Cryoablation - Tumor Freezing Surgery

A needle the width of a pencil lead, a ball of ice the size of the tumor. No incision, and home within a day or two.

A scan has found a small tumor in a kidney, a lung, a bone or the liver, and the question is whether it has to be cut out. For many of them it does not. Cryoablation kills a tumor by freezing it. One or more thin probes go through the skin under CT guidance, argon gas cools their tips to well below minus 40 degrees, and a ball of ice grows around the tumor while the radiologist watches it on the screen. Cells inside the ice die. Everything outside it is spared. At the Mayo Clinic, patients with small kidney tumors treated by freezing had a five-year cancer-specific survival of 100 percent, against 99 percent after partial removal of the kidney. In the SOLSTICE study of lung metastases, 91 percent of treated tumors were controlled at one year after at most two sessions. In the MOTION study, freezing painful bone metastases cut the pain score by 2.6 points on a 10-point scale within eight weeks. This page sets out which tumors suit freezing, which do not, how the procedure runs, what can go wrong, and how to arrange it during a visit of a few days to Istanbul.

How freezing kills a tumor

Cryoablation - Tumor Freezing Surgery is treatment in which a tumor is destroyed by cold rather than removed. Freezing kills cells in three ways. Ice crystals form inside them and tear their membranes. Water is drawn out of them as the surrounding fluid freezes, and the salt left behind poisons what remains. And the small blood vessels feeding the area clot as they thaw, so that any cell that survived the ice starves in the days that follow.

The temperature that guarantees death is minus 40 degrees Celsius. The visible edge of the ice ball on a CT scan sits near zero, so the radiologist grows the ice five to ten millimeters beyond the edge of the tumor to be sure the lethal zone covers all of it.

The ice can be seen. That is the practical difference from heat. On CT and MRI the ice ball shows as a sharp dark shape, and the operator can watch it reach the far side of the tumor and stop before it reaches a nerve or a bowel loop.

Two freeze cycles of ten minutes each, with a thaw between them, are standard, because the second freeze kills cells the first one only injured. Nothing is cut and nothing is removed. The dead tissue is absorbed by the body over months and the scans show it shrinking.

Which tumors are treated by freezing

Seven sites, in rough order of how much evidence stands behind each.

Three sites carry most of the evidence, and each has its own section below.

Kidney tumors

Small kidney tumors are the commonest reason for cryoablation. Many of them are found by accident on a scan done for something else, in people who are older or unwell and would rather keep the kidney.

The Mayo Clinic followed 1,798 patients treated between 2000 and 2011 for kidney tumors of stage T1, and published the comparison in European Urology in 2019. Among 1,422 patients with tumors up to 4 centimeters, 187 had cryoablation, 180 radiofrequency ablation and 1,055 partial nephrectomy. Five-year cancer-specific survival came to 100 percent after cryoablation, 96 percent after radiofrequency and 99 percent after surgery, and the differences in local recurrence, spread and death from kidney cancer were small, none of them reaching significance.

For tumors of 4 to 7 centimeters the picture changes. Fifty-two patients had cryoablation and 324 had partial nephrectomy, and five-year cancer-specific survival was 91 percent after freezing against 98 percent after surgery, a gap the authors could not rule out as real, and one they asked for more research on. For a tumor over 4 centimeters we say the same. Surgery first. Freezing for patients who cannot have it.

Kidney function is the second reason. Freezing removes only the tumor and a thin rim, so a patient with one kidney, or with kidney disease, keeps more working tissue than after any operation.

Lung metastases

Lung metastases from bowel, kidney and other cancers are the second field, and two multicenter studies set the figures.

A metastasis that grows back after freezing can be frozen again. In SOLSTICE the second treatment lifted control at one year from 85 to 91 percent, a property surgery does not have.

A collapsed lung is the price, in a quarter of procedures, and a drain for a day or two fixes it.

Painful bone metastases

A metastasis in a bone hurts because it stretches the periosteum, the sensitive sheath around the bone, and because the tumor itself releases substances that irritate the nerves. Freezing both the tumor and the nerve endings around it stops the pain at its source.

MOTION enrolled 66 adults at centers in the United States and France with moderate to severe pain from bone metastases who had not been helped by standard treatment, most of them by radiation, and published the results in Radiology Imaging Cancer in 2021. Pain scores fell by 2 points within a week and by 2.61 points at eight weeks on a 10-point scale, and kept falling through six months. Quality of life improved, opioid doses held steady rather than rising, and three patients had a serious adverse event.

The place of freezing here is after radiation, or in place of it when the same bone has already had its full dose. Radiation remains the first treatment for a painful bone metastasis, and the palliative radiotherapy page on this site explains why.

Freezing, heating or cutting

Three tools do the same job of destroying a small tumor, and the choice between them turns on what lies next to it.

None of the three wins everywhere. Heat is faster and seals its own bleeding, which makes it the usual choice deep in the liver, while surgery hands the pathologist the whole tumor and remains the standard for anything large or central.

When cryoablation is the wrong tool

Freezing has limits, and the review says so before anyone books a flight.

