{"id":4769,"date":"2016-05-25T00:00:00","date_gmt":"2016-05-25T06:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2016\/05\/25\/doc-uses-cryotherapy-to-keep-cancer-at-bay\/"},"modified":"2022-07-29T12:32:09","modified_gmt":"2022-07-29T18:32:09","slug":"doc-uses-cryotherapy-to-keep-cancer-at-bay","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/doc-uses-cryotherapy-to-keep-cancer-at-bay\/","title":{"rendered":"Doc uses cryotherapy to keep cancer at bay"},"content":{"rendered":"
<\/div>
Dr. Michael Nosler, a gastroenterologist with UCHealth Northern Colorado, performs cryotherapy treatment on Kevin Schmidt. Once Schmidt\u2019s esophagus cancer was treated through chemotherapy and radiation, the underlying condition that caused it needed to be addressed, and cryotherapy seemed to be the answer. Photo by Kati Blocker, UCHealth.<\/figcaption><\/figure>\n

There was no way Kevin Schmidt was going to let doctors remove his esophagus \u2014 even if it might mean it would also remove his cancer.<\/p>\n

\u201cSleeping in a recliner the rest of my life and eating saltine crackers the rest of my days \u2014 for me that was not an option,\u201d said Schmidt, who was diagnosed with stage 3B esophageal cancer three years ago, at age 55. \u201cSo I asked my doctors, \u2018What\u2019s plan B?\u2019 and they said, \u2018Let\u2019s get outside the box,\u2019 and that is what we did.\u201d<\/p>\n

The esophagus connects the throat to the stomach with 10 to 13 inches of muscular tube comprised of layers. Esophageal cancer, of which there are two kinds, starts in the inner layer and grows outward. Common treatment is an esophagectomy with gastric pull-up, a surgical procedure in which the stomach is used to replace the esophagus.<\/p>\n

Schmidt had a large tumor at the base of his esophagus that had spread to seven of his lymph nodes. And in 2013, he was diagnosed with adenocarcinoma esophageal cancer.<\/p>\n

Esophageal adenocarcinoma commonly starts in the lower esophagus and is often the result of Barrett\u2019s esophagus \u2014 which Schmidt also had. \u201cBarrett\u2019s esophagus is a precancerous condition in which the normal tissue lining in the esophagus changes to tissue that resembles the lining of the intestine. This is thought to be a complication of longstanding gastroesophageal reflux disease,\u201d said Dr. Michael Nosler, a therapeutic gastroenterologist with UCHealth in northern Colorado. Barrett\u2019s esophagus increases the chance of esophageal cancer thirty-fold, but only 1 percent of Barrett\u2019s patients develop the cancer each year.<\/p>\n

Radiology oncologist Dr. Joshua Petit and oncologist Dr. Ross McFarland decided to attack Schmidt\u2019s cancer with an aggressive chemotherapy and radiation strategy.<\/p>\n

\u201cAny time you use chemo and radiation together it\u2019s more toxic than either alone — and this was a sensitive area,\u201d McFarland said. \u201cThe chemotherapy is used to kill the tumor, but also makes the radiation more effective on the tumor.\u00a0 Unfortunately, it also makes it more effective on normal cells as well.\u201d<\/p>\n

Because Schmidt\u2019s lymph nodes were at risk, a large area of radiation was necessary, which caused a lot of pain, McFarland said. Schmidt was on a feeding tube and lost a lot of weight.<\/p>\n

\u201cI lost about 70 pounds in five months,\u201d Schmidt said. \u201cI was a wreck. It was bad, but I bounced back and I got healthier. These guys did a good job. They definitely saved my life.\u201d<\/p>\n

To make sure Schmidt continued to enjoy his life, doctors had to eliminate the cancer\u2019s precursor: Barrett\u2019s.<\/p>\n

\"Cryotherapy_nosler_gas
While anesthesiologist Dr. Kathleen Hodges, left, monitors the patient, Denise Kilber, center, helps therapeutic gastroenterology specialist Dr. Michael Nosler, right, insert a ventilation tube in the stomach of the patient to vent the gas when liquid nitrogen is sprayed through a scope. This treatment, called cryotherapy, destroys cells without much damage to the esophagus and is being used in this case to treat Barrett\u2019s esophagus, a precancerous condition. Photo by Kati Blocker, UCHealth.<\/figcaption><\/figure>\n

\u201cBecause we were treating the cancer without removing the esophagus, we needed to do something about his Barrett\u2019s,\u201d Nosler said. \u201cWe needed to take away that cancer risk as well as the cancer.\u201d<\/p>\n

Nosler had been following cryotherapy\u2019s use and effectiveness to eliminate tumors and cancerous cells.<\/p>\n

\u201cCryotherapy has a good tissue-depth effect,\u201d he said. \u201cWhen you are applying it to a large portion, it has a lower risk of forming scars inside the esophagus than radiofrequency ablation (heat and radio-wave treatment). \u2026 It was consistent with the broader treatment plan that he [Schmidt] was looking for.\u201d<\/p>\n

Cryotherapy uses liquid nitrogen to spray and destroy cells without much damage to the esophagus. Under general anesthesia, a scope the size of a pinky finger is directed down the esophagus, and a ventilation tube in the stomach vents the gas as liquid nitrogen is sprayed through the scope. Nosler freezes a small area for about 20 seconds, lets it thaw for about two minutes, and then repeats the process \u2014 typically two cycles for each site. \u201cIt is the thawing that destroys the bad cells,\u2019\u2019 he said. \u201cOver time, the body regenerates that area with healthy cells \u2014 similar to what happens with a blister.\u2019\u2019<\/p>\n

\u201cThis was a patient-directed idea,\u201d Nosler said. \u201cIt was consistent with doing something that may possibly be effective but minimizing the side effects.\u201d<\/p>\n

\"Cryotherapy\"
Cryotherapy, a treatment that uses liquid nitrogen to freeze bad cells (but it\u2019s the thaw that counts), is being used here to treat Barrett\u2019s esophagus. Photo courtesy of UCHealth.<\/figcaption><\/figure>\n

So far, the treatment is working. Nosler has been able to reduce the portion of Schmidt\u2019s esophagus affected by Barrett\u2019s \u2014 which started at 9 centimeters \u2014 at the rate of about 2 centimeters per visit. After each visit, Schmidt is sore for a few days and on a diet of mostly liquids. The next few days he experiences no pain, but then as the new skin forms, the tenderness in his throat returns for a few more days. Sessions are about eight weeks apart.<\/p>\n

\u201cIt\u2019s important that we educate patients about all the treatment choices available to them,\u201d Nosler said. \u201cCryotherapy is an alternative for those who have a high surgical risk or who decide to opt out of surgery. The difference is one surgery, with higher risk versus multiple smaller treatments that equal a few years of treatment. For Kevin, cryotherapy reflects the vision of how he saw his health care.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

There was no way Kevin Schmidt was going to let doctors remove his esophagus \u2014 even if it might mean it would also remove his cancer. \u201cSleeping in a recliner the rest of my life and eating saltine crackers the rest of my days \u2014 for me that was not an option,\u201d said Schmidt, who […]<\/p>\n","protected":false},"author":2164,"featured_media":2683,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[28,241,9138,1112],"class_list":["post-4769","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-cancer-care-oncology","tag-cancer-services","tag-ear-nose-and-throat-care","tag-ear-nose-throat-care-otolaryngology"],"acf":[],"yoast_head":"\nDoc uses cryotherapy to keep