Cryoablation
Cryoablation, also known as cryotherapy or cryosurgery, uses cold to freeze and kill cancer tissue.
What diseases does cryoablation treat?
Cryoablation can treat several cancers, including breast cancer, colorectal cancer, kidney cancer, lung cancer, and various other soft tissue cancers. In these cases, it can be part of a plan to cure the patient.
It is also used to treat cancers that have spread, or metastasized, to the bone, soft tissue and, in limited cases, liver. If there are a small number of these tumors, the treatment can help cure the disease. When there are more metastatic tumors, the treatment is instead used to help slow or stop the cancer’s progress and relieve symptoms.
Who gets cryoablation?
Cryoablation is typically offered to patients who are not healthy enough for surgery or whose cancer cannot be removed with surgery due to the size, location or the number of tumors. In some cases, the procedure can be used with cancer drugs such as immunotherapies to make the drugs more effective.
What happens during a cryoablation procedure?
During a cryoablation procedure, doctors use a live image from an ultrasound or CT scan to guide a needle-thin probe into the tumor. The probe is then cooled to below freezing. A ball of ice forms at the tip of the probe, freezing and destroying cancerous tissue.
Cryoablation is performed under general anesthesia. Most patients spend one night in the hospital after the procedure, though some are able to go home the same day. Patients are usually able to walk a few days after the procedure and are fully recovered in two to three weeks.
What are the side effects of cryoablation?
Cryoablation side effects are usually mild, though they can be more serious depending on the treatment location.
Possible side effects include pain at the injection site, bleeding and nerve injury, such as loss of sensation or motor function. Some patients experience flu-like symptoms, which can be treated with over-the-counter medications.
Lung cancer patients may develop pneumothorax, or a collapsed lung caused by air collecting around and putting pressure on the organ. Patients may get a temporary tube in the chest that helps release this air.
Cryoablation at MD Anderson
Choosing where to go for cancer care is one of the most important decisions you can make. At MD Anderson, patients are treated by a team of doctors that usually includes a medical oncologist, surgeon, radiation oncologist and interventional radiologist. They work together to design a personalized treatment plan tailored to each patient.
If the team recommends cryoablation, you’ll get care from leaders in the field. Our doctors are among the most experienced in the world at cryoablation treatment. This gives them incredible experience and expertise when designing each treatment. As members of a top-ranked cancer center, they have access to the most advanced technologies, allowing them to deliver the most effective treatment while minimizing side effects.
And at MD Anderson you will be surrounded by the strength of one of the nation's largest and most experienced cancer centers. From support groups to counseling to integrative medicine care, we have all the services needed to treat not just the disease, but the whole person.
When Gene Jones was diagnosed with stage IV colon cancer in 1993, cryoablation was such a new therapy that MD Anderson was still waiting on delivery of the equipment from the manufacturer.
But a clinical trial here enabled Gene to become one of the very first patients to benefit from this now well-established surgery, which treats cancer by freezing it. And today, the 81-year-old farmer is still out baling hay and lifting 50-pound feed sacks.
“I can laugh about it now,” Gene says, “because it was so long ago. Thanks to MD Anderson, I beat the odds.”
Colon cancer symptoms lead to a stage IV diagnosis
Gene’s first symptoms of colon cancer cropped up early in the year he turned 51.
“I just started having stomach problems and got to where I couldn’t go to the bathroom,” he recalls.
His wife took him to a gastroenterologist, who ordered a colonoscopy. But the tumor in Gene’s colon was so big that the doctor couldn’t advance the scope. His large intestine was almost completely obstructed.
“The doctor told us it was not a good sign that he couldn’t even get past the growth to look around,” Gene says. “We could tell that it was very, very serious.”
Poor prognosis prompts outreach to MD Anderson
Gene underwent surgery almost immediately. When he woke up from the anesthesia, there was both good news and bad news. The surgeon told Gene’s family that he’d been able to remove the entire tumor while still preserving part of his colon, so the blockage was gone and Gene wouldn’t need an ostomy. But the cancer had already spread to his liver.
“He said he could start me on chemotherapy right away, but I probably didn’t have much time left — maybe six months to a year,” Gene remembers. “I needed to get my affairs in order.”
Gene’s adult children found that prognosis unacceptable. They requested an appointment at MD Anderson.
Clinical trial offers 11th-hour hope
At MD Anderson, doctors confirmed Gene’s diagnosis. Then, they started him on chemotherapy to try to shrink the cancer. But after several rounds, it became apparent that the chemotherapy wasn’t working.
“At that point, I thought my options had played out,” recalls Gene. “But then, my doctors told me about a new therapy called cryosurgery. It was so new back then that they couldn’t even give me any statistics on it, much less guarantee that it would work. But I thought, ‘Hell, I’m gonna die anyway. Why not try it?’ When you have nothing to lose, you go forward and you don’t look back.”
Still cancer-free at 30 years and counting
Doctors removed the entire right lobe of Gene’s liver during the procedure because it was so covered with tumors. But they were able to freeze the few spots they found in the left lobe. They also noted that the left lobe was much larger than normal, probably due to a birth defect. “And that ended up working in my favor,” Gene laughs.
Gene would have two more cancer surgeries before all was said and done: one in September 1995 to remove a new spot on his liver and another one in 1997 to remove half of his left lung due to a tumor.
“Without that upper lobe, I run out of air real quick,” he says. “So, I have to rest sometimes when I’m out working in the summer heat. But I wouldn’t have it any other way. If I had accepted my original prognosis, I wouldn’t be here today. Thanks to MD Anderson, I still am.”
