Level 1: Hospital name. University College Hospital. Lung Tumour Ablation

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1 Level 1: Hospital name University College Hospital Lung Tumour Ablation Interventional Oncology Service (IOS) Imaging Department

2 If you would like this document in another language or format, or require the services of an interpreter, contact us on: or Mobile no (Clinical Nurse Specialist) We will do our best to meet your needs. Contents Page 1. Introduction 2 2. What does ablation mean? 2 3. How can ablation help? 2 4. What are the risks of ablation? 3 5. What will happen if I choose not to have ablation? 4 6. What alternatives are available? 4 7. How should I prepare for ablation? 5 8. Asking for consent (permission) 5 9. What happens during ablation? What should I expect after ablation? Where can I get more information? References Contact details How to find us & transport 10 Page 1

3 1. Introduction This booklet contains information for patients, (and their family and carers), who are considering having lung tumour ablation. It explains what is involved and the possible risks. 2. What does ablation mean? Ablation is a technique that destroys tissue, in this case through heating. In order to produce that heat, needles are placed into the lung using image guidance (Computed Tomography - CT scans). Only a small amount of heat is produced (slightly less than a boiling kettle) and the heat only travels a small distance (a few centimetres) within your body. Most of the normal lung tissue is not affected. A radiofrequency electric current or microwaves may be used to generate this heat. Radiofrequency ablation (RFA) has been available since the late 1990s and had been used successfully in Europe and America. It is now being used increasingly in England. Microwave ablation has been used in a similar fashion for the last 5 years. Both have a similar effect on tissues, but microwave treatment may be slightly faster. 3. How can ablation help? Ablation may be used in patients with small, early-stage lung cancers or small numbers of lung metastases who are unsuitable for, or prefer not to undergo surgery. It may also have a place in multi-modality treatment of more advanced primary lung cancers (1). If necessary the procedure can be repeated. Most people are able to resume normal activities within a few days. Page 2

4 4. What are the risks of ablation? All treatments and procedures have risks and we will talk to you about the risks of ablation. Thousands of ablations have been performed worldwide, however there are unfortunately always risks involved, but these will be minimised by making sure the procedure is appropriate in your circumstances. There are recognised complications of the procedure both generic and unique to the area being ablated. The risk of certain complications also varies with the size and position of the lesion, its proximity to other structures and the experience of the operator. For the most, ablation is an extremely successful method of providing focal tumour ablation and in skilled hands has a low and acceptable rate of complications, with a significant morbidity and mortality of less than 2-5% and 0.5% (2). Problems that may happen straight away Air leaking into the space around the lung, causing the lung to deflate (pneumothorax). Having a small amount of air around the lung (pneumothorax) immediately after treatment is very common. In most cases your body will absorb the air by itself. In around 1/3 of cases, there is sufficient air around the lung to require a small tube to be inserted to drain it (the tube is soft and normally around half the size of a drinking straw). If this happens the drain remains in place overnight and is removed the next morning if the lung has re-inflated. Bleeding from the needle insertion site or coughing up blood. This normally requires no treatment. Page 3

5 Problems that may happen later Post ablations syndrome, which occurs in about 1 in 4 patients. This a flu-like illness that happens 3-5 days after treatment and is due to the immune system dealing with the treated tumour. This settles without treatment, but may require Paracetamol if there is a fever. Lung infection, requiring antibiotics. Problems that are rare, but serious Very occasionally the lung takes a little longer to re-inflate. If this happens we keep you in hospital until it does. If the lung does not re-inflate after a week, we have a discussion with the chest surgeons who may suggest a small operation to seal the lung. Bleeding that does not settle by itself may require further treatment. 5. What will happen if I choose not to have ablation? There are many different forms of treatment available for tumours in the lung. All the different types of treatment possible have been considered by the team of oncologists, surgeons and radiologists (specialist X-ray doctors) looking after you. 6. What alternatives are available? Ablation may be combined with other treatments to treat lung tumours. Your doctor will discuss with you the best course of treatment in your case. In cases where surgery is not suitable, radiotherapy is often considered. There are new forms of radiotherapy in Page 4

6 development, such as stereotactic radiotherapy, which may also be suitable. 7. How should I prepare for ablation? We will ask you to come for a pre-operative assessment appointment. At this appointment we will ask you about your medical history and carry out any necessary clinical examinations and investigations to make sure you are well enough for the procedure to go ahead. You may need an electrocardiogram (ECG) and a blood test. We will check the functioning of your lungs. We will also give you written information that tells you about eating and drinking before your procedure, what to bring with you, when you should arrive and the need to have an escort home. The nurse will ask you about any medicines or tablets that you are taking either prescribed by a doctor or bought over the counter in a pharmacy. It helps us if you bring written details of your medicines with you to this appointment. We will tell you whether you need to stop taking any of your medicines before your procedure. When you come into the hospital for the procedure itself, please bring all of your medicines with you. Generally, the ablation itself will take 60 to 90 minutes, but on occasion it may take longer. This is variable depending on the complexity and size of tumour. 8. Asking for your consent (permission) We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves. The radiologist will explain all the risks, benefits and alternatives before they ask you to sign a Page 5

