tumor.

The procedure will always be performed using image guidance, with computerized axial tomography to have constant control and safety during the introduction of the needle and that the energy transfer is applied exclusively to the tumor. This minimally invasive technique will be performed under sedation or general anesthesia, depending on certain parameters.

How is it performed? It consists of placing one or several needles in the center of the tumor to be treated very precisely and guided by an imaging technique. Using different technologies, these needles apply energy that destroys a volume of tissue in a predictable and controlled manner, thus eliminating the tumor. Ablation can be curative in some cases and has a high level of scientific evidence. Among the best-known ablation technologies are radiofrequency, microwaves, or lasers (they destroy tissue at high temperatures); cryoablation or cryotherapy (destroys tissue by freezing) and irreversible electroporation PEF (Pulsed Electric Field that destroys tissue without using heat or cold, instead using very short but very intense electrical pulses).

The most common way to perform an ablation is percutaneous, that is, with a needle from the skin without opening the patient. Compared to conventional surgery, ablation causes fewer complications and has a shorter recovery time. If the tumor is difficult to access percutaneously, ablation can also be performed in the operating room where, with the organ exposed and guided by ultrasound, the needle will be placed in the tumor. The organs that can be treated with ablation are liver tumors, lung tumors, kidney tumors, pancreatic tumors, bone and soft tissue tumors, and recently thyroid tumors. Ablation is a treatment that often can be combined with immunotherapy, chemotherapy, or radiotherapy.

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