CANCER TREATMENT MODALITIES

Cryosurgery

Overview

Cryosurgery (also called cryotherapy)

is the use of extreme cold produced by liquid
nitrogen (or argon gas) to destroy abnormal
tissue. 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. 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. 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).

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:

https://www.cancer.gov/about-cancer/treatment/types/surgery/cryosurgery-fact-sheet
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 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.

Advantages

 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.

https://www.cancer.gov/about-cancer/treatment/types/surgery/cryosurgery-fact-sheet
CANCER TREATMENT MODALITIES

Disadvantages

 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.

PROPERTY OF LIQUID NITROGEN (LN2)

 Liquid nitrogen, which boils at −195.6°C (77.4 K), is the most effective cryogen
for clinical use. It is particularly useful in the treatment of malignant lesions.
 Temperatures of −25°C to −50°C can be achieved within 30 seconds if a
sufficient amount of liquid nitrogen is applied by spray or probe.
 Generally, destruction of benign lesions requires temperatures of −20°C to
−30°C. Effective removal of malignant tissue often requires temperatures of
−40°C to −50°C

Cryogens - Boiling point

 Liquid nitrogen (most commonly used) : -196°C

 Nitrous oxide : - 89°C

 Solidified CO 2 (dry ice, CO 2 snow) : -78°C

 Chlorodifluoromethane : -41°C

 Dimethyl ether and propane : -24°C, -42°C

Mechanism of cryosurgery

The destructive effect of freezing tissue has been categorized into two major
mechanisms

1. Immediate cell destruction

https://www.cancer.gov/about-cancer/treatment/types/surgery/cryosurgery-fact-sheet
CANCER TREATMENT MODALITIES

2. Delayed cell destruction

PROCEDURE

 Warts, moles, skin tags, solar keratoses, and small skin cancers are candidates for
cryosurgical treatment.

 Several internal disorders are also treated with cryosurgery, including liver
cancer, prostate cancer, cervical disorders and, more commonly in the
past, hemorrhoids.

 Cryosurgery works by taking advantage of the destructive force of freezing

temperatures on cells. At low temperatures, ice crystals form inside the cells,
which can tear them apart. More damage occurs when blood vessels supplying the
diseased tissue freeze.

 In this approach, several hollow probes (needles) are placed in direct contact with
target tissue.

 The doctor guides them into the gland(tumor) using Trans-Rectal Ultra-Sound
(TRUS

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 This type of procedure requires spinal or epidural anesthesia (where the lower half
of your body is numbed) or general anesthesia (where you are asleep).

 Very cold gases are then passed through the needles, creating ice balls that
destroy the gland(tumor).

 To be sure the prostate is destroyed without too much damage to nearby tissues,
the doctor carefully watches the ultrasound images during the procedure

 After the procedure, there will be some bruising and soreness in the area where
the probes were inserted. Patients might need to stay in the hospital overnight, but
many patients leave the same day.

 The most common method of freezing lesions is using liquid nitrogen as the
cooling solution. The super-cooled liquid may be sprayed on the diseased tissue,
circulated through a tube called a cryoprobe.

Key Nursing Diagnoses

Risk for infection related to change in tissue integrity caused by cryosurgery.

Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:

 Maintain normal body temperature and white blood cell count

 Not have purulent discharge in the treated area
 Remain free from infection

Acute pain related to tissue sensitivity to extreme cold as a result of cryosurgery.

Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will:

 Express a relief of pain after analgesic administration

 Take precautions to prevent bumping or injuring the treated area
 Become pain-free after healing is complete

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Disturbed body image related to transient skin changes caused by dermatologic

cryosurgery. Based on this nursing diagnosis, you’ll establish these patient outcomes.
The patient will:

 Verbalize his feelings about transient changes in body image

 Not cover the treated area with anything other than a loose dressing when
outdoors
 Express positive feelings about his body image

Nursing Management

Specific nursing care related to cryosurgery includes:

 preparing the patient for the procedure.