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
Ablation therapy is a minimally invasive surgical procedure that kills cancer cells with either very hot or very cold temperatures.
It is used to treat both primary tumors in their original locations and cancers that have spread — or metastasized — to other organs.
To learn more about the risks and benefits of ablation therapy, as well as how it works and which patients might be eligible to receive it, we spoke with Interventional Radiologist Joshua Kuban, M.D.
How many types of ablation therapy are there?
Right now, the only ablation therapy that uses extremely cold temperatures to kill cancer cells is called cryoablation.
There are several types of ablation therapy that use heat energy:
How does ablation therapy work?
With cryoablation, probes are inserted into tumors through tiny holes in the skin. A compressed gas travels through the probes and as it expands, an ice ball forms around each needle, creating a “zone of death.” The frozen tissue is allowed to thaw for a few minutes, then refrozen. The process of repeated freezing and thawing is what destroys the cancer cells.
With ablation therapies that use high heat, thin metal rods called antennae are inserted in or around a tumor, then activated to become really hot. Once they’ve reached the desired temperature, they’re left in place for a few minutes. Then, they’re deactivated and removed.
Do patients need anesthesia to receive ablation therapy?
Some do. But it depends on the location of the cancer and the type of therapy being administered.
If the cancer is easy to target, we might just give someone a sedative and pain medication so they will be very relaxed. But if it’s located deep inside the body, we often use general anesthesia.
What are the benefits of ablation therapy?
The biggest benefit is probably that it’s so minimally invasive. Pain is often minimal, too. Some patients go home the same day as the procedure, and some stay for 12 hours or so. It’s rare that patients have to be admitted to the hospital, though, and most can get back to a desk job within a day or two.
Another benefit of ablation therapy is that it’s not a systemic treatment like chemotherapy, which affects the entire body. So, you won’t see side effects like fatigue or hair loss.
Some recent technological advances have helped us quite a bit, too. Up until five or six years ago, we went in, did the ablation and hoped we got all the cancer. Now, we have advanced 3D targeting and artificial intelligence (AI)-enhanced software that help us to make sure we get the entire tumor during an ablation. That’s significantly improved our success rates and made MD Anderson the leading center in the U.S. for ablation therapy.
Are there any risks with ablation therapy?
As with any surgical procedure, there’s always some risk of infection or bleeding, but those risks are very small. The incision itself is usually about the size of a pen tip, so the risks are much lower with ablation therapy than they would be with traditional open surgery.
Does ablation therapy have any side effects?
The most commonly reported side effect with ablation therapy is pain. But most patients have light to moderate pain that can be easily controlled with either over-the-counter drugs or prescription pain relievers. And some patients don’t experience any pain with ablation therapy.
What types of cancer can be treated with ablation therapy?
Cryoablation therapy is used a lot with lung cancer, as well as any disease that frequently metastasizes to the lungs, such as pancreatic cancer, colorectal cancer, bone cancer, kidney cancer and soft tissue sarcoma. It is also sometimes used to treat nerve pain.
Radio frequency ablation (RFA) was the earliest form of ablation therapy. It’s not used as much anymore, but it’s still used in the kidney, spine, lungs, and sometimes the liver.
Microwave ablation therapy is more powerful than RFA, making treatments faster, but it can also be less forgiving in some tissues. So, we use this method mostly to treat liver cancer and kidney cancer, as well as anything that can spread to the liver, such as colon, breast cancer or neuroendocrine tumors. It can also be used to treat tumors in the lung when they are in certain locations.
Are there any other forms of ablation therapy?
Yes. The methods described above are what we most commonly use, and then we have the next level, which includes approaches for cancers that don’t respond well to any other methods.
- Irreversible electroporation (IRE) uses a change in electrical voltage to kill cancer cells, rather than heat or cold. High voltage electricity creates holes (or pores) in the cancer cells, but if it doesn't last long enough, the cells can repair themselves. With higher voltage and longer times, the damage remains, so the cells leak fluids and die. This is a great option for diseases like bile duct cancer, since IRE kills the cancer cells but leaves the scaffolding around them unchanged.
- High-dose brachy-radio therapy (HDBRT) involves putting a catheter in a tumor and passing a really high dose of radioactive material into the tumor instead of heat energy. It sits there for between 30 seconds and 5 minutes, treating the cancer from the inside out, then is removed. This minimizes damage to any surrounding tissues. It’s used mostly in the liver and for soft tissue tumors.
How would a patient know if they’re eligible for ablation therapy?
There are three main pathways to ablation therapy:
- In-house referrals: Interventional radiologists like me sit on all the same tumor boards as the surgical oncologists and medical oncologists at MD Anderson. These are teams of experts who meet regularly to decide on the best treatment plans for their patients. If we think ablation would be a good option for a particular patient, we’ll speak up and say so.
- Outside providers: Oncologists from other medical systems routinely ask us if we’ll take a look at some of their patients.
- Interventional Oncology Clinic: We work directly with patients and other medical professionals to provide access to cutting-edge therapies and procedures which we offer that other facilities don’t.
What’s the one thing you want people to remember about ablation therapy?
Ablation therapy can be both minimally invasive and maximally effective. But where you go for it really matters.
You want to make sure you’re going to a place that has the right equipment, the right expertise and the right patient volume to give you a good result. That means choosing a facility that does seven or eight of these procedures a day, not just one or two a month.
MD Anderson is so big that our doctors subspecialize in particular areas of ablation therapy. That means better results for our patients. So, that’s what we offer that’s different from everyone else.
Request an appointment at MD Anderson online or call 1-877-632-6789.