Cryoablation
Ablation means destroying tissue and cryo means cold or freezing.
WHAT IS CRYOABLATION?
Cryoablation is the freezing of tumors to destroy them.
The freezing is achieved with liquid nitrogen which flows through a probe (needle.) The needle is inserted into the tumor under ultrasound guidance. This allows us to position it very precisely, ensuring that the tumor is at the centre of the freezing zone.
The liquid nitrogen never leaves the needle, but it causes the tissue around the needle tip to freeze rapidly. This creates a large ball of ice that engulfs the tumor. By alternating freeze and thaw cycles, the cells in the tumor are destroyed. By the end of the procedure there should be no viable cancer cells left. The progress of ice ball development is closely monitored throughout the procedure to ensure safety.
The procedure is performed after the administration of local anesthetic. The skin and deeper tissues are completely numbed prior to the introduction of the cryoablation needle.
It is therefore a painless procedure. Cryoablation of a breast tumor takes 30 – 40 minutes. Patients can go home soon thereafter.
Since cryoablation involves tissue destruction, patients can expect to develop bruising of the breast that lasts usually for one to two weeks. Post procedure pain is usually mild and can be controlled with anti-inflammatories and paracetamol.
A palpable lump remains at the tumor site after cryoablation. This is scar tissue that forms after tumor destruction. It will resolve within 6 to 12 months.
Follow up studies with mammograms, ultrasound and MRI confirm the absence of any residual breast cancer.
The purpose of cryoablation is to offer an alternative to surgery for selected breast cancers.
PROCEDURE DIAGRAM
ultrasound imaging is used to locate the lesion. The breast is prepared and local anesthesia is given
A 2mm incision (aobut 1/8 inch) is made in a cosmetically and technically appropriate location
Using ultrasound guidance, a vesical cryoprobe is positioned in the center of the lesion
The cycle in activated and on iceball forms around the tumor. The freezing temperatures destroy the tumor tissue
BREAST CANCER
What role does cryoablation play in breast cancer treatment?
Cryoablation replaces lumpectomy but does not remove the need for supplementary treatments prescribed by your oncologist. Most patients will still need to be on chronic endocrine treatment following the procedure. The purpose is to prevent a recurrence. Some patients may also need radiotherapy following cryoablation. As they would if they had undergone lumpectomy.
Cryoablation was developed as a treatment for breast cancers around 15 years ago. There have been 3 large clinical trials (2 of which are ongoing) and multiple smaller studies. All the published results show >95% successful ablation in tumors smaller than 1.5cm.
There have been very few complications from this procedure. The most significant complication is frostbite of the skin overlying the ice ball.
It is therefore a painless procedure. Cryoablation of a breast tumor takes 30 – 40 minutes. Patients can go home soon thereafter.
Since cryoablation involves tissue destruction, patients can expect to develop bruising of the breast that lasts usually for one to two weeks. Post procedure pain is usually mild and can be controlled with anti-inflammatories and paracetamol.
A palpable lump remains at the tumor site after cryoablation. This is scar tissue that forms after tumor destruction. It will resolve within 6 to 12 months.
Follow up studies with mammograms, ultrasound and MRI confirm the absence of any residual breast cancer.
The purpose of cryoablation is to offer an alternative to surgery for selected breast cancers.
01
QUICK
Cryoablation treatment takes less than an hour to complete, and is conveniently performed in our rooms.
02
PROVEN EFFECTIVENESS
There have been 3 large clinical trials (2 of which are ongoing) and multiple smaller studies. All the published results show >95% successful ablation in tumors smaller than 1.5cm.
03
NO HOSPITAL ADMISSION
This means reduced costs and infection exposure, less cost and the ability to return to normal life sooner.
04
NO GENERAL ANESTHESIA
Only local anesthesia is required for the treatment.
05
EXCELLENT COSMETIC OUTCOME
No scarring or breast disfigurement, a palpable lump remains at the tumor site after cryoablation. This is scar tissue that forms after tumor destruction. It will resolve within 6 to 12 months.
06
MINIMAL POST PROCEDURE DISCOMFORT
Post procedure pain is usually mild and can be controlled with anti-inflammatories and paracetamol.
