Meet our Docs: Eric Cubin, M.D., blasts cancer tumors with hot and cold smart ‘bombs’
By Kristy Bleizeffer Mar 2, 2015
If he needed to, from a 3-mm nick in your skin, Dr. Eric Cubin could access most any system in your body. He could open a clotted artery in your brain, administer extremely high dose chemotherapy directly to a tumor in your liver, or freeze to negative 200 degrees Celsius a tumor in your kidney. He could follow your vast highway of blood vessels to get to an organ other specialists couldn’t reach. In some cases, you could walk into the hospital with cancer but leave without it.
As a general and interventional radiologist with Casper Medical Imaging and Outpatient Radiology, Dr. Cubin specializes in minimally invasive, image-guided procedures. He performs these procedures primarily at Wyoming Medical Center. “The technology is constantly evolving. These procedures are truly at the cutting edge,” he says.
In this interview, Dr. Cubin talks about practicing the “most exciting field in medicine” and why he thinks the face of cancer care will change dramatically in his lifetime.
Tell us a little about yourself. Where did you grow up?
I was born and raised in Casper. I was actually born in Wyoming Medical Center.
I tell people that I was born in the building where I work. I went to Southridge Elementary, then to CY Junior High, and graduated from NCHS in 1995. I went to the University of Wyoming where I got a Bachelor’s degree and then a Master’s degree.
I went to medical school on the WWAMI program (Washington, Wyoming, Alaska, Montana and Idaho). I then went to the University of Wisconsin for my post-graduate training. I came back, and now I work at Casper Medical Imaging and with Outpatient Radiology. Really, because I do interventional radiology, I spend the majority of my time at Wyoming Medical Center.
What got you interested in medicine?
The truth is, my dad, Dr. Fritz Cubin, was an internist here in Casper for 30 years or so. He was a very prominent internist. He was the Jim Anderson of internal medicine. I just grew up around it. I saw what my father was doing. I loved the sciences, and I loved taking care of people, so it was just a good fit.
What’s it like working in the community where you grew up?
When I first got back here it was a little unnerving. You train in a place where you are essentially anonymous, and it does not have the same emotional and social implications that it has when you work on people you’ve known your whole life. Immediately after I started working in Casper, three of my very best friends’ parents were my patients. Having to operate on the people who you grew up with really raises the stress level.
How did you choose interventional radiology?
First of all, I think that radiology is an incredibly exciting and promising field. For better or worse, modern-day doctors have become much more reliant on imaging to make diagnoses. Historically, doctors only had history and physical exams with maybe some labs. Now, because of imaging, we can see so much more. With interventional radiology, we can now diagnose the patient’s problem with imaging and use that same imaging to fix the problem in a minimally invasive fashion. How cool is that? It has opened up a world of possibilities.
As far as interventional radiology goes, I really think it is the most exciting field in medicine. Interventional radiology specializes in minimally-invasive surgery. There are very, very few places that we do not go. We don’t really go in the heart because the cardiologists take that. We do not go into the eyes because they aren’t really accessible. Beyond that, there is really nowhere else we cannot and do not go.
For example, if a patient has a stroke and they come within 6 to 8 hours of symptom onset – and if they meet the criteria for intra-arterial intervention – we can put a catheter in the femoral artery, run the catheter up the aorta, around the heart, up the carotid artery, and out into the middle cerebral artery. We then fish the clot out and restore blood flow to the brain.
In a lot of cases, our outcomes are as good as or better than traditional surgery. The recovery time and time in the hospital is much shorter. The complications are much less. If you are offered a procedure that is done through a 10-inch incision or a 3-mm nick in the skin, with both having the same outcome, which would you take?
Is there an emerging technique that you are really excited about?
One of the things I find to be most exciting is in the realm of interventional oncology, specifically, percutaneous ablation of tumors. Ablation is a minimally invasive way of destroying tumors without ever cutting the patients open.
Historically, if a patient was found to have a tumor in his/her kidney, liver or lungs, they would have to have a big surgery to remove either the entire organ or a significant part of it. Obviously, any time they surgically resect an organ it is a big deal. There is usually a big incision, the recovery takes a long time and complications are not infrequent.
With percutaneous ablation, we use imaging to place a probe through the patient's skin directly into the tumor. Depending on where the tumor is and its characteristics, we can either use extreme heat or extreme cold to destroy it right in place. For example, in the kidney, we advance the probes through 2-3 mm skin nicks into the center of the tumor. We then use liquid argon to decrease the temperature to -200 Celsius which creates an ice ball that envelops the tumor and literally freezes it right in place. There is complete destruction of frozen tissue and the destroyed tissue is naturally resorbed by the body over the next several weeks. We can actually watch the ice ball grow under imaging so we know when we have an adequate margin. The procedure often does not require general anesthesia and it is painless. The truth is, most of these patients have cancer when they come in, and they oftentimes leave cured.
On what kinds of cancers is this treatment effective?
We primarily perform ablation in the lungs, liver, kidneys and bone. Obviously, the earlier we find the tumors, the more successful we are at destroying them. Treatment success depends on tumor size and location. There are other circumstances in which ablation could also be considered. For example, a 98-year-old lady who is found to have breast cancer and says there is no way a surgeon is going to cut her open. In that case, I would consider doing it for breast cancer.
There are other weird little things that come up, like an osteoid osteoma which is a painful bone tumor seen in young people. I have treated several of these at Wyoming Medical Center. These are tumors that, when treated surgically, typically require 6-9 months of non-weight bearing on the affected leg. With ablation, the treatment takes 30-90 seconds, the pain resolves completely, the tumor is destroyed, and the patient can walk out of the hospital.
The truth is, ablation technology is only now really coming to the forefront. I truly believe it is the way of the future. It is still in its early days, but there is no doubt that it is on the horizon and coming fast.
As you look forward, are you optimistic about improving cancer patients’ prognoses during the span of your career?
Yes. Already in my career, from the day I began medical school, the outcomes are vastly different. With the amount of research going on and the amount of money being spent, there is absolutely no doubt in my mind that the face of cancer treatment is going to change. We may look back on the things that we are doing today and think they are totally antiquated.
For right now, we are doing the best we can. Our outcomes are really good. They are going to get better. In my opinion, the treatment of cancer in the future is most likely going to be individualized. It is going to be based on biomarkers and bioassays. It will be based on individual characteristics of each person’s cancer that are specifically targeted.