Medical Oncologist
CION Cancer Clinics
Percutaneous ethanol injection for a small liver tumour | CION Cancer Clinics
Percutaneous ethanol injection, or PEI, destroys a small liver tumour by injecting pure alcohol into it through a thin needle. It is an older form of ablation, now kept mainly for tumours where heat would be risky. This page explains how it works, when it is chosen, who it does not suit and what a course of sessions involves. At CION Cancer Clinics, a multidisciplinary tumour board weighs your liver function and your scans before recommending any treatment.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
17+specialists on panel
15,000+patients treated
35+centres across Telangana & AP
4.8★ / 800+Google rating
On this page
- What is percutaneous ethanol injection for a liver tumour?
- When would a doctor choose ethanol injection over heat ablation?
- What happens during a course of ethanol injection?
- How does ethanol injection compare with heat ablation?
- Who is ethanol injection not right for?
- What this page cannot tell you
- Common questions about ethanol injection for liver tumours
The short answer
What is percutaneous ethanol injection for a liver tumour?
Percutaneous ethanol injection (PEI) kills a small liver tumour by injecting pure alcohol straight into it through a thin needle in the skin. It is an older form of ablation, now used mainly when heat-based ablation is not safe or not possible.
How it works
Under ultrasound guidance, a doctor places a fine needle into the tumour and slowly injects concentrated alcohol (ethanol). The alcohol draws water out of the cancer cells and damages the small blood vessels feeding them, so the tumour dies. Liver tumours are soft and surrounded by firmer, scarred liver, which helps keep the alcohol inside the tumour.
Who this page is about
PEI is used almost only for small hepatocellular carcinoma (HCC, cancer that starts in the liver cells), usually in a liver with cirrhosis. It is rarely used for cancer that has spread to the liver from somewhere else. If that is your situation, read ablation for liver metastases.
The alcohol used here is a medical-grade liquid placed inside the tumour. It has nothing to do with drinking, and it does not harm the rest of the liver the way drinking does.Why it is still used
When would a doctor choose ethanol injection over heat ablation?
Most centres now prefer microwave or radiofrequency ablation for small liver cancers. PEI keeps a place for a few specific situations.
A tumour in an awkward spot
Heat can injure nearby structures. When a tumour sits right against the gallbladder, a large bile duct, the bowel or the heart, alcohol may be a safer way to treat it.
A very small tumour
PEI works best on small tumours. For the smallest ones, results can come close to heat ablation, though more sessions are usually needed.
It suits best when
- There is one tumour, or very few
- Each one is small
- The tumour has a clear edge on the scan
When heat ablation is not available
PEI needs only ultrasound and a fine needle. It can be an option where microwave or radiofrequency equipment cannot be arranged, although the team will usually try to arrange heat ablation first.
Alongside another treatment
It is sometimes combined with heat ablation or with TACE to reach a part of a tumour the main treatment cannot safely reach. See ablation combined with TACE.
Not sure whether this applies to you?
Ask an oncologistSession by session
What happens during a course of ethanol injection?
The plan is agreed on your scans
A triple-phase CT or MRI confirms the tumour's size and position. The team agrees PEI is the right choice and how many sessions are likely to be needed.
Blood tests are checked
Clotting and platelet count are tested, because a needle passes through the liver. You will be told which medicines to pause, especially blood thinners.
The injection is given under ultrasound
The skin is numbed with local anaesthetic, sometimes with light sedation. The doctor watches the needle on ultrasound and injects the alcohol slowly while it spreads through the tumour.
Several sessions over some weeks
Unlike heat ablation, PEI is usually given over more than one session, often on separate days, until the whole tumour has been treated.
A contrast scan checks the result
A follow-up scan shows whether any part of the tumour is still alive. If it is, more injections or a different treatment may follow. See the follow-up scan after ablation.
Side by side
How does ethanol injection compare with heat ablation?
Ethanol injection (PEI)
Microwave or radiofrequency ablation
Usually several sessions
Usually one session per tumour
Works best on the smallest tumours
Can treat somewhat larger tumours
Safer next to the gallbladder, bowel or bile ducts
Heat can injure nearby structures
Simple equipment, local anaesthetic
Needs an ablation machine, often sedation or general anaesthetic
Higher chance the tumour comes back in the same spot
Lower chance of local return in most studies
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
Did you know
Ethanol injection was one of the first treatments to show that a small liver cancer could be destroyed without surgery. Newer heat methods built on that idea, which is why PEI is still taught and kept for the cases where heat is risky.