PATIENT TESTIMONIALS
The doctor and staff were professional but also kind and supportive with it being a new procedure. One of the ladies stroked my arm to give me comfort which I greatly appreciated. Dr Schoub also phoned me that evening and for a few days afterwards to check on me.
The rooms and the environment were comfortable and well-appointed and the parking was good so I did not need to stress about parking,
It was a little uncomfortable during the procedure but I did not feel any pain. Everyone kept checking on me as well to see how I was feeling. It was also good to have the procedure in the rooms and to not have to go to a clinic.
Afterwards I had bruising but as I had been warned it would happen it did not concern me. The wound did not bleed and I did not have any pain. The best thing was thing was the peace of mind and knowing that I did not have to have surgery.
Firstly, I want to thank my Lord Jesus for sending Prof Carol Ann Benn as well as Dr Peter Schoub across my path, I could experience their love and dedication to their calling.
I was pleasantly surprised to visit both Prof Carol ‘s rooms and the Parklane Mammography Department, to notice the cleanliness and the professionalism of the staff, there was also tea and coffee available in the waiting room, that I really enjoyed to calm my nerves.
The level of service and care provided by all the doctors and staff was so great. I want to mention Kerri’s name (she referred to herself as “scarry Keri”) but what an beautiful young lady she is, with the warmest heart ever. When going for the procedure, she was with me for the whole 2 hours, holding my hand, and telling me what dr. Schoub is now going to do, her reassurance and comforting smile made the whole process quite comfortable.
Dr. Schoub has such a gentle personality, I really felt so calm with him doing the procedure, and after the procedure was done, he spoke to me and my husband to reassure us that all was fine, he said that for a few days my breast will be sensitive and uncomfortable, but that was a small price for me to pay for the amazing work he had done.
I can confidently advise any lady that is thinking of this procedure to have it done as soon as possible to have the reassurance that you will be in great and caring hands.
Thanking you and blessings for the great work you all do.
I was diagnosed with lobular breast cancer in my left breast at the beginning of December 2020 and by the 21st December I was scheduled for a double mastectomy with reconstruction on 19th January 2021. The 'double' mastectomy being my choice to avoid any problems that might arise in the future and for what it is worth, none of the doctors tried to talk me out of it.
I had 10 years previous, consulted with Prof Carol Benn and as luck would have it, she still gets copies of my reports. On Friday 8th January I received a call from her rooms and once she heard my story she asked if I would be willing to see her for a second opinion and or to put my mind at rest. I thank God every day for that phone call.
Prof Benn in consultation with an oncologist, put me on a course of Hormone Therapy Treatment to see if it would kill off the tumor as it was very small. After a few months there was no significant change and importantly it had not grown at all. Prof Benn then arranged for me to see Dr Peter Schoub at the Parklane Mammography Dept, to assess if I was a candidate for 'Cryoablation Treatment', whereby they freeze the tumor from the center to kill it off. Fortunately, I was a candidate and was scheduled for the procedure on 24th November 2021.
The treatment day went well. On my arrival the staff were all very pleasant and caring. Kelly and Wendy, whom I had met at my assessment visit, assisted Dr Schoub. The atmosphere in the procedure room was very pleasant and calming. They take great care in positioning you for the procedure and you are giving a set of headphones with your choice of music. The procedure went well, I was comfortable and was asked continuously if I was ok. Besides the pinprick for the local anesthetic and the pressure of inserting the probe that administers the nitrogen for freezing, the procedure is painless.
After the procedure a dressing and a small icepack was placed over the incision area. Doctor Schoub then sat with me and my family and explained what he had done and what I could expect in the next few days and into the future.
For a few days after the procedure, I had mild pain and tenderness and the breast was red in the treatment area with slight bruising. Dr Schoub messaged me on the first two mornings to see how I was doing and he was satisfied that the symptoms I was experiencing were the norm.
On the 13 January 2022 I had my post cryo checkup. Dr Schoub was happy with the results and said the mass of dead tissue should gradually get smaller as it is absorbed into the body. I continued with 6 monthly mammogram and ultrasound checks while also seeing my oncologist for 6 monthly blood tests.
