Cryotherapy is a technique that uses an extremely cold liquid or instrument to freeze and destroy abnormal skin cells that require removal. The technique has been in use since the turn of the century, but modern techniques have made it widely available to dermatologists and primary care doctors. The technique is also called cryosurgery.
Description
There are three main techniques to performing cryotherapy. In the simplest technique, usually reserved for warts and other benign skin growths, the physician will dip a cotton swab or other applicator into a cup containing a "cryogen," such as liquid nitrogen, and apply it directly to the skin growth to freeze it. At a temperature of -320°F (-196°C), liquid nitrogen is the coldest cryogen available. The goal is to freeze the skin growth as quickly as possible, and then let it thaw slowly to cause maximum destruction of the skin cells. A second application may be necessary depending on the size of the growth. In another cryotherapy technique, a device is used to direct a small spray of liquid nitrogen or other cryogen directly onto the skin growth. Freezing may last from five to 20 seconds, depending on the size of the lesion. A second freeze-thaw cycle may be required. Sometimes, the physician will insert a small needle connected to a thermometer into the lesion to make certain the lesion is cooled to a low enough temperature to guarantee maximum destruction. In a third option, liquid nitrogen or another cryogen is circulated through a probe to cool it to low temperatures. The probe is then brought into direct contact with the skin lesion to freeze it. The freeze time can take two to three times longer than with the spray technique.
Who Performs the Procedure and Where Is It Performed?
Cryotherapy is performed by the treating physician, who may be a gynecologist (cervical cryotherapy) or a dermatologist (wart removal) or an oncologist (tumor removal). The procedure is usually carried out on an outpatient basis, but may require a hospital setting depending on the condition requiring the cryotherapy.
Questions to Ask the Doctor
What happens on the day of surgery?
What type of anesthesia will be used?
What will I feel during cryotherapy?
What happens after cryotherapy?
What are the risks associated with cryotherapy?
How is cryotherapy done?
Will there be a scar?
Definition
Cryotherapy is a technique that uses an extremely cold liquid or instrument to freeze and destroy abnormal skin cells that require removal. The technique has been in use since the turn of the century, but modern techniques have made it widely available to dermatologists and primary care doctors. The technique is also known as cryocautery or cryosurgery.
Purpose
Cryotherapy is used to destroy a variety of benign skin growths, such as warts, pre-cancerous lesions (actinic keratoses), and malignant lesions (basal cell and squamous cell cancers). It has been used at several medical centers for tumors of the prostate, liver, lung, breast, and brain as well as for cataracts, gynecological problems, and other diseases. The goal of cryotherapy is to freeze and destroy targeted skin growths while preserving the surrounding skin from injury.
Description
In dermatology applications, there are three main techniques used in cryotherapy. In the simplest technique, usually reserved for warts and other benign skin growths, the physician dips a cotton swab or other applicator into a cup containing a "cryogen" such as liquid nitrogen and applies it directly to the skin growth to freeze it. At a temperature of –320°F (–196°C), liquid nitrogen is the coldest cryogen available. The goal is to freeze the skin growth as quickly as possible, and then let it thaw slowly to cause maximum destruction of the skin cells. A second application may be necessary depending on the size of the growth. In another approach, a device is used to direct a small spray of liquid nitrogen or other cryogen directly onto the skin growth. Freezing may last from five to 20 seconds, depending on the size of the lesion. A second freeze-thaw cycle may be required. Sometimes, the physician inserts a small needle connected to a thermometer into the lesion to make certain the lesion is cooled to a temperature low enough to guarantee maximum destruction. In a third option, liquid nitrogen or another cryogen is circulated through a probe to cool it to low temperatures. The probe is then brought into direct contact with the skin lesion to freeze it. The freeze time can take two to three times longer than with the spray technique.
When used for cancer treatment, cryotherapy is usually performed as follows: for external tumors, liquid nitrogen is applied directly to the cancer cells with a cotton swab or spraying device; for internal tumors, liquid nitrogen is circulated through an instrument called a cryoprobe that is placed in contact with the tumor. To guide the cryoprobe and to monitor the freezing of the cells, the treating physician uses ultrasound to guide his work and spare nearby healthy tissue.