 Minor discomfort can be expected with little or no local anesthesia. Expect
swelling, local tenderness, and hemorrhagic blister formation 1 to 2 days after the
procedure.
 After the procedure, the area is cleansed as ordered and prescribed ointments are
applied.

When caring for a patient undergoing cryosurgery, your primary responsibilities will
include instructing the patient and preparing for and assisting with the procedure.

Before surgery

 Ask the patient if he has any known allergies or hypersensitivities, especially to

lidocaine, iodine, or cold.
 Most patients will be unfamiliar with cryosurgery, so briefly explain the
procedure and its intended purpose. Outline the basic steps of the procedure to the
patient.
 Tell the patient that he'll initially feel cold, followed by burning, during the
procedure. Caution him to remain as still as possible to prevent inadvertent
freezing of unaffected tissue.

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 Inform the patient having gynecologic cryosurgery that she may experience
headache, dizziness, flushing, or cramping during the procedure. Reassure her that
these adverse reactions are transient.
 After providing the patient with this overview, gather the necessary equipment. If
you'll be using thermocouple needles and a pyrometer, obtain them as well; make
sure they're sterile and in proper working order. You may also need tape to secure
theneedles to the base of the lesion, and you'll need a watch or clock with a
second hand to time the thaw and freeze cyclesaccurately. Obtain the local
anesthetic, alcohol swabs, and gauze.
 Some surgeons use gentian violet or a surgical marker to delineate the margins of
the lesion. If necessary, obtain the appropriate marker.
 Check to be sure the patient or a responsible family member has signed a consent
form.
 Position the patient comfortably and as required by the particular site being
treated.

After surgery

 After dermatologic cryosurgery, clean the area gently with a cotton-tipped

applicator soaked in hydrogen peroxide. Because
 cryosurgery doesn't cause bleeding, you needn't apply a bandage. In fact,
occlusive dressings are contraindicated.
 After gynecologic cryosurgery, monitor the type and amount of vaginal drainage.
 After ophthalmic cryosurgery, remove the eye patch when the anesthesia has
worn off.
 If necessary, apply an ice bag to relieve swelling and give analgesics to relieve
pain as ordered. Cryosurgery may cause
 considerable pain, especially if it was performed on or near the lips, eyes, eyelids,
tongue, or plantar surfaces of the feet.
 Generalized headache may persist for more than an hour after freezing of a scalp
tumor.

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CANCER TREATMENT MODALITIES

Home care instructions

 Tell the patient to expect pain but also tell him he may take the prescribed
analgesic as needed.
 Tell the dermatologic patient to expect pain, redness, and swelling and that a
blister will form within 6 hours of treatment.
 Ordinarily, it will flatten within a few days and slough off in 2 to 3 weeks. Serous
exudation may follow during the first week, accompanied by the development of
a crust or eschar. Advise the patient to avoid breaking the blister.
 Warn the dermatologic patient that the blister may be large and may bleed. Warn
him not to touch it, to promote healing and prevent infection. Tell him that if the
blister becomes uncomfortable or interferes with daily activities, he should call
the physician, who can decompress it with a sterile blade or pin.
 Tell the dermatologic patient to clean the area gently with soap and water,
alcohol, or a cotton-tipped applicator soaked in hydrogen peroxide as ordered. To
prevent hypopigmentation, instruct him to cover the wound with a loose dressing
when he's outdoors. After the wound heals, he should apply a sunscreen over the
area.
 Tell the gynecologic patient that she will have a watery vaginal discharge for
several weeks. Advise her not to use tampons and to avoid sexual intercourse
while the discharge is present because the cervix is very fragile during this time.
 Emphasize the importance of calling the physician immediately if the
dermatologic patient experiences extreme pain, a widening area of erythema,
oozing (of other than serous material), or fever; if the gynecologic patient
experiences a vaginal discharge other than a watery appearance and fever; and if
the ophthalmic patient experiences sudden changes in vision or an increase in eye
pain.
 If the patient had a cancerous lesion destroyed, urge him to have regular checkups
since cancers may recur.

Mills, E. 2006. Handbook of Medical‐Surgical Nursing Fourth Edition. Pg. 226