In August 2023 I had a breast MRI and Dr Schoub was happy that both breasts were clear and that the cancer in the left breast had been killed off and that there were no signs of new disease and that going forward I only need see him once a year. I continue to see my oncologist every 6 months for blood tests and will continue on the Hormone Therapy Treatment for up to 4 years. Just recently on 15th August 2924, I had my annual mammogram and ultrasound and Dr Schoub was happy that both tests were clear.
My experience with Parklane Radiology and the Breast Centre and now their beautiful new, welcoming rooms at Melrose Arch, has been very pleasant. From the front-line reception ladies, to the technicians, Dr Schoub, Dr Gill and for me, most importantly, the heated examination bed and warm gel in the ultrasound room.
Thank you all for making my journey easier and acceptably pleasant.
I found the level of service and care provided by the doctors and staff highly professional. The practice and its physical environment reflect the professional service one receives and can expect.
Dr’s explanation before and after the procedure put me at ease, which not only brought comfort, but enabled me to know what to expect. The staff made me feel very comfortable. I was not fearful before nor during the procedure.
I did experience a bit of pain and swelling after the procedure. Dr Schoub sent me a WhatsApp message 2 days after each other to find out how I was doing.
The aftercare and follow up visitation feedback, made me feel very good and satisfied.
Op 27 November 2021 het n roetine mammogram letsels in my een bors getoon en my huisdokter het dadelik chirurgie voorgestel. Ek het egter besluit om eers n spesialis te raadpleeg en was gelukkig genoeg om in Januarie 2022 n afspraak by Prof Carol Ann Benn te kry. Na haar ondersoek het sy my na Dr Naicker (onkoloog) verwys en hy het n reeks bloedtoetse laat doen en n nuwe mammogram by Dr Schoub van Parklane Radiology aangevra, wat ook letsels in die ander bors gewys het en op daardie stadium is borskanker amptelik gediagnoseer.
Biopsies is gedoen en Prof Benn het voorgestel dat ek Cryoablation moet oorweeg in plaas van chirurgie en het my van die nodige literatuur daaroor voorsien. Sy was baie positief oor die prosedure hoewel dit n relatief nuwe behandeling in Suid Afrika is en gemeld dat Dr Schoub al uitstekende resultate daarmee behaal het. Dr Naicker het Kessar voorgeskryf om die letsels te laat krimp asook verskeie aanvullings en het ook my hormoonvervangingsmedikasie gestaak.
Vanaf my eerste besoek aan Parklane Radiology is ek op my gemak gestel en met vriendelikheid en empatie behandel deur n uiters professionele span. Die prosedure is volledig aan my beskryf en verduidelik deur Dr Schoub en Kerry (radiografis) en my man is ook daarby betrek.
My eerste Cryoablation (regterbors) is op 29 Augustus 2022 deur Dr Schoub gedoen en ek moes my Ecotrin 3 dae voor die prosedure staak om bloeding te voorkom. Die prosedure is weereens volledig aan my verduidelik en Dr Shoub en Kerry het my ingelig dat ek die volgende dag seer en gekneus gaan wees.
Die voorbereiding van die Cryoablation is omtrent n proses, maar ek was rustig en op my gemak omdat ek kon sien dat almal wat betrokke was hoogs opgelei en seker van hul taak is. Ek is gemaklik gemaak op die bed en geposisioneer vir die prosedure en het die aanbod om oorfone op te sit en na musiek van my keuse te luister van die hand gewys omrede ek alles wou hoor en beleef. Kerry wou selfs n elektriese kombers op die bed sit, maar as gevolg van die gloede het ek dit ook bedank.
Dr Schoub het eers n sonar gedoen om die presiese posisie van die merker te bepaal en daarvolgens is lokale verdowing in my bors toegedien wat regtig nie seer was nie. Met die inplaas van die trocar en kannule moes ek doodstil lê terwyl hulle met die sonar bepaal het of dit in die regte area is. Die hele prosedure net omtrent n uur en n half geduur en die vriesproses is twee keer gedoen. Ek het op geen stadium enige pyn ervaar nie, hoewel die stil lê nogal ongemaklik was.