Preparation
No extensive preparation is required prior to cryotherapy. The area to be treated should be clean and dry, but sterile preparation is not necessary. Patients should know that they will experience some pain at the time of the freezing, but local anesthesia is usually not required. In dermatology applications, the physician may want to reduce the size of certain growths such as warts prior to the cryotherapy procedure, and may have patients apply salicylic acid preparations to the growth over several weeks. Sometimes, the physician will pare away some of the tissue using a device called a curette or a scalpel. In the case of cervical cryotherapy, the procedure is not performed during, or from two to three days before, the menstrual period.
Aftercare
In dermatology applications, redness, swelling, and the formation of a blister at the site of cryotherapy are all expected results of the treatment. A gauze dressing is applied, and patients should wash the site three or four times daily while fluid continues to ooze from the wound, usually for five to 14 days. A dry crust will form that falls off by itself. Wounds on the head and neck may take four to six weeks to heal, but those on the body, arms, and legs can take longer. Some patients experience pain at the site following the treatment. This can usually be eased with acetaminophen (Tylenol), though in some cases a stronger pain reliever may be required.
Risks
In dermatology applications, cryotherapy poses little risk and can be well tolerated by elderly and other patients who are not good candidates for other surgical procedures. As with other surgical procedures, there is some risk of scarring, infection, and damage to underlying skin and tissue. These risks are generally minimal in the hands of experienced physicians.
Care should be taken, however, in subjecting people with diabetes or certain circulation problems to cryotherapy for growths located on their lower legs, ankles, and feet. In these patients, healing can be poor and the risk of infection can be higher than for other patients.
Although cryotherapy is a relatively low-risk procedure, some side effects may occur as a result of the treatment. They include:
Infection. Though uncommon, infection is more likely on the lower legs where healing can take several months.
Pigmentary changes. Both hypopigmentation (lightening of the skin) and hyperpigmentation (darkening of the skin) are possible after cryotherapy. Both generally last a few months, but can be longer lasting.
Nerve damage. Though rare, damage to nerves is possible, particularly in areas where they lie closer to the surface of the skin, such as the fingers, the wrist, and the area behind the ear. Reports suggest this will disappear within several months.
In cancer treatment, cryosurgery does have side effects, although they may be less severe than those associated with conventional surgery or radiation therapy. Cryosurgery of the liver may cause damage to the bile ducts or major blood vessels, which can lead to heavy bleeding or infection. Cryosurgery for prostate cancer may affect the urinary system. It also may cause incontinence (lack of control over urine flow) and impotence (loss of sexual function), although these side effects are often temporary. Cryosurgery for cervical tumors has not been shown to affect fertility, but this possibility is under study. More studies must be conducted to determine the long-term effects of cryosurgery as a cancer treatment approach.
Normal Results
Some redness, swelling, blistering, and oozing of fluid are all common results of cryotherapy. Healing time can vary by the site treated and the cryotherapy technique used. When cryogen is applied directly to the growth, healing may occur in three weeks. Growths treated on the head and neck with the spray technique may take four to six weeks to heal, while growths treated on other areas of the body may take considerably longer. Cryotherapy boasts high success rates in permanently removing skin growths; even for malignant lesions such as squamous cell and basal cell cancers, studies have shown a cure rate of up to 98%. For certain types of growths such as some forms of warts, repeat treatments over several weeks are necessary to prevent the growth's return.
Alternatives
Alternatives to cryotherapy depend on the specific medical condition being treated. A general alternative is the use of conventional surgical procedures.
Dawber, R., G. Colver, A. Jackson, and F. Pringle. CutaneousCryosurgery: Principles and Clinical Practice, 2nd ed. Oxford: Blackwell Science Inc., 1996.
Korpan, N. N. Basics of Cryosurgery. New York: Springer Verlag, 2002.
Lynch, Peter J., and W. Mitchell Sams Jr. Principles and Practice of Dermatology, 2nd ed. New York: Churchill Livingstone, 1996.
Roenigk, Randall K., and Henry H. Roenigk Jr. Roenigk andRoenigk's Dermatologic Surgery: Principles and Practice. New York: Marcel Dekker, 1996.
