Cryotherapy

The most common medical use of cryotherapy is for treatment of skin conditions, including:

• Freckles 

• Nodules

• Precancerous moles

• Skin tags

• Warts 

Cryotherapy is also used for treating certain cancers, including:

• Cervical cancer

• Prostate cancer, if the tumor has not spread beyond the prostate

Cryotherapy may be used to treat skin cancer lesions, but this is not a common practice as the treatment destroys the tissue, making it impossible to send it to a laboratory for a biopsy.

Dermatologists use cryotherapy most often, to treat various skin lesions. However other specialists, such as gynecologists, also can perform the procedure.

Cryotherapy for an internal organ, like the prostate gland, is performed by an interventional radiologist. This is a board-certified specialist who uses radiology imaging to perform minimally invasive treatments such as cryotherapy.

Liquid nitrogen is most commonly used for cryotherapy. When cooled below -130°F, nitrogen gas liquifies. As liquid nitrogen is released from a pressurized canister it immediately transforms into a supercooled gas. The extreme cold of liquid nitrogen freezes and destroys tissue.

How cryotherapy is performed depends on the purpose of the procedure.

• For skin lesions, the freezing gas is applied directly to the target area either with a device that sprays the gas on, or with a swab. 

• For internal lesions, the gas is sent through a needle that is inserted either through the skin, as for prostate cancer, or in the case of cervical cancer, with a long probe inserted through the vagina. 
  

In general, people who need cryotherapy for a skin lesion do not need to do anything to prepare. When you arrive at the office, the dermatologist will clean the target area and then apply the freezing gas. He or she may apply a bandage after, especially if the affected area may rub against clothing.

Cryotherapy for prostate cancer takes about two hours. It is usually an outpatient procedure; however, some patients may need to remain in the hospital overnight.

If you take anticoagulants (blood thinners), your doctor may tell you to stop taking them a few days before the procedure. Ask your doctor when you can start taking them again after cryotherapy.

Prostate cancer cryotherapy typically involves these steps:

• A nurse may start an intravenous (IV) so you can receive medications.

• A blood pressure cuff or oximeter may be attached to your arm and finger to monitor your blood pressure, pulse, and blood oxygen level.

• The doctor or nurse will give you a sedative or an anesthetic before the procedure. 

• Once the sedative or anesthetic takes effect, the doctor will insert a urinary catheter into your penis. 

• Using ultrasound for guidance, the doctor will insert needles through the skin in the perineal area (the skin between the scrotum and rectum) to the prostate. These needles then transport the gas to the prostate, where ice balls form and kill tissue in the prostate gland.

• While the gas is going through the needles to freeze the gland, warm water is inserted into the catheter to flow into your bladder. This protects the urethra, the tube that carries urine from the bladder.

• The needles are removed but the catheter usually remains in place for about three weeks.

Unlike with prostate cancer, cryotherapy for cervical cancer does not require anesthetic. However, your doctor may recommend you take an over-the-counter pain reliever, like ibuprofen, an hour before the procedure, which is often done in a doctor’s office.

• You will be asked to lie on the treatment table with your feet in stirrups, as you would for a pelvic examination.

• The doctor will insert a device through the vagina to provide access to the cervix. 

• Using a long thin tube called a cryoprobe, the doctor will apply nitrogen oxide to the surface of the cervix. When the gas makes contact with the cervix, ice balls form and kill abnormal cells. This takes about three minutes.

• After a five-minute resting period, during which the cervical tissue thaws, the freezing is repeated for another three minutes.

All medical procedures have some risks, and it is important to talk with your doctor about your individual risk factors and how to manage them.

The most common risks for cryotherapy include:

• Bleeding 

• Blisters and ulcers on the skin 

• Changes in skin color 

• Infection 

• Nerve damage

• Scars

For people who undergo cryotherapy for prostate cancer, possible complications include:

• Blood in urine

• Difficulty urinating

• Erectile dysfunction

• Fistula, an opening between the rectum and bladder

• Swelling of the scrotum or penis

For people who undergo cryotherapy for cervical cancer, possible complications include:

• Bleeding

• Cramping

• Infection

You can reduce your risk of certain complications by following your doctor’s instructions for the recovery period. For all types of cryotherapy, watch for signs of infection and notify your healthcare team if you suspect you may have an infection.

Signs of infection include:

• Fever

• Foul-smelling or cloudy urine (after prostate cryotherapy)

• Foul-smelling vaginal discharge (after cervical cryotherapy)

• Increasing pain

• Pus or discharge

• Redness around the treatment site

Following skin treatment, you can reduce your risk of infection by:

• Covering the area with a clean bandage if it could rub against clothing or be easily injured

• Keeping the area clean and dry

• Not picking at any scabs

Following cervical cancer treatment, avoid sexual intercourse, using tampons, or douching for several weeks as recommended by your doctor.

Following prostate cancer treatment, keep the urinary catheter in place for as long as your doctor recommends.

When in doubt, contact your healthcare provider about any symptoms you experience after your cryotherapy procedure to avoid any further, more serious complications.

Prior to cryotherapy, your doctor may advise you to avoid using creams, ointments or deodorant, depending on the location of the procedure.

If you are to undergo cervical cryotherapy:

• Tell your doctor about all medications you take, including supplements and natural products.

• Avoid sexual intercourse or douching or for at least 24 hours before the procedure.

• Do not use tampons or any vaginal suppositories for at least 24 hours prior to cryotherapy.

• Ask someone to come with you to your appointment so you have support getting home.

If you are to undergo prostate cryotherapy:

• You may be told to fast for 24 hours before your procedure.

• You may be told to stop taking medications, like blood thinners, for a few days before the procedure.

• You may have to empty your bowels, with laxatives or an enema, the night before the procedure.

• Ask someone to come with you to your appointment to assist you getting home.

Knowing what to expect during and after cryotherapy makes it easier to plan and prepare for a successful recovery.

Recovery for cryotherapy for skin lesions takes only a few days. You may have some pain in the treatment area in the days after the procedure, and a scab that lasts a bit longer.

Recovery from cryotherapy for cervical cancer can take a few weeks. You might have some watery vaginal discharge for 2 to 3 weeks after the procedure. You will likely have a follow-up appointment for a Pap test or a cervical biopsy so your doctor can confirm the cryotherapy killed all abnormal cells. Women who have cryotherapy often have more frequent Pap smears for the first two years after the procedure.

If you had cryotherapy for prostate cancer, you may have some bruising and swelling where the needles were inserted. You will also have the urinary catheter in place for several days after the procedure, which may cause some blood in your urine.

Talk to your doctor if your recovery seems to be taking longer than expected or if you experience any unexpected symptoms.

Most people who experience pain from cryotherapy find relief with over-the-counter medications, such as ibuprofen (Advil). Ask your doctor for guidance on which pain reliever is best for you, or if you experience pain that does not go away with over-the-counter treatment.

Follow-up appointments for skin cryotherapy may not be necessary. After cryotherapy for cervical cancer or prostate cancer, your doctor will schedule a follow-up exam to confirm that the procedure was successful and check for any complications.

Call your doctor if you experience fever, foul-smelling urine or discharge, or redness in the treatment area, as these may be signs of infection. If you have pain that does not go away with over-the-counter medications, contact your healthcare provider.