What is cryosurgery

Cryosurgery is also called cryotherapy, is a medical procedure that uses intense cold produced by liquid nitrogen (or argon gas) to destroy cancerous cells. Cryosurgery is used to treat external tumors, such as those on the skin. For external tumors, liquid nitrogen is applied directly to the cancer cells with a cotton swab or spraying device.

Cryosurgery is also used to treat tumors inside the body (internal tumors and tumors in the bone). For internal tumors, liquid nitrogen or argon gas is circulated through a hollow instrument called a cryoprobe, which is placed in contact with the tumor. As the liquid gas flows through a hollow instrument—called a cryoprobe—ice crystals form around the probe. The doctor uses ultrasound or MRI to guide the cryoprobe and monitor the freezing of the cells, thus limiting damage to nearby healthy tissue. (In ultrasound, sound waves are bounced off organs and other tissues to create a picture called a sonogram.) A ball of ice crystals forms around the probe, freezing nearby cells. When the probe makes contact with the tumor, the cancer cells are frozen and destroyed. In addition, connective tissue and small blood vessels around the tumor are damaged. This cuts off the blood supply that the tumor needs to continue growing. Sometimes more than one probe is used to deliver the liquid nitrogen to various parts of the tumor. The probes may be put into the tumor during surgery or through the skin (percutaneously). After cryosurgery, the frozen tissue thaws and is either naturally absorbed by the body (for internal tumors), or it dissolves and forms a scab (for external tumors).

Cryosurgery offers advantages over other methods of cancer treatment. It is less invasive than surgery, involving only a small incision or insertion of the cryoprobe through the skin. Consequently, pain, bleeding, and other complications of surgery are minimized. Cryosurgery is less expensive than other treatments and requires shorter recovery time and a shorter hospital stay, or no hospital stay at all. Sometimes cryosurgery can be done using only local anesthesia.

Because physicians can focus cryosurgical treatment on a limited area, they can avoid the destruction of nearby healthy tissue. The treatment can be safely repeated and may be used along with standard treatments such as surgery, chemotherapy, hormone therapy, and radiation. Cryosurgery may offer an option for treating cancers that are considered inoperable or that do not respond to standard treatments. Furthermore, it can be used for patients who are not good candidates for conventional surgery because of their age or other medical conditions.

What are the disadvantages of cryosurgery?

The major disadvantage of cryosurgery is the uncertainty surrounding its long-term effectiveness. While cryosurgery may be effective in treating tumors the physician can see by using imaging tests (tests that produce pictures of areas inside the body), it can miss microscopic cancer spread. Furthermore, because the effectiveness of the technique is still being assessed, insurance coverage issues may arise.

What types of cancer can be treated with cryosurgery?

Cryosurgery is used to treat several types of cancer, and some precancerous or noncancerous conditions. In addition to prostate and liver tumors, cryosurgery can be an effective treatment for the following:

• Retinoblastoma (a childhood cancer that affects the retina of the eye). Doctors have found that cryosurgery is most effective when the tumor is small and only in certain parts of the retina.
• Early-stage skin cancers (both basal cell and squamous cell carcinomas).
• Precancerous skin growths known as actinic keratosis.
• Precancerous conditions of the cervix known as cervical intraepithelial neoplasia (abnormal cell changes in the cervix that can develop into cervical cancer).

Cryosurgery is also used to treat some types of low-grade cancerous and noncancerous tumors of the bone. It may reduce the risk of joint damage when compared with more extensive surgery, and help lessen the need for amputation. The treatment is also used to treat AIDS-related Kaposi sarcoma when the skin lesions are small and localized.

Researchers are evaluating cryosurgery as a treatment for a number of cancers, including breast, colon and kidney cancer. They are also exploring cryotherapy in combination with other cancer treatments, such as hormone therapy, chemotherapy, radiation therapy, or surgery.