Periodicals
Housman, T. S., and J. L. Jorizzo. "Anecdotal Reports of Three Cases Illustrating a Spectrum of Resistant Common Warts Treated with Cryotherapy Followed by Topical Imiquimod and Salicylic Acid." Journal of the American Academy of Dermatology 47 (October 2002): 1501–1505.
Otte, J. W., M. A. Merrick, C. D. Ingersoll, and M. L. Cordova. "Subcutaneous Adipose Tissue Thickness Alters Cooling Time during Cryotherapy." Archives of Physical and Medical Rehabilitation 83 (November 2002): 1501–1505.
Palner, E. A., et al. "Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter Trial of Cryotherapy for Retinopathy of Prematurity: Ophthalmological Outcomes at 10 Years." Archives of Ophthalmology 119 (2001): 1110–1118.
Uchio, Y., M. Ochi, A. Fujihara, N. Adachi, J. Iwasa, and Y. Sakai. "Cryotherapy Influences Joint Laxity and Position Sense of the Healthy Knee Joint." Archives of Physical and Medical Rehabilitation 84 (January 2003): 131–135.
Wozniacka, A., A. Omulecki, and J. D. Torzecka. "Cryotherapy in the Treatment of Angiolymphoid Hyperplasia with Eosinophilia." Medical Science Monitor 9 (January 2003): CS1–CS4.
Organizations
American Academy of Dermatology. 930 N. Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-0230. Fax: (847) 330-0050. http://www.aad.org.
American Society for Dermatologic Surgery. 930 N. Meacham Road, PO Box 4014, Schaumburg, IL 60168-4014. (847) 330-9830. http://www.asds-net.org.
Cryotherapy is a technique that uses an extremely cold liquid or instruments to freeze and destroy abnormal or cancerous skin cells that require removal. The prefix cryo- comes from the Greek word for frost. The technique has been in use since the turn of the century, but modern techniques have made it widely available to dermatologists and primary care doctors. Recent advances have also led to more frequent use of cryotherapy in treating internal cancer. The technique is also called cryosurgery.
Purpose
Cryotherapy can be employed to destroy a variety of such benign skin growths as warts, precancerous lesions (such as actinic keratoses), Bowen's disease, and such malignant lesions as basal cell and squamous cellcarcinomas. It has also found new use in treating internal cancers, such as cancers of the prostate gland and the breast. The goal of cryotherapy is to freeze and destroy targeted skin growths or cancers while preserving the surrounding tissue from injury. For this reason cryosurgery appears to be useful in performing lumpectomies for smaller breast cancers.
Internal cancers that are being treated with cryosurgery as of 2003 include cancers of the kidney and liver as well as of the prostate gland.
Precautions
Cryotherapy is not recommended for certain areas of the body because of the danger of destruction of normal tissue or unacceptable scarring. These areas include: skin that overlies nerves, the corners of the eyes, the fold of skin between the nose and lip, the skin surrounding the nostrils, and the border between the lips and the rest of the face. Lesions that are suspected or known to be malignant melanoma, an aggressive form of skin cancer, should not be treated with cryotherapy, but should instead be removed surgically. Similarly, basal cell or squamous cell skin cancers that have reappeared at the site of a previously treated tumor should also be removed surgically.
If it remains unclear whether a growth is benign or malignant, a sample of tissue should be removed for analysis (biopsy) by a pathologist before any attempts to destroy the lesion with cryotherapy. Care should be taken in people with diabetes or certain circulation problems when cryotherapy is considered for growths located on their lower legs, ankles, and feet. In these patients, healing can be poor and the risk of infection can be high.
Description
There are three main techniques used to perform cryotherapy. In the simplest technique, usually reserved for warts and other benign skin growths, the physician will dip a cotton swab or other applicator into a cup containing a "cryogen," such as liquid nitrogen, and apply it directly to the skin growth to freeze it. At a temperature of −320 deg;F (−196°C), liquid nitrogen is the coldest cryogen available. The goal is to freeze the skin growth as quickly as possible, and then let it thaw slowly to cause maximum destruction of the skin cells. A second application may be necessary depending on the size of the growth.