Being honest about limits
Who is ethanol injection not right for?
PEI is not a good choice for larger tumours. The alcohol does not spread evenly through a bigger tumour, and pockets of living cancer can be left behind. For these, heat ablation, TACE or surgery are usually better.
When the tumour has spread or invaded vessels
If the cancer has grown into the portal vein, the main vessel bringing blood into the liver, or has spread outside the liver, local injection will not control it. Treatment by mouth or drip, such as treatment for advanced liver cancer, is usually discussed instead.
When the liver is failing or bleeding is a risk
Large amounts of fluid in the belly, a very low platelet count or clotting problems make needle procedures riskier. With very advanced cirrhosis, a transplant assessment or supportive care may matter more than treating the tumour. Metastases from other cancers are also seldom treated this way.
If PEI is offered where heat ablation would also be safe, it is fair to ask why.Being straight with you
What this page cannot tell you
It cannot tell you whether ethanol injection is right for your tumour. That depends on its exact size and position, your liver function and what other treatments can safely be arranged. The decision is made by a team looking at your images, not by a general description.
Where CION fits in
At CION, the tumour board and your oncologist review your scans and reports and decide whether PEI, heat ablation, surgery, TACE or another route fits best. CION coordinates ablation procedures through accredited partner hospitals with interventional radiology teams, and your team will tell you where the procedure takes place. Follow-up and surveillance stay with your CION oncologist.
It cannot give you a price
The cost of PEI depends on the number of sessions and the hospital. Ask for a written, itemised estimate that covers every session, not just the first. The ablation cost page explains what goes into the bill.
Questions we are asked
Common questions about ethanol injection for liver tumours
Can ethanol injection destroy a liver cancer completely?
For a very small HCC, PEI can destroy the whole tumour and is treated as a curative option. It is less reliable than heat ablation for anything larger, and the tumour is more likely to return at the same spot. Regular scans afterwards are essential.
Is ethanol injection painful?
The skin is numbed, but many people feel a burning or aching pain in the liver area or the right shoulder while the alcohol goes in. It usually settles within a short time. Some centres add light sedation. Tell the doctor during the procedure if pain is strong.
How many sessions will I need?
It depends on the size of the tumour and how well the alcohol spreads. Several sessions are common, often spread over a few weeks. Your team will give you an expected number at the start and adjust it based on the follow-up scan.
I have stopped drinking. Will this alcohol harm my liver?
No. The injected alcohol is placed inside the tumour and is a measured medical treatment. It does not act like drinking and does not undo the good you have done by stopping. Keep away from drinking alcohol as advised by your doctor.
Why is it used less often than before?
Microwave and radiofrequency ablation usually destroy a tumour in one session and are less likely to leave cancer behind. So most teams now use heat first and keep PEI for tumours where heat could injure nearby organs or bile ducts.
What side effects can happen?
Pain, mild fever and feeling flushed are the common ones, and usually pass within a day or two. Bleeding, infection or injury to a bile duct are uncommon. High fever, worsening pain or yellowing of the eyes need a doctor the same day.
Can PEI be repeated if the cancer comes back?
Often, yes. A small return at the same spot, or a new small tumour elsewhere in the liver, can be treated again with PEI or with heat ablation. The choice depends on size, position and how the liver is coping at that time.
How do I find out whether PEI is an option for me?
Bring your latest triple-phase CT or MRI, the report and your recent blood tests. The CION tumour board will look at whether ablation of any kind fits your tumour and liver, and explain the choices. Call the helpline to arrange a review.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationBook an appointment with our specialist
Share your name and number — we'll call you back within 30 minutes to schedule your consultation.
Sources
- American Cancer Society — Liver Cancer Ablation: RFA, MWA, Cryotherapy, PEI, Histotripsy
- EASL — EASL Clinical Practice Guidelines: management of hepatocellular carcinoma
- Cancer Research UK — Treatment for liver cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Liver tumour ablation explainedEvery ablation method in one placeMicrowave ablation of the liverThe heat method most often used insteadWhy tumour position can rule out ablationWhy location decides which method is safeIncomplete ablation and repeat treatmentWhat happens if part of the tumour survives
Talk to us
Is ablation an option for my tumour?
Send us your latest scan and blood reports, and the CION tumour board will look at which kind of ablation, or which other route, fits your liver. We will explain the choices in plain words. One helpline serves every CION centre.