Cryosurgery for prostate cancer

Cryosurgery also known as cryotherapy or cryoablation, can be used to treat men who have early-stage prostate cancer that is confined to the prostate gland. Cryosurgery is less well established than standard prostatectomy and various types of radiation therapy. Long-term outcomes are not known. Because it is effective only in small areas, cryosurgery is not used to treat prostate cancer that has spread or metastasized outside the gland, or to distant parts of the body.

Some advantages of cryosurgery are that the procedure can be repeated, and it can be used to treat men who cannot have surgery or radiation therapy because of their age or other medical problems.

While the cryosurgery procedure is less invasive, has a shorter recovery time, and may have fewer side effects when compared to other cancer treatments, it is less established and its long-term outcomes are unknown. Still, cryosurgery is a viable option, especially for men who can’t have radiation therapy or surgery due to their age or additional medical problems.

Advantages of cryosurgery for prostate cancer

Cryosurgery offers several advantages over other prostate cancer treatments, including:

• Less invasive, with only a small incision for inserting the cryoprobe
• Less pain and bleeding after surgery
• Less expensive
• Shorter recovery time and hospital stay (or no hospital stay)
• Can sometimes be done with local anesthesia
• Focused procedure, which allows surgeons to avoid damaging nearby tissue
• Works along with other treatments, such as hormone therapy, radiation, chemotherapy, and prostatectomy
• May be done on cancers that are considered inoperable

Disadvantages of cryosurgery for prostate cancer

The main disadvantage of cryosurgery for prostate cancer is that its long-term benefits are unknown. During the procedure, surgeons freeze tumors that they can see with imaging tests (like ultrasound). Very small sections of tumor may not be visible on those images, and could be missed during the surgery. As a result, the tumor can grow, requiring further treatment.

Cryosurgery for prostate cancer procedure

Cryosurgery for prostate cancer is done under either general or spinal anesthesia. Before the procedure, an ultrasound probe is placed in the rectum to give the surgeon a visual of the prostate. This allows the doctor to monitor the prostate and nearby organs/tissues during surgery.

Several probes may be placed in the prostate at locations determined before the procedure. These are positioned to avoid the area of the urethra, the tube which passes through the prostate as it carries urine out of the body from the bladder.

In addition, a warming catheter is inserted into the urethra to keep the urethra warm throughout the procedure. Other probes may be placed in and around the prostate gland in order to monitor the temperature and prevent damage to noncancerous tissue.

Cryosurgery takes under two hours and is done in two freezing cycles. In between these cycles, the prostate is allowed to warm, either on its own or with the aid of a warmer gas (such as helium or argon) moving through the probe. After the second thaw, a catheter is inserted into the bladder to help with urination during the recovery period. This tube may be inserted through the urethra, or through a small cut (incision) in the lower belly. The catheter will remain in place for several days after surgery.

Cryosurgery for prostate cancer healing time

Cryosurgery is generally done as an outpatient procedure, which means the patient will be able to go home that day. The most common side effects of cryosurgery include:

• This goes away after several days or a few weeks.
• Inability to urinate. The catheter will be removed—usually within 5 to 15 days—when the man can urinate on his own. Recovery may take longer for some men.
• Infection or irritation around the catheter. Oral antibiotics and medications may be given to reduce the risk of these.
• Less common side-effects. Such as scrotal swelling, numbness at the tip of the penis, painful or burning during urination, urgent or frequent urination, urination of small pieces of tissue.

Most men have little pain after the procedure, with symptoms mainly caused by the placement of the catheter. In general, men return to their normal activities within a week.

A prostate-specific antigen (PSA) test is usually done three months after surgery to look for signs of prostate cancer. A biopsy of the prostate may also be done at some point to determine if cancer cells are still present.

Side effects of cryosurgery for prostate cancer

Cryosurgery for the prostate gland can cause side effects. These side effects may occur more often in men who have had radiation to the prostate.

• Cryosurgery may obstruct urine flow or cause incontinence (lack of control over urine flow); often, these side effects are temporary.
• Many men become impotent (loss of sexual function).
• In some cases, the surgery has caused injury to the rectum.