In another cryotherapy technique, a device is used to direct a small spray of liquid nitrogen or other cryogen directly onto the skin growth. Freezing may last from 20–30 seconds, depending on the size of the lesion. A second freeze-thaw cycle may be required. In a third option, liquid nitrogen or another cryogen is circulated through a probe to cool it to low temperatures. The probe is then brought into direct contact with the lesion, either on the skin or in the case of internal cancers, inside the patient. The freeze time can take two to three times longer than with the spray technique.
Preparation
Extensive preparation prior to cryotherapy is not required for external lesions. The area to be treated should be clean and dry, but sterile preparation is not necessary. Patients should know that they will experience some pain at the time of the freezing, but local anesthesia is usually not required. The physician may want to reduce the size of certain growths, such as warts, prior to the cryotherapy procedure, and may have patients apply salicylic acid preparations to the growth over several weeks. Sometimes, the physician will pare away some of the tissue using a device called a curette or a scalpel.
Preparation for treating cancers inside the body, such as prostate cancer, is slightly more complicated. The areas that are to be cooled are precisely mapped using ultrasound imaging or a specialized x-ray machine known as a computed axial tomography (CAT) scan. Temperature sensors are then placed inside and around the tumor to monitor the temperature. Lastly, cooling probes are then placed in and around the tumor.
Risks
Cryotherapy poses little risk and can be well tolerated by elderly and other patients who are not good candidates for other surgical procedures. As with other surgical procedures, there is some risk of scarring, infection, and damage to underlying skin and tissue. These risks are generally minimal in the hands of experienced users of cryotherapy.
Normal Results
Some redness, swelling, blistering, and oozing of fluid are all common results of cryotherapy. Healing time can vary by the site treated and the cryotherapy technique used. When cryogen is applied directly to the growth, healing may occur in three weeks. Growths treated on the head and neck with the spray technique may take four to six weeks to heal; growths treated on other areas of the body may take considerably longer. Cryotherapy boasts high success rates in permanently removing skin growths; even for malignant lesions such as squamous cell and basal cell cancers, studies have shown a cure rate of up to 98%. For certain types of growths, such as some forms of warts, repeat treatments over several weeks are necessary to prevent the growth's return.
In the case of internal tumors, such as cancers of the prostate, cryotherapy has been shown to be at least as effective as other means, such as radiation therapy, with fewer side effects and faster recovery time. In addition, cryosurgery appears to have less severe effects on the patients' quality of life than other forms of treatment for prostate cancer.
Abnormal Results
Although cryotherapy is a relatively low-risk procedure, some side effects may occur as a result of the treatment. They include:
Infection. Though uncommon, infection is more likely on the lower legs where healing can take several months.
Pigmentary changes. Both hypopigmentation (lightening of the skin) and hyperpigmentation (darkening of the skin) are possible after cryotherapy. Both generally last a few months, but can be longer lasting.
Nerve damage. Though rare, damage to nerves is possible. Reports suggest this will disappear within several months.
Resources
Books
Abeloff, Martin D., James O. Armitage, Allen S. Lichter, and John E. Niederhuber. Clinical Oncology. New York: Churchill Livingstone, 2000.
Beers, Mark H., MD, and Robert Berkow, MD, editors. "Principles of Cancer Therapy: Hyperthermia and Cryotherapy." Section 11, Chapter 144 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2002.
Periodicals
Anastasiadis, A. G., R. Sachdev, L. Salomon, et al. "Comparison of Health-Related Quality of Life and Prostate-Associated Symptoms After Primary and Salvage Cryotherapy for Prostate Cancer." Journal of Cancer Research and Clinical Oncology 129 (December 2003): 676–682.
Johnson, D. B., and S. Y. Nakada. "Cryoablation of Renal and Prostate Tumors." Journal of Endourology 17 (October 2003): 627–632.
Nadler, R. B., S. C. Kim, J. N. Rubinstein, et al. "Laparoscopic Renal Cryosurgery: The Northwestern Experience." Journal of Urology 170 (October 2003): 1121–1125.
Shinohara, K. "Prostate Cancer: Cryotherapy." Urology Clinics of North America 30 (November 2003): 725–736.
Subar, D. A., A. J. Sheen, and D. J. Sherlock. " Cryoablation for Liver Tumors—Is There Clinical Utility?" Medscape General Medicine 7 (November 2003): 19.
