Fire and ice: Using minimally-invasive thermal ablation to blast cancerous tumors
By Kristy Bleizeffer Jul 17, 2018
It sounds a little like science fiction: Doctors using extreme cold or heat to blast tumors inside of human organs.
Cryoablation – administered through a small probe directed through the skin under direct imaging guidance – freezes tumors at temperatures as low as negative 150 degrees Celsius. Microwave ablation heats tumor cells to the point of “coagulative necrosis,” leaving no chance for cell survival.
While highly technical, there’s no fiction about it. Physicians use these treatments in Wyoming Medical Center’s Interventional Radiology suite and CT scanner to heat or freeze cancerous tumors. Ablation is the controlled application of extreme temperatures to various tissues within the body, essentially removing those tissues without open surgery. With specialized applicators, interventional radiologists can pinpoint tumors with real-time X-ray imaging. The techniques are minimally invasive, and most patients are able to walk out of the hospital the same day.
“Thermal ablative techniques can kill any kind of cancer,” said Charles Bowkley, III, M.D., an interventional radiologist at Wyoming Medical Center and Casper Medical Imaging in Casper.
“As with any ablation technology, many factors are pertinent to ensure a successful outcome. A team of physicians willing to participate in a multidisciplinary approach to cancer is essential to ensure best patient outcomes.”
Following is the story of two patients, both men in their early 70s, both with tumors in their kidneys, who underwent the treatments recently at Wyoming Medical Center. Their tumors were eradicated with the extreme temperatures achieved through ablative technology – one with fire, one with ice.
While still living in Arizona, Michael Skinner had a CT scan to see if the previously discovered spots on his liver had grown.
That’s when doctors discovered a tumor in his right kidney. His Arizona doctor recommended removing the kidney entirely, but Skinner was in the middle of planning a move back to Casper where he and his wife raised their family. They decided to seek treatment here.
One of our local urologists here in Casper, Dr. Brandon Trojan, referred him to Dr. Bowkley who recommended ablation technology for his kidney tumor.
“Dr. Bowkley was so kind and courteous. He was so kind in explaining it all to us,” Skinner said.
A number of factors determine whether a patient is a good candidate for ablation treatment, including tumor size, location, cell type and whether there are other tumors present.
“The complexity of cancer in general speaks to the necessity of a multidisciplinary approach to managing kidney tumors,” Dr. Bowkley said. “Just because a tumor is of a certain size in one patient does not mean that it will be responsive to ablation. The location of a given tumor is also an extremely important factor and where the tumor resides will likely dictate its treatment options.”
Skinner’s tumor was small and located at the rim of his right kidney, far from the collecting system – or the place urine is drained from the kidney to the bladder. This made the tumor a good candidate for microwave ablation, Dr. Bowkley said.
Skinner’s CT guided ablation was quick. Skinner lay down on his side and had a CT scan to pinpoint the exact location of the tumor. After his side was cleaned, his skin and surrounding tissues were numbed with local anesthetic, and Dr. Bowkley inserted the microwave applicator into the tumor with CT guidance.
“Microwaves produced at the tip of the applicator heat up the water elements of the tumor cells,” Dr. Bowkley said. “The heat produced locally within the tumor is so extreme, no cells exposed to the heat will survive.”
Skinner’s tumor was ablated for eight minutes. The maximum temperature reached 132 degrees Centigrade, or 270 degrees Fahrenheit.
After the procedure, Skinner ate a small meal and was discharged home that day.
“The only pain I felt was the needle going in to numb my back,” Skinner said. “During the procedure, they all said they could see the tumor shrink right there on the screen. I just knew I was in good hands and I had no fear.”
You could say David Miller, 71, did everything right. Last October, he went in for a routine prostate screening. Urologist J. Paul Jones, M.D., detected elevated prostate-specific antigen (PSA) which may indicate prostate cancer.
Dr. Jones performed a biopsy on Miller’s prostate and ordered a CT scan which incidentally discovered a tumor on each of his kidneys.
After biopsies identified that the tumors were cancerous, Dr. Jones consulted with Dr. Bowkley for possible ablation.
One reason Miller was a good candidate for cryoablation was because he had a tumor in both kidneys, so it required a minimally-invasive option that would save as much functioning kidney tissue as possible, Bowkley said. Miller underwent two cryoablation treatments, one on each kidney tumor.
Whether or not a patient requires general anesthesia depends on a number of factors. Miller had general anesthesia for the cryoablation on the tumor in his left kidney, but didn’t need it for the cryoablation on his right. Cryoablation is performed under direct CT guidance to allow interventional radiologists to pinpoint the precise location of the applicators. Two applicators were required to encompass the entire mass of both of Miller’s tumors, creating an ice ball large enough to kill them -- at a temperature of a chilly -150 degrees Celsius.
Dr. Bowkley allowed the ice to “thaw” for eight minutes before beginning a second freezing session. Rapid freezing and rapid thawing breaks the cancerous cells apart, effectively killing the tumor.
Because Miller didn’t need general anesthesia for his second ablation, he and Dr. Bowkley were able to communicate throughout the procedure and he went home the same day.
“It was just a tremendous experience, because everybody took the time to explain things and answer all of my questions,” Miller said. “It is really important to us to have a hospital like Wyoming Medical Center in Casper because being at home is part of your recovery, plus our family is here. It helps you to heal.
“We really appreciated all the smiles, whether it was from the nurses, the doctors, the anesthesiologists, the housekeepers or the lady who wheeled me down from radiology. They are all, in my way of looking at it, like family.”
Follow up CT scans for both Skinner and Miller showed no viable tumors in the treated areas, Dr. Bowkley said.
Skinner continues to follow up with his doctors. “Can you believe it?” he said. “After eight minutes, I walked out of there and my tumor was dead.”
Miller is following up with an oncologist for the issues with his prostate, detected during the abnormal prostate exam by his urologist. He feels lucky that that issue led to the detection and treatment of his kidney tumors.
Cancer can be a frightening diagnosis. Thermal ablation is one of many treatment options that can be considered with the counsel of your team of doctors. Patients react differently to any prescribed treatment, and one patient’s experience cannot be considered typical for any particular procedure. But understanding the options available can help empower patients to ask questions and actively participate in their care.
“When it comes to cancer care, an important question to ask your physician is, ‘Are ablative technologies – such as cryoablation, microwave ablation or radiofrequency ablation – right for my tumor?’ If so, we can help you,” Dr. Bowkley said.
Dr. Bowkley is the only neurointerventional radiologist in Wyoming and Wyoming Medical Center’s 2017 Physician of the Year. He is board certified in diagnostic and vascular / interventional radiology. He practices at Casper Medical Imaging in Casper. Call 307-232-5054 for an appointment or referral.
Dr. Trojan is an urologist at Central Wyoming Urological Associates. Call (307) 577-8600 for an appointment or a referral, or go to wyomingurology.com.
J. Paul Jones is a board-certified urologist at Central Wyoming Urological Associates. Call (307) 577-8600 for an appointment or a referral, or go to wyomingurology.com.