Tumours — liver, kidney, lung
Targeted tumour treatment through a 1–2 mm incision — ablation and embolization, guided by imaging.
OVERVIEW
Dr Marios Agathangelou performs interventional oncology — tumour ablation and embolization in Nicosia and Limassol, Cyprus — covered by GESY, €0 for GESY beneficiaries. Interventional oncology delivers treatment directly to a tumour while sparing the organ around it. Ablation destroys tumours in place with heat or cold; embolization blocks their blood supply — sometimes carrying chemotherapy or radiation directly into the lesion.
These treatments are performed through a 1–2 mm incision under imaging guidance, often in a single session, and can be combined with surgery, chemotherapy or radiotherapy as part of a personalised oncology plan.
WHO IT’S FOR
- Liver, kidney, lung and bone tumours, evaluated case-by-case
- Patients unfit for — or wishing to avoid — surgery
- Local tumour control alongside a wider oncology plan
BENEFITS
GESY COVER
The procedure is fully covered by GESY. It is done as an inpatient admission, and that admission includes the treatment — you pay nothing for the procedure.
Separately, the outpatient visit — the initial assessment, where it is decided whether the treatment suits you — may carry a small co-payment, usually €0–10, as any specialist visit within GESY does.
The co-payment is per activity, and it stops once your total co-payments for the year reach €150 — past that you pay nothing. Some categories of beneficiary have different limits.
Both need a valid referral, from your personal doctor or from a specialist.
Outside GESY, or with private insurance? We provide the documentation your insurer asks for, and a clear cost estimate at your consultation, before you decide anything.
WHERE IT FITS
Interventional oncology does not replace your oncologist or your surgeon. It is one more option on the table, and whether it suits you is decided by a team — oncologist, surgeon, radiologist — not by one doctor alone. If anyone tells you a single method is always best for every tumour, they are not telling you the truth.
WHAT IT CAN AND CANNOT DO
Two very different aims often hide under the same word. For some small tumours the aim is to destroy the lesion completely. In other cases the aim is control — to shrink a tumour, slow it, relieve symptoms, or buy time for another treatment. Which of the two applies in your case matters, and we will tell you plainly which it is.
WHEN IT IS NOT RIGHT
The method is chosen from the type, number, size and position of the lesions, the organ's function, and your general condition. Tumours that are very large, scattered, or dangerously close to other organs may not be suitable. Clotting disorders, active infection and impaired organ function are reasons not to proceed. When the answer is a different treatment — surgery, systemic therapy, radiotherapy — we will say so.
RISKS
The risk in these treatments is measured against two parameters: the complications, and whether the tumour comes back in the exact place that was treated.
For a single hepatocellular carcinoma of up to three centimetres, the evidence disagrees with itself. In a review of 39 studies and 6,356 patients, the two randomised trials found no survival difference between ablation and surgical removal, while the observational studies favoured surgery.
In another review, of 11 studies and 1,334 patients with early hepatocellular carcinoma, complications after ablation were less than half those after surgery, and survival at one and at three years did not differ. Local recurrence, however, was about one and a half times more common.
In patients over 65 the data were as follows: local recurrence was about five times more common after ablation, adverse events about a fifth of those after surgery, and the hospital stay two weeks shorter on average.
When hepatocellular carcinoma returns after an operation, ablation and a second resection gave similar survival across 17 studies. Major complications were more than three times as frequent after the second operation, with the same mortality.
Fever, pain and nausea in the first days after chemoembolisation are the expected reaction to closing the vessels that were feeding the tumour, and are not a complication. There is randomised evidence that a corticosteroid before the procedure reduces them.
In the kidney, cryoablation against partial nephrectomy gives fewer overall complications, less blood loss, a shorter stay and better preservation of kidney function, with local recurrence more frequent.
Across 33 studies and 74,946 patients with a small renal tumour, cancer-specific survival, distant metastases and recurrence-free survival beyond five years did not differ from partial nephrectomy. Overall survival was worse after ablation. That is explained by these patients being on average nearly six years older than those sent for surgery, and by the greater burden of other illness they carry.
Cryoablation can be repeated, and that changes what a recurrence means. A tumour that comes back in the same place is treated a second time by the same method: in a series of 53 patients, two such repeat procedures were enough for every lesion to be treated in full.
In the lung, across 33 studies and 1,400 patients with stage I cancer, pneumothorax affected about one in three and pain about as many. Local recurrence was 23%.
The risks that matter most are the ones that come from where the tumour sits: proximity to a bile duct, to the diaphragm or to a large vessel changes what is possible and what is not. That assessment is made on your own images, before anything is scheduled.
COMMON QUESTIONS
Dr Marios Agathangelou, an interventional radiologist, treats tumours in place with ablation and embolization in Nicosia and Limassol. It is covered by GESY — €0 for GESY beneficiaries.
No. It works alongside the rest of your treatment, not instead of it. Any change to your systemic therapy is your oncologist's decision, not ours.
By a team looking at your imaging, your pathology and your general condition together. One doctor deciding alone is how the wrong treatment gets chosen.
The treatment is done under sedation or general anaesthesia, so not at the time. Afterwards there is usually pain or discomfort over the treated area for some days, and it is managed.
Usually the same day or one night, depending on the treatment and how you are afterwards.
Sometimes. Some treatments are planned as a course from the start; in other cases a repeat is decided from the follow-up imaging. We will tell you which applies before you start.
Then we say so, and we say what would be better. Being told a treatment is not for you is a useful answer, not a wasted appointment.
Nothing, if you are a GESY beneficiary. GESY covers the procedure in full: it is done as an inpatient admission, and that admission includes the treatment. The outpatient visit where it is decided whether the treatment suits you may carry the usual small GESY co-payment, and you need a valid referral from your personal doctor or from a specialist. Outside GESY, or with private insurance, you get a clear cost estimate at your consultation, before you decide anything.
SOURCES
Clinical statements on this page follow the CIRSE Standards of Practice on thermal ablation of liver tumours and published systematic reviews and meta-analyses comparing ablation with surgery in hepatocellular carcinoma, in renal cell carcinoma and in stage I lung cancer. They describe these treatments in general; they are not advice about your case, and they are not a substitute for the plan agreed with your oncology team.