Tafra, L., S. J. Smith, J. E. Woodward, et al. "Pilot Trial of Cryoprobe-Assisted Breast-Conserving Surgery for Small Ultrasound-Visible Cancers." Annals of Surgical Oncology 10 (November 2003): 999.
Organizations
American Academy of Dermatology. 930 N. Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847)330-0230. .
Other
National Cancer Institute..
—Edward R. Rosick, D.O., M.P.H.; Rebecca J. Frey, PhD
Treatment of an injury or disease with cold. Cryotherapy includes the use of ice packs, cold baths, and coolant sprays. It reduces pain and swelling, decreases muscle spasms, and lowers the metabolic and oxygen needs of damaged tissue. It is particularly useful in the treatment of acute muscle and soft-tissue injuries. See also cold therapy and RICE.
A use of cryosurgery in the treatment of cutaneous tags, warts, actinic keratosis, and dermato-fibromas. The agent is usually liquid nitrogen, applied briefly with a sterile cotton-tipped applicator.
Cryotherapy is the local or general use of low temperatures in medical therapy or the removal of heat from a body part. The term "cryotherapy" comes from the Greek cryo (κρυο) meaning cold and the word therapy (θεραπεια) meaning cure. It has been around since the 1880-1890s.
Its goal is to decrease cellular metabolism, increase cellular survival, decrease inflammation, decrease pain and spasm, promote vasoconstriction, and when using extreme temperatures, to destroy cells by crystallizing the cytosol. The most prominent use of the term refers to the surgical treatment, specifically known as cryosurgery. Other therapies that use the term are cryogenic chamber therapy and ice pack therapy.
Cryosurgery is the application of extreme cold to destroy abnormal or diseased tissue. Cryotherapy is used to treat a number of diseases and disorders, most especially skin conditions like warts, moles, skin tags and solar keratoses. Liquid nitrogen is usually used to freeze the tissues at the cellular level. The procedure is used often because of its efficacy and low rates of side effects.
Ice pack therapy
Ice pack therapy is a treatment of cold temperatures to an injured area of the body. An ice pack is placed over an injured area and is intended to absorb heat of a closed traumatic or edematous injury by using conduction to transfer thermal energy. The physiologic effects of cold application include immediate vasoconstriction with reflexive vasodilation, decreased local metabolism and enzymatic activity, and decreased oxygen demand. Cold decreases muscle spindle fiber activity and slows nerve conduction velocity, therefore it is often used to decrease spasticity and muscle guarding. It is commonly used to alleviate the pain of minor injuries.
Cryogenic chamber therapy
Cryogenic chamber therapy is a treatment whereby the patient is placed in a cryogenic chamber for a short duration (i.e. no more than three minutes, which is comparable to ice swimming), and if used properly, will not destroy tissue. Whole body cryotherapy initially originated in Japan in 1880. However, it was a group of Polish scientists who took the idea and made whole body cryotherapy the physical therapy it is today. The Olympic rehabilitation centre in Spala, Poland opened in May 2000 and has been used as a training and injury rehabilitation centre for many sporting bodies.
The chamber is cooled, typically with liquid nitrogen, to a temperature of −110 °C (−166.0 °F). The patient is protected from acute frostbite with socks, gloves and mouth and ear protection, but in addition to that, wears nothing but a bathing suit. The patient spends a few minutes in the chamber. During treatment the average skin temperature drops to 12 °C (54 °F), while the coldest skin temperature can be 5 °C (41 °F). The core body temperature remains unchanged during the treatment, however it may drop slightly afterwards. Therapy triggers the release of endorphines which induce analgesia (immediate pain relief).
Patients report that the experience is invigorating and improves a variety of conditions such as psychological stress, insomnia, rheumatism, muscle and joint pain, fibromyalgia, itching, and psoriasis. The immediate effect of skin cooling and analgesia lasts for 5 minutes, but the release of endorphines can have a lasting effect, where the pains and signs of inflammation as found in blood tests remain suppressed for weeks. The effects of extreme cold and endorphine release are scientifically studied. Curiously, some patients compare the feeling to sauna at 110 °C (230 °F).[citation needed]