7 consent form. If you are unsure about any aspect of your proposed treatment, please do not hesitate to speak with the radiologist again. University College London is one of the top academic centres in the world. AS such, it is likely that you will be invited to participate in an ongoing research trial. This may involve new treatment techniques or new ways of imaging or assessing tumours. Involvement in research is entirely voluntary, and you will be provided with full details of any trials, which may be suitable. 9. What happens during ablation? After admission, the radiologist will see you to talk about your procedure and to answer any remaining questions you may have. Once you have understood all the information, including the benefits and risk of complications, the radiologist will ask you to sign a consent form to give your agreement to go ahead. The anaesthetist will also see you before the procedure and talk you about the sedation or anaesthetic. If you have any questions or concerns, this is the time to ask. Ablation is performed by a radiologist who has a particular expertise in guiding needles using imaging. There are several consultant radiologists; members of the Interventional Oncology Service (IOS), who deliver this treatment. The team works with other doctors involved in your care. We will scan you again prior to the actual procedure. This will help the radiologist to further plan the treatment and confirm the best means of access to the tumour. Usually this is done with you lying on your back or on your side. After the scan has been performed, we will give you a general anaesthetic (or very deep sedation) and mark the treatment site on your skin. This area is Page 6

8 then cleaned with antiseptic solution and local anaesthetic may be used to numb the area. The needles are guided into the tumour using Computed Tomography (CT) images to ensure the tumour is correctly targeted. The ablation is then undertaken. A completion scan is then performed to assess the immediate results of the ablation therapy. 10. What should I expect after ablation? When you wake up from your anaesthetic you will be in the recovery area. The nurse will regularly check your pulse rate and blood pressure. Once you are comfortable and your blood pressure is table, you will be taken to the ward for an overnight stay. You will also have a chest X-ray 3 hours after your ablation to check if air has leaked around your lung. On the ward, you will gradually be allowed to drink water. If you are able to tolerate good amounts and do not feel sick, then you will be able to have a hor drink and something light to eat. You will have an intravenous drip in your arm, which will be removed before you go home. Your nurse will offer you pain relief to help with any discomfort. By the next day most people require pain relief no stronger than Paracetamol. When you get out of bed for the first time a nurse will need to be with you in case you feel faint or dizzy. The day after treatment, you will have another CT scan of the treated region and will be reviewed by the team before being discharged. If you have a chest drain, this will be removed before you leave. We will provide you with written post discharge instructions and the contact numbers of the team in case of emergency. Page 7

9 What happens when I go home? Normally, you will able to go home the day after your procedure. Before you go home we will discuss your follow-up treatment with you. You should expect to be off work for one week after treatment. You will have an appointment to come back to the clinic 4 weeks after the procedure for a repeat scan and to check that you have made a good recovery. Signs to look out for: Worsening shortness of breath or pain on breathing in Pain that is not controlled by regular pain relief, e.g. Paracetamol Increasing fever or pain more than 1 week after the procedure Coughing up more than 1/3 cup blood. A little streaky blood in the spit is expected If you have cause for concern for concern following discharge please contact our Clinical Nurse Specialist on If you are unable to contact our team out of hours, please contact the UCH 24-hour nurse led helpline on Page 8

10 We will update your GP after your discharge, but immediately after the procedure they may not be aware of the details. If you see your GP after the treatment please take your post discharge instructions with you. 11. Where can I get more information? Macmillan Cancer Information Centre Ground Floor Rosenheim Building 25 Grafton Way London WC1E 6AU Tel: Macmillan Cancer Backup Telephone: (Monday to Friday 9am-8pm) Website: UCH cannot accept responsibility for information gained from external organisations. 12. References 1. https://www.nice.org.uk/guidance/ipg https://www.rcr.ac.uk/sites/default/files/docs/radiology/pdf/b FCR%2813%298_Standards_RFA.pdf Page 9

11 13. How to contact us Interventional Oncology Clinical Nurse Specialist: Interventional Oncology vice Co-ordinator: or Interventional Oncology Service Imaging Department Podium 2 UCLH#235 Euston Road NW1 2BU Fax: UCH Switchboard: Hospital Transport Services: Website: 14. How to find us & Transport Clinic appointments: 4 th floor of the Macmillan Cancer Centre on Huntley Street (see map on page 13). Procedures: The Imaging Department, Level 2 Podium in the main University College Hospital building with the entrance on Euston Road (see map on page 13). Page 10

12 Travelling to the hospital No car parking is available at the hospital. Street parking is limited and restricted to a maximum of 2 hours. Please note the University College Hospital lies outside, but very close to the Central London Congestion Charging Zone. Tube The nearest tube stations, which are within 2 minutes walk are: Warren Street (Northern and Victoria lines) Euston Square (Hammersmith & City, Circle and Metropolitan lines) Overground trains Euston, King Cross & St Pancras and Kings Cross Thames link railway stations are within minutes walk. Bus Bus services are shown on the map on page 7. Further travel information can be obtained from Hospital transport services If you feel that you are eligible for transport please call: (Mon to Fri 8am-8pm) to speak to a member of the Transport Assessment Booking Team. You will need to call at least 7 days before your appointment. Page 11

13 If you have a clinical condition or mobility problem that is unlikely to improve you will be exempt from the assessment process. However, you will still need to contact the assessment team so that your transport can be booked. If your appointment is cancelled by the hospital or you cannot attend it, please to cancel your transport. Can an escort be arranged to accompany me in hospital transport? This will depend on your clinical condition or mobility. If you meet the criteria then an escort will be booked to accompany you to and from the hospital. However, we aim to keep these to a minimum as escorts take up seats that would otherwise be used for patients. Page 12

14 Page 13

15 Space for notes & questions Page 14

16 Page 15

17 First published: June 2016 Date last reviewed: June 2016 Date next review due: June 2018 Leaflet code: UCLH/S&C/IMG/LTA/1 University College London Hospitals NHS Foundation Trust Page 16

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