Doctors froze my kidney to save my life

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Reproduced through kind permission of the Daily Mail
24 April 2007

Around 7,000 people are diagnosed with kidney cancer each year in Britain. Barbara Hancock, 68, was one of the first in the UK to be treated with cryotherapy, where the tumour is frozen and killed off. Barbara, who lives with her husband, William, in Port Tennant, near Swansea, tells her story and then her surgeon explains the procedure.

The patient
For four months I'd had constant stomach ache and had lost my appetite, so last March my GP referred me to Morriston Hospital, Swansea, for an ultrasound scan.

At first, he suspected something was wrong with my liver or that I had gallstones, but the scan detected a shadow on my right kidney. As a result, I was sent for a CAT (computed tomography) scan for more detailed images.

It was a shock when the scan revealed a 2.2cm tumour. My urologist explained that kidney cancer is often diagnosed quite late - because the kidneys lie hidden deep inside the body and symptoms are varied.

They can include pain in the side, tiredness and blood in the urine. I was lucky because my tumour was caught early.
In the past, surgeons have had no option but to remove the kidney. I was presented with three other options.

The first was to remove the part of the kidney that contained the tumour, which would involve a major operation, up to ten days in hospital and three months' recovery.

The second was keyhole surgery, where the surgeon would insert a camera to help remove the affected area. The recovery would be quicker, with four days in hospital and up to six weeks' recuperation.

The third was a new treatment called cryotherapy. The surgeon could kill off cancerous cells by freezing the affected area to a temperature between minus 40c and minus 50c. This would allow me to keep more of my kidney intact.

All the options have a high success rate, but for me the third, the least invasive, was the most attractive.

The procedure took two hours. After waking, I found it incredible to think my kidney tumour had been treated by giving it frostbite. At those temperatures, nothing can survive, including cancer cells.

I felt very well and suffered no pain after the operation. I was discharged the morning after the operation. All I was left with were three 1cm scars.

A six-month follow-up scan showed the cancer had disappeared, leaving just scar tissue, while the rest of the kidney was working normally.

I feel privileged to be the first person in Wales to be treated with cryotherapy for kidney cancer.

The operation took place a couple of weeks before my 68th birthday, so I could happily celebrate the day.

The surgeon
Neil Fenn is a consultant urologist at Morriston Hospital, Swansea. He says:

Over the past 20 years, the incidence of renal (kidney) cancer has increased at a rate of 2 per cent per year. We don't understand why, although the use of ultrasound and CAT scans has helped detect cancer at an earlier stage.

Cryotherapy was introduced in Europe and America 20 years ago. People will be familiar with the use of liquid nitrogen to freeze off skin lesions - it's the same principle for treating renal cancer.

In 2000, ultra-thin cryotherapy needles were pioneered, which have paved the way for today's treatments. Cryotherapy has already been approved to treat prostate cancer, and the National Institute for Clinical Excellence has approved its use in treating renal cancer. It could also be used for lung and liver tumours.

I came across it in the treatment of renal cancer in Ohio, U.S., in 2003. Two years later, urologist Mr Frank Keeley, from the Bristol Urological Institute, helped me set up the cryotherapy programme in Wales.

Barbara's tumour had been caught at an early stage and was small - less than 4cm, the cut-off point for treating renal cancer without having to remove the kidney. This made cryotherapy a realistic option.

Her other problems - heart disease and hypertension - were taken into account.

Often patients with such problems can experience complications from a major operation, so this less-invasive procedure was ideal for her.

Cryotherapy is carried out by laparoscopy (keyhole) surgery.
Three 1cm incisions are made in the abdomen. This allows us to place a camera and small instruments inside so we can see the kidney and tumour.

First we confirm the abnormality seen on the scans is indeed cancer. A piece of the abnormal tissue is sent to the laboratory for analysis.

The results come back within 15 minutes, and once we have confirmation that it is a malignant tumour, we proceed with the cryotherapy.

Using the camera as a guide, we insert five or six cryotherapy needles through the 1cm incisions and then into the tumour.
The needles are about 20cm long, but the tips are only about 1-2mm in diameter. An ultrasound helps us ensure the needles are at the correct depth inside the tumour.

Two temperature sensors are also inserted, one in the middle of the tumour and another on its edge. Once all the needles are in place, the cryotherapy can begin.

Argon gas is pumped down each needle. All gas expands under pressure, producing a rapid drop in temperature resulting in freezing, and argon is used because it is particularly easy to handle.

At the end of each needle, an ice ball starts to form that eventually joins up with the others to form one giant ice ball. The size of the ball can be monitored by the camera and the ultrasound machine.

The pressure of the gas to each needle can be controlled so that just the right amount of tumour and a rim of normal tissue is destroyed.

The two temperature probes ensure the whole area reaches minus 40c - the temperature at which cancer cells die. The freezing process is repeated twice and takes ten minutes.
After each freeze, the tumour is left to start thawing for five minutes at body temperature.

Helium gas is then pumped down the needles to actively thaw the tumour.

Helium produces heat when it expands, allowing the thawing process to progress at an increased rate, thus speeding up the thaw cycle which would otherwise last for hours.

The thawing process also helps the cell-killing process, so is vital to control. Once thawing is complete, the needles are removed and we check there are no complications such as bleeding.

Patients are usually discharged the next day. The tumour is starved of its blood supply after the freezing process — similar to frostbite - so it dries up and disappears over a period of six months.

Barbara was followed up with regular CAT scans to ensure that the tumour had died. Around 94 per cent of cases are successful, but if treatment fails, further surgery is an option.

Cryotherapy costs the NHS around £5,000. Privately, it costs around £7,000.