Na die prosedure het ek die minimum pyn en ongemak ondervind, maar was wel baie gekneus. Die kneusing het na ongeveer 10 dae opgeklaar en ek het geen ander nagevolge gehad nie.
Op 15 Otober 2022 is n opvolg mammogram en sonar gedoen, wat getoon het dat die letsels alreeds gekrimp het. Dit het saamgeval met my tweede Cryoablation (linkerbors) wat weereens op n uiters professionele wyse uitgevoer is. Ek het ook na hierdie prosedure geen nagevolge gehad nie, buiten die erge kneusing wat ook weer na ongeveer 10 dae opgeklaar het. Hierna moes ek elke ses maande vir n mammogram en sonar gaan en elke keer het dit gewys dat die letsels in beide borste kleiner word. Ek kan werklik sonder teenspraak net met die grootste lof praat van die Mammogramafdeling van Dr Shoub en al die betrokke personeel met wie ek te doen gekry het en met vrymoedigheid die prosedure aanbeveel.
My onkoloog het ook elke 6 maande n reeks bloedtoetse laat doen en is tot dusver baie tevrede met die uitslae asook met die resultate van die mammogram en sonar. Ek gebruik steeds Kessar en in Julie 2024 is besluit dat die mamogram en sonar nou net jaarliks gedoen moet word, maar die bloedtoetse steeds elke 6 maande. Volgens my onkoloog sal ek in November 2024 kan ek sê dat ek in remissie is.
Ten spyte daarvan dat ons mediese fonds nie magtiging vir die Cryoablation prosedure wou gee nie en ons self daarvoor moes betaal, het ons wel daarop besluit omdat dit minder ingrypend is as chirurgie en
ook omdat dit minder gesondheidsgevare vir my sou inhou as gevolg van my ouderdom en “co morbidities”. Dit sal so wonderlik wees as die prosedure wel eendag deur die mediese fondse gedek word.
Your level of service and friendly staff made me feel most welcome as it is a daunting experience to anticipate. Once I had completed the necessary forms, I relaxed in your reception area with an offer of coffee.
I was then called through for the examination and was spoken to most kindly by all staff and made comfortable on the bed. I was initially nervous not really knowing what to expect but your staff filled me in on the details.
I honestly hardly felt the anaesthetic injection and my breast was totally numb for the rest of the procedure. I was surprised at the amount of swelling that followed, but after a week it had reduced considerably.
Currently I have a pigeon egg size lump in the breast which causes me no discomfort at all. This will reduce in time I have been told.
I am most willing to partake in video testimonials regarding this procedure as it is an excellent alternative to surgery.
It is very important to me that patients that are diagnosed with breast cancer, know that they have many options to manage breast cancer.
I had two options: Choice and time.
When Dr Schoub diagnosed me with a borderline Phyllodes tumor, he reassured me that I had many options available to me and that I had time to make an informed choice. The medical team has supported me with every decision that I have had to take. They explained medical procedure options, until most of my fears and thousands of questions were answered.
2023 Healthwise was a very bad year for me. I was admitted to hospital three times with heart failure and during a month-long hospital admission, I was diagnosed with organ failure as well. My heart capacity when I was discharged, was 39%.
I travelled the breast cancer road with my mom, my cousin, my sister, my daughter and a very dear friend. My daughter was diagnosed with a Phyllodes tumor in 2023. After a lumpectomy, the sample taken, proved malignant. The Phyllodes was timeously and successfully removed. My mom and my friend lost the battle. They unfortunately passed away.
At the time of my breast cancer diagnoses, I was petrified and knew I could not withstand a lumpectomy operation, nor chemo therapy or radiation due to my heart condition. My treating cardiologist advised me that anesthetic and extensive surgery was not an option for me. I would not survive the operation. After consultation, Prof. Carol Ann Benn and Dr. Schoub recommended Cryoablation as a medically safe treatment option for me.
The Phyllodes tumor unfortunately grew rapidly between the initial biopsy date and the Cryoablation procedure date. Proving the Phyllodes tumor as aggressive and malignant.
