After my first line of chemotherapy, Oxalyplatin and 5FU (FOLFOX) although it was very successful in destroying all the tumours in my lungs, there was one particularly stubborn one in segment 3 of my liver that was left behind and was now small enough to be treated by RFA (Radiofrequency Ablation Therapy).
I went up to London to speak to the liver team to check that I was fit enough for the procedure and that I fully understood what was being done, the risks and benefits.
A few weeks later, I was admitted the night before the procedure was to take place and put on nil by mouth at midnight. Now, I have an ileostomy and my fluid intake is necessarily more than the normal patient, as I lose it out of my stoma before it has gone to all the right places! So, when I am nil by mouth I dehydrate quicker than the normal patient, so I always ask to be put on a drip to counteract the dehydration and the inevitable headache that comes with it!
The next day dawned and I was taken to the procedure room and given my general anaesthetic. General anaesthetic is used more often these days than local anaesthesia and sedation, to minimise discomfort and ensure that there is no movement, as the procedure is a very precise art and any movement can displace the siting of the probe, therefore not hitting the right spot!
When the patient is under the general anaesthetic they are placed in a CT machine, so that the consultant radiologist can pinpoint accurately the tumour. A probe ( electrode), or several probes are then inserted through the abdominal wall, guided by the CT machine, into the centre of the tumour(s). The electron is then heated to a very high temperature to destroy the tumour from the inside out! The joy of this is that no other tissues are damaged during this process and there are no entry or exit burns. Hopefully all the tumour will be destroyed, but treatment can be done again if the tumour unfortunately starts to grow again.
My procedure took about 2 hours and I woke up in recovery very quickly as the amount of anaesthetic used is minimal. My consultant radiologist came to see me there, to tell me that as far as he was concerned the procedure had been successful and he had not needed to do as much work as he had first thought. He warned me that I was likely to get pain in my shoulder from the procedure, which would last approximately a day, this is because nerves in the liver are damaged during the procedure and they are connected to feeling in the shoulder area. Later on I was also likely to get localised pain in my liver but this was unlikely to be severe and both pains would be managed by analgesia. A small dressing had been placed over the tiny hole made by the probe and that was the only visible evidence of the RFA.
I was taken back to the ward and rested for a while before being allowed to eat, I like my food and little is likely to spoil my appetite! The pain in my shoulder did indeed kick in later and was worse than I was expecting, it actually felt as if I'd been kicked by a horse! As I'd been informed the pain lasted for only a day, but by this time my liver was extremely sore and was making walking difficult as it was making me bend double, it was decided to keep me in another night to monitor the pain. The next day dawned and although the pain was still bad, the after affects of the anaesthetic had lifted and I was managing the pain better so was allowed home that afternoon. I improved daily at home and was back at work the next week with no after affects.
So RFA is a very simple procedure, yes there are always risks with any procedure including the anaesthetic, but the success rate is high, you can have RFA multiple times on an increasing range of tumours both in the liver and lungs. It is quick, minimally invasive, with no side effects and as in my case has eradicated that particular tumour from my liver.
Yes, I would certainly consider it again, at the moment I have six tumours on my lungs that are too big or in the wrong place to be considered for RFA, but if chemo is successful in shrinking them, then maybe RFA will be considered for them and with time and increased knowledge and practice, RFA may also be suitable for tumours that would not have been considered for treatment before.
RFA is an exciting development in the treatment of tumours and I look forward to its increased success and the use of it in in many more hospitals in the UK.