Cryosurgery for prostate cancer prognosis

The outcome—or prognosis—after cryosurgery for prostate cancer depends upon several factors, such as the size of the tumor, how far advanced the cancer was at the time of the procedure, and whether other treatments were done before cryosurgery. The technique used can also affect the outcome.

In several studies, between seven and 25 percent of men treated with cryosurgery had signs of prostate cancer cells three to 24 months after the procedure. Other research has found signs of cancer in the outer layer of the prostate (epithelium) in up to 71 percent of men treated with cryosurgery.

Cryosurgery for cervix

Cervix cryosurgery is a procedure to freeze and destroy abnormal tissue in the cervix.

Cervix cryosurgery procedure may be done to:

• Treat cervicitis
• Treat cervical dysplasia

Your doctor will help you to decide if cryosurgery is right for your condition.

Cryosurgery procedure for cervix

Cryosurgery is done in your health care provider’s office while you are awake. You may have slight cramping. You may have some amount of pain during the surgery.

Your doctor may suggest you to take medicine such as ibuprofen 1 hour before the cryosurgery procedure. This may reduce pain during the procedure.

To perform the cryosurgery procedure:

• An instrument is inserted into the vagina to hold the walls open so that the doctor can see the cervix.
• The doctor then inserts a device called a cryoprobe into the vagina. The device is placed firmly on the surface of the cervix, covering the abnormal tissue.
• Compressed nitrogen gas flows through the instrument, making the metal cold enough to freeze and destroy the tissue.

An “ice ball” forms on the cervix, killing the abnormal cells. For the treatment to be most effective:

• The freezing is done for 3 minutes
• The cervix is allowed to thaw for 5 minutes
• Freezing is repeated for another 3 minutes

Cryosurgery aftercare

You might feel lightheaded right after the procedure. If this happens, lie down flat on the examination table so that you do not faint. This feeling should go away in a few minutes.

You can resume almost all of your normal activities right after surgery.

For 2 to 3 weeks after the cryosurgery procedure, you will have a lot of watery discharge caused by the shedding (sloughing) of the dead cervical tissue.

You may need to avoid sexual intercourse and using tampons for several weeks.

Avoid douching. This can cause severe infections in the uterus and tubes.

Cryosurgery procedure for cervix risks

Risks for any surgery are:

• Bleeding
• Infection

Cryosurgery may cause scarring of the cervix, but most of the time, it is very minor. More severe scarring may make it more difficult to get pregnant, or cause increased cramping with menstrual periods.

Cryosurgery procedure for cervix prognosis

Your doctor should do a repeat Pap test or biopsy at a follow-up visit to make sure that all abnormal tissue was destroyed.

You may need more frequent Pap smears for the first 2 years after cryosurgery for cervical dysplasia.

Cryosurgery for liver cancer

Cryosurgery may be used to treat primary liver cancer that has not spread. It is used especially if surgery is not possible due to factors such as other medical conditions. The treatment also may be used for cancer that has spread to the liver from another site (such as the colon or rectum). In some cases, chemotherapy and/or radiation therapy may be given before or after cryosurgery. Cryosurgery in the liver may cause damage to the bile ducts and/or major blood vessels, which can lead to hemorrhage (heavy bleeding) or infection.

Cryosurgery side effects

Cryosurgery has side effects, although they may be less severe than those associated with surgery or radiation therapy. The side effects depend on the location of the tumor. Cryosurgery for cervical intraepithelial neoplasia has not been shown to affect a woman’s fertility, but it can cause cramping, pain, or bleeding. When used to treat skin cancer (including Kaposi sarcoma), cryosurgery may cause scarring and swelling; if nerves are damaged, loss of sensation may occur, and, rarely, it may cause a loss of pigmentation and loss of hair in the treated area. When used to treat tumors of the bone, cryosurgery may lead to the destruction of nearby bone tissue and result in fractures, but these effects may not be seen for some time after the initial treatment and can often be delayed with other treatments. In rare cases, cryosurgery may interact badly with certain types of chemotherapy. Although the side effects of cryosurgery may be less severe than those associated with conventional surgery or radiation, more studies are needed to determine the long-term effects.