Cryoablation

Cryoablation is a type of tumor ablation that uses extreme cold. We place one or more thin needles, called cryoprobes, through the skin and into the tumor. Gas flowing inside the tips makes them very cold, and an ice ball grows around them. Freezing, thawing, and freezing again tears the tumor cells apart and shuts down their tiny blood vessels.

Its main advantage is that ice shows up clearly on CT. We can watch the ice ball grow and make sure it covers the whole tumor plus a safety margin, while keeping it away from nearby structures. Freezing also numbs tissue, so it tends to be less painful afterward than heat-based ablation, which is helpful for tumors near the chest wall, nerves or bone.

On CT, the ice ball appears as a dark, sharply outlined oval around the probe tips. We check that it reaches past every edge of the tumor before we stop.

Other options include microwave ablation, focused radiation (SBRT), and for some small kidney tumors, careful watching with regular scans, called active surveillance. We will talk through each one with you.

1. 1
   Getting ready

   You receive moderate sedation or general anesthesia, depending on the tumor. You lie on the CT table in the position that gives the safest path to the tumor, often on your stomach or side.

2. 2
   Placing the probes

   We numb the skin and use CT images to guide one or more thin cryoprobes into the tumor. If bowel or another organ is close, we may inject fluid or gas to gently push it away.

3. 3
   Freezing

   We run two freeze cycles, usually about 10 minutes each, with a thaw in between. CT scans during the freeze confirm that the ice ball covers the whole tumor.

4. 4
   Finishing

   The probes are warmed and removed. A small bandage covers each tiny skin puncture. A final scan checks for bleeding or, in the lung, a collapsed lung.

1. First few hours
   You rest in recovery while nurses check your vital signs. After a lung treatment, a chest X-ray checks the lung. You can eat and drink once awake.
2. Day 1
   Many people go home the same day or the next morning. No driving for 24 hours after sedation.
3. Days 2–7
   Soreness at the needle site is common and should get better each day. After kidney treatment, pink urine for a day or two can be normal. Some people have flu-like aches for several days.
4. About 1 week
   Most people are back to normal activities. We see you for a check-up.
5. About 1–3 months
   A CT or MRI checks that the tumor was fully treated, followed by regular scans.

For small kidney tumors, published studies show cryoablation controls the tumor in roughly 9 out of 10 cases, and many tumors that come back can be treated again. For painful bone tumors, most people notice less pain within days to a couple of weeks. Results in the lung depend on tumor size and type.

What I love about cryoablation is that I can see what I am doing. I watch the ice ball grow on every scan and stop only when it has swallowed the tumor with room to spare. When a tumor sits near a nerve, the bowel or the skin, I plan the probe angles to protect those structures before I ever start freezing.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos