What is Cryotherapy?

Cryotherapy uses image guidance, a needle-like applicator called a cryoprobe, and liquid nitrogen or argon gas. The treatment creates intense colds to freeze and destroy diseased tissue, including cancer cells. Doctors use cryotherapy to treat various skin conditions, as well as tumours inside the liver, kidneys, bones, lungs, and breasts.

Your doctor will explain how to prepare, including any changes to your medication schedule. Talk to your doctor if you are pregnant. Tell him about any recent illnesses, medical conditions, allergies, and medications you are taking, including herbal supplements and aspirin. They may need to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or blood thinners for several days before the procedure. Ask your doctor if you will need to spend the night in the hospital. Leave jewellery at home and wear loose, comfortable clothing. You may need to change into a gown for the procedure. Make plans for someone to drive you home.

What is Cryotherapy?

Cryotherapy is also called cryosurgery, cryoablation, percutaneous cryotherapy, or targeted cryoablation therapy. It is a minimally invasive treatment that uses intense cold to freeze and destroy diseased tissue, including cancer cells. While the terms cryotherapy and cryoablation may be used interchangeably, the term “cryosurgery” refers to cryotherapy performed surgically and openly.

During cryotherapy, high-pressure liquid nitrogen or argon gas flows into a needle-like applicator (or cryoprobe). This creates intense colds that the doctor uses to freeze and destroy diseased tissue. Doctors use ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) to help guide these cryoprobes to treatment sites inside the body.

What are Some of the Common Uses of this Procedure?

Doctors can use cryotherapy topically (on the surface of the skin), percutaneously, or surgically.

They generally use topical cryotherapy for skin and eye lesions. Sometimes the lesion is below the surface of the skin. In this case, the doctor places a needle-like therapy probe or applicator through the skin to reach the lesion. Occasionally, this requires a surgical incision. Doctors use cryotherapy to:

• skin tumours.
• precancerous moles on the skin.
• skin tags.
• unaesthetic freckles.
• retinoblastomas, a childhood cancer of the retina.
• cancers of the prostate, liver, and cervix, especially if surgery is not possible.

Cryotherapy also treats tumours in the kidneys, bones (including the spine), lungs, and breasts. (also treats benign breast lumps called fibroadenomas). While additional research is needed to determine its long-term effect, doctors find cryotherapy to be effective in certain patients.

How should I Prepare?

For skin treatment, some doctors recommend taking ibuprofen (400 mg) half an hour before this procedure to relieve minor discomfort. Others give a dose of antibiotics before cryotherapy as a way to protect against infection. For deeper treatments involving tumors, patients should avoid blood-thinning medications prior to treatment for the recommended period.

Talk to your doctor about all medications you are taking. List any allergies, especially to local anaesthetics, general anaesthesia, or contrast materials. Your doctor may tell you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or blood thinners.

Women should always tell their doctor or technologist if they are pregnant. Doctors will not do many tests during pregnancy to avoid exposing the fetus to radiation. If an x-ray is needed, the doctor will take precautions to minimize the baby’s exposure to radiation.

See the Safety in X-Rays, Interventional Radiology and Nuclear Medicine Procedures page for more information on pregnancy and X-rays.

Some doctors recommend a short hospital stay after cryotherapy for deep tumours. If the procedure uses large surgical incisions (cryosurgery), you will need a short hospital stay. Doctors can perform percutaneous cryotherapy on an outpatient basis, but you may need a short hospital stay.

Make plans to have someone drive you home after the procedure is done.

You may need to change into a gown for the procedure.

What will I Experience During and after the Procedure?

The doctor or nurse will attach devices to your body to monitor your heart rate and blood pressure.

You will feel a small sting when the nurse inserts the needle into your vein for the IV line and when the local anaesthetic is injected. Most of the sensation will be felt at the skin incision site. The doctor will numb this area using a local anaesthetic. You may feel pressure when the doctor inserts the catheter into your vein or artery. However, you will not feel much discomfort.

