Freezing Cancer Cryosurgery
Giving hope to cancer patients
As I was writing this article, it had been exactly three days since the cremation of my aunt, whom we lost from cancer. Her death on Christmas day brought both grief and relief to the whole family. Grief because we will not be seeing her anymore, ever; relief because she was finally free from physical pain. The mere mention of the word cancer makes most people cringe. But to those who have actually seen its horrid face up close, to those who have actually experienced the pain this deadly disease has caused, cancer is something that needs to be defeated.
Cancer is the leading cause of death in Singapore. According to the Interim Report of Singapore Cancer Registry (2002 to 2006), there were 43,424 cancer cases diagnosed in the country during the period of 2002 to 2006. Although colorectal cancer and breast cancer were the most common cancers among the male and female resident population, respectively, it was lung cancer in males and breast cancer in females that had the highest mortality rates.
Trying to beat cancer will always be a long journey, not just for patients and their family, but for medical professionals as well. Nowadays, the three most common treatment options for cancer are surgery, chemotherapy, and radiation therapy. However, alternative, less known treatment options are also available for cancer patients. One of which is cryosurgery.
Cryosurgery makes use of extreme cold or freezing produced by liquid nitrogen (or argon gas) to destroy abnormal tissue. This technique for cancer treatment has been approved by the United States’ Food & Drug Administration (FDA) in 1998 and China’s State Food and Drug Administration in 1999.2 In Singapore, cryosurgery is best known in dermatology. Cryosurgery is a particularly useful tool in the treatment of benign skin conditions such as warts, non-cancerous moles, skin tags, and solar keratoses.3 However, one Hospital in China, the Fuda Cancer Hospital in Guangzhou, has used the technique in cancer treatment since 2000. To date, Fuda has dealt with nearly 5,000 cases with a variety of malignant tumours (more than 34 different kinds of cancers), making it a leader in experience and research on cryosurgery treatment for cancer in the world.
In his recent visit to Singapore, Dr Xu Ke Cheng, Chief President and Chief Physician at Fuda Cancer Hospital in Guangzhou, shared that they cater to thousands of patients from 54 countries, mostly from South East Asia, Middle East, US, and Europe. “Fuda manages four kinds of cancer patients,” he explained. “First are those with the non-receptable cancer; i.e, those that are non-operable. Second, those with chemo failure. Third, those with radiotherapy failure. And fourth, those with cancer recurrence.”
Hope for cancer patients
Most of the patients who come to Fuda Cancer Hospital belong to stage three or stage four cancer patients. “Patients see hope in Fuda,” shared Dr Xu “They’re being given a treatment option, not a long-term survival or a cure, but an option to treat the disease.” He added that most of their patients are not suitable for surgery anymore. “So the option one, surgery, is out. Chemo and radio are the options left,” he added.
Dr Xu used three Ps to describe the current cancer condition. He said in order to achieve effectiveness against the fight against cancer, we must have the three Ps. “First is Patient-centred treatment. If we only treat the cancer, if the patient is not benefitting from it in the end, then that’s not good. The focus of the treatment must be the well-being of the patient,” he explained. “Second is Pathway. We must use the right method or modality. If the current treatment mode is not very effective in treating cancer, then the method used has to be re-analysed. And third is Progress. It must be an improvement and advancement.” According to him we must change our thinking. We need to think out of the box to work with innovation in order to find the right way to treat cancer.
Evolution of cryosurgery
During the last century, a new idea in treating cancer – the ablation – has been started. “The new idea is to treat cancer locally. With this, researchers came up with a new treatment that does not require open surgery by doing it through percutaneous injection,” shared Dr Xu. At the very beginning, alcohol injection was used, then it progressed to radio-frequency ablation, a method used to destroy the cancer cells by increasing the temperature to above 90 degrees Celcius.
“However, in the 19th century, we have started using the freezing method,” added Dr Xu. “Throughout my years of research involving cancer treatment, we found many methods of ablation. And we found out that this freezing method actually complements surgery.” Dr Xu explained that they can use the ablation method on patients who are
not candidates for surgery. “The indication of this ablation method is good for those non-operable cancer patients. In fact, you cannot replace it with surgery. So, therefore, when this concept was invented, it becomes a useful method for most cancer patients since majority of them belong to the non-operable group.”
Cryosurgery is performed through intraoperative, endoscopic or percutaneous routes, depending upon the location and size of tumour. Cryoablation is performed by using argon-helium system. Two to three cycles of the freezing/thawing are performed. The freezing continues until the “ice-ball” formed at the tip if the cryoprobe is large enough to cover tumour. A five to 10mm margin of normal tissue is included in the freezing process. For larger tumours, multiple cryoprobes were used. In some cases, it may become necessary to perform at least two to three sessions of the cryoablation procedure. This is possible because the procedure is minimally invasive, and often does not require cutting. The probes are simply inserted through the skin and guided by real-time ultrasound.2
Almost all parenchymal cancers are candidates for cryosurgery ablation. These include kidney cancer, liver cancer, lung cancer (i.e, non-small cell lung cancer), ovarian cancer, pharyngeal cancer, testicular cancer, uterine tumours, vaginal cancer, breast cancer, prostate cancer, pancreatic cancer, skin cancer and melanoma, tumour of soft tissues, and others. Cryosurgery can also be an effective treatment for retinoblastoma (a childhood cancer that affects the retina of the eye), early-stage skin cancers (both basal cell and squamous cell carcinomas), precancerous skin growths known as actinic keratosis, and pre-cancerous conditions of the cervix known as cervical intraepithelial neoplasia (abnormal cell changes in the cervix that can develop into cervical cancer).2
When you have cancer, or when you know someone who does, it can be easy to lose hope. So it’s always good to know there are more options available out there to help you beat it.