• Kidney tumors over 4 centimeters, where surgery gives better cancer control
• Lung tumors in the center of the chest beside the large airways and vessels, and primary lung cancers that a surgeon can remove
• More than a handful of metastases, or metastases growing quickly elsewhere, where the problem is systemic and the treatment is drugs
• A tumor touching bowel that cannot be moved away with fluid or gas
• Bleeding that cannot be corrected, since cold does not seal vessels
• An infection at the site

A tumor that fails the list is not a tumor without options. The same team offers heat ablation, stereotactic radiation on an Elekta Versa HD linear accelerator, and surgery, all on one site, and the review names the one that fits.

Preparation

Preparation runs along the lines of any needle procedure through the skin.

The procedure, step by step

The procedure runs in six steps and takes one to two hours.

1. Anesthesia. Sedation with local anesthetic for most kidney, bone and lung procedures. General anesthesia for children, for long procedures with several probes, and for anyone who prefers it.
2. Planning scan. You lie in the CT scanner in the position that gives the straightest path to the tumor, and the radiologist marks the entry point on the skin.
3. Protecting the neighbors. Where bowel, a nerve or the skin lies close, fluid or carbon dioxide is injected to push it away, and a warming pad or a temperature probe guards tissue that must stay warm.
4. Probes. One to six probes, each about 1.5 millimeters across, are advanced under CT guidance until their tips sit inside the tumor at planned distances from each other. A biopsy is taken through the same track if none exists.
5. Freeze, thaw, freeze. Argon gas drives the tip temperature down for around ten minutes while scans every few minutes show the ice ball growing. A thaw follows, then a second freeze, and some units add a third cycle for larger tumors.
6. Withdrawal and check. The probes are warmed and removed, the tracks are sealed where needed, and a final CT looks for bleeding or air.

One night of observation is the rule, since bleeding and a collapsed lung declare themselves in the first hours. Many kidney and bone procedures are followed by discharge the next morning.

Risks

Serious complications of cryoablation are uncommon, and they follow the organ.

Pain after the procedure stays mild for the majority, and that is one of the reasons cold is chosen over heat for bone and for tumors near the skin. Fever for a day or two after a large freeze is expected.

Scans afterwards, and what a recurrence means

A frozen tumor does not vanish. It stays on the scan as a dead zone. Over months it shrinks, and follow-up is about telling that zone apart from regrowth.

The first scan comes at one to three months, with contrast. A treated tumor takes up no contrast. A rim or a nodule that does take it up means living tumor at the edge, and a second freeze deals with it, which explains the gap between the SOLSTICE figures for one treatment and two. After that, scans every six months for two years and then yearly.

Days in Istanbul

A single tumor means a visit of a few days. The lung adds a rule about flying.

Flying after a kidney or bone procedure is cleared the day after discharge. The lung is different. Flying waits for a chest X-ray showing no residual air, which is a rule of the airlines as much as of the doctors, and a lung that needed a drain adds a week to the stay, since the drain comes out only when the lung has stayed up for a day without it and the X-ray after that has to be clean too.

What a quote contains

No figure appears on this page. Probes decide most of a cryoablation quote. Their number follows the size of the tumor.

• Probes. Each is a single-use device, and a large tumor needs several
• Anesthesia. Sedation and general anesthesia are priced differently
• Hospital nights. One is inside most quotes, and a second after a lung procedure with a drain may not be
• Displacement fluid, a kidney stent, bone cement and a biopsy, each a separate item
• The planning CT and the first follow-up scan

Packages published by Turkish hospitals and medical travel agencies for tumor ablation cover the consultation, the procedure with a stated number of probes, one night in hospital, an interpreter and transfers, and leave out flights, insurance, accommodation and the treatment of any complication.

A quote you can compare names the number of probes it assumes, the type of anesthesia, the number of hospital nights and whether the first follow-up scan is included. It follows the free review.

Coordinator, language, companion

Language

Biruni Hospital gives every international patient one coordinator from the first message, reachable on the same WhatsApp number afterwards. The international patients team works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and arranges interpreters for other languages, which matters at the consultation, where the choice between freezing, heat and surgery is explained, and at discharge, when the warning signs are gone through.

Companion and paperwork

Bring a companion. Sedation requires one. The night after a needle in the kidney or the lung is easier with someone in the room. The office books accommodation close to the hospital, arranges airport transfers and the car to the hospital, and issues an appointment confirmation and invitation letter for a visa ten days or so before travel. Patient rooms have a companion bed. The hospital kitchen prepares halal, vegetarian and diabetic meals, a prayer room is on site, and a female physician is arranged where the rota allows for anyone who asks in the first message.

Follow-up at home

Once you get back home, four things go to your own oncologist or urologist. The procedure report. The images of the ice ball at its largest. The biopsy result. The follow-up calendar.

Fever above 38 degrees after the first three days, blood in the urine that does not clear, breathlessness, or pain that gets worse instead of better go to a local emergency department the same day, with the discharge note in hand.

Cryoablation - Tumor Freezing Surgery FAQ