If you are given general anaesthesia, you will be unconscious for the entire procedure. An anesthesiologist will monitor your condition.

If the procedure uses sedation, you will feel relaxed, drowsy, and comfortable. You may or may not be able to stay awake, depending on the intensity of the sedative.

You may experience some discomfort from having to lie still during the procedure.

After percutaneous cryotherapy, you should be able to return to normal activities within one to three days.

If you have had open cryotherapy, you should be able to return to your normal activities within seven to ten days. Avoid heavy lifting for at least 72 hours. Ask your doctor when you can resume your usual activities.

What are the Benefits and Risks?

Benefits

• When an open surgical procedure is used, recovery time after cryosurgery for kidney or liver tumours may be less than for open, surgical removal of the tumour.
• For percutaneous cryotherapy, the patient may need to stay overnight or be discharged several hours after the procedure. In general, it is not necessary to spend the night in the hospital to control pain.
• Percutaneous cryotherapy is less traumatic than open surgery. Because the doctor only makes a small incision to pass the probe through the skin, damage to healthy tissue is minimal. As a result, percutaneous cryotherapy is less expensive and has fewer side effects than open surgery. The patient can usually resume daily activities 24 hours after the procedure or even sooner. However, the precaution of not lifting heavy objects for several days after an abdominal treatment may be necessary.
• For the treatment of fibroadenomas, cryotherapy produces little scarring and causes no apparent post-treatment calcifications.

Risks

• As with any percutaneous procedure, there may be bleeding – both from the puncture and from the freezing of tissues such as the liver, kidneys, or lungs.
• There may be damage to normal structures. Liver cryotherapy can cause injury to the bile ducts. Kidney cryotherapy can damage the urethra or the collecting system. Prostate cryotherapy can damage the rectum. Any abdominal treatment can damage the intestine. If a perforation occurs, the contents of the intestine could be released into the abdomen. This could cause a life-threatening infection.
• If frostbite occurs near the diaphragm, fluid can collect in the space around the lungs.
• If the procedure is in or near the lungs, it can cause the lung to collapse.
• There may be nerve damage. Totally frozen nerves can produce muscle weakness or tingle in the area supplied by the nerves.
• Complications related to the procedure medications, including anaesthesia, can occur.
• Women should always tell their doctor and X-ray technologist if they are pregnant. See the page on Safety in X-Rays, Interventional Radiology and Nuclear Medicine Procedures for more information on pregnancy and X-rays.
• This procedure may involve exposure to x-rays. However, the risk of radiation is not of major concern when compared to the benefits of the procedure. See the page on Safety in X-Rays, Interventional Radiology and Nuclear Medicine Procedures for more information on radiation dose resulting from interventional procedures.

Cryotherapy for prostate cancer has potential specific complications such as:

• Permanent impotence because the nerves that control sexual potency are usually affected by the freezing process. However, the nerves can regenerate and this solves the problem in some patients.
• When the patient is under anaesthesia, a tube is placed in the bladder to drain urine until the swelling of the bladder neck—as a result of the procedure—is gone.
• A urethral slough can occur: that is, dead tissue can block the flow of urine. Dislodgement is reduced by keeping the urethra warm with sterile water continuously circulating through a catheter placed in the urethra during the procedure.

What are the limitations of Cryotherapy?

Cryotherapy is an alternative treatment for cancer when surgery may be difficult or impossible for some patients. Doctors are still examining its long-term effectiveness. Currently, there is very little published information on the long-term effects of percutaneous cryotherapy. However, long-term follow-up of prostate cancer suggests that the rate of cancer control is similar to that of surgery or radiotherapy.

Cryotherapy is a localized treatment. You can only treat disease at one site; it is not used to treat cancer that has spread to other parts of the body. Because doctors treat tumours they see on x-ray images, you may not see microscopic cancer.

Although its use in bone, kidney, liver, and lung shows promise, doctors continue to investigate percutaneous cryotherapy to determine longer-term clinical results.