Before the Cryoablation procedure, the most stressful consultation was whether the rapidly growing large tumor was going to disqualify me from the only safe medical treatment option available to me. Is the tumor just too big? Is there enough tissue between the tumor and the skin?
Cryoablation surgical procedure is a minimal invasive procedure. Cryoablation is done in the consulting room at Melrose Arch Mammography. The Cryoablation procedure is painless, any discomfort is minimal. The local injections administered directly into the breast, is brief and tolerable.
During the procedure I was able to see exactly how the probe was entering the tumors. The nitrogen effectively enters the tumor and freezes the tumor and encircling tissue. A Saline drip is also administered to the procedure area.
The Cryoablation procedure took more or less than two hours, with very little discomfort or pain. As I watched the monitors, I felt a massive sense of relief that, my rapidly growing Phyllodes tumor and surrounding tissue, was effectively frozen.
The three days after the Cryoablation procedure had its brief moments of discomfort. I took Panado once a day post Cryoablation procedure to deal with the bit of discomfort. I used a hot water bottle on my back as part of post-procedure discomfort control.
The two wound plasters came off after a few days. No wound treatment was required, the initial procedure plasters came off after three to five days respectively.
There is minimal scarring on the treated breast caused by the Cryoablation procedure. The ball size lump that represents the frozen tumor and the surrounding frozen tissue, in the treated breast, is still sensitive, but does not necessitate any treatment.
When I left the practice, I felt so relieved and felt a deep sense of incredible gratitude. I was given a chance by an incredible medical team, to fight and possibly beat a malignant Phyllodes tumor. Dr. Schoub did freeze the tumor successfully and effectively. Melrose Arch Mammography and the medical team will monitor this tumor every six months.
I am thankful in gratitude, for an exemplary medical team that supported me and advised me of different treatment plans available to me.
I am grateful that the frozen tumor is now just dead tissue, that my body over time, will re-absorb.
My cryoablation procedure was a very easy experience and I felt very at home with and taken care of by the staff and the practice. Peter did a stunning job and I was able to watch the entire procedure which I really appreciated.
I am in the process of sending my data to my German medical aid and motivate them to look at this method as an alternative to the standard surgical procedure.
We need to get the medical aids of this world on board to pay for Cryoablation instead of butchering (sorry for this harsh word) women with breast cancer …
I would like to say the level of service and care by Dr Schoub and staff was excellent. Dr Schoub's experience and procedure were very professional. I felt at ease during the time of the procedure. Doctor and staff were patient and friendly.
First 2 days after the procedure was a bit painful but Dr Schoub Whatsapped me twice to find out how I was feeling and prescribed painkillers which helped tremendously.
I had been told good things about Dr Shoub before I went to the consulting rooms in Parktown. The reception there was pleasant and all the staff were friendly and even funny.
While I waited I could do knitting which is a good idea.
During the operation I could hear what was said. Because of the type of operation I was held securely, not able to move...but I could hear everything that was said. Even afterwards I find that comforting.
The operation was successful and I went through all Dr Shoub warned me about. Sonetime later all the bruises went too.
I've been to a Oncologist and my blood showed I'm still cancer free...thanks to the Lord.
INTERNATIONAL AND CLINICAL TRIAL
Internationally, there is considerable experience with cryoablation of fibroadenomas of the breast. In the last 10 years there is growing evidence for effective cryoablation of small malignant carcinomas of the breast. There is almost universal agreement across the studies that for smaller breast lesions (<1,5cm) cryoablation results in absence of residual disease and negligible recurrence in the first 3 – 5 years.
The largest (completed) clinical trial so far (ACOSOG Z1072) demonstrated >90% success rate for complete ablation of breast cancers smaller than 2cm. The ICE-3 and FROST trials are larger multi-center clinical trial based in the United States. Preliminary results show close to 100% cryoablation success in smaller cancers (≤ 1,5cm). It is important to remember that >75% of patients diagnosed with breast cancer have NO family history or any other risk factor.
Professor Eiseke Fukuma is a pioneer of cryoablation based in Kameda, Japan. He has performed more than 400 procedures since 2006. Less than 1% cancer recurrence has been recorded.
In the USA there is FDA approval for treatment of fibroadenomas and cancers (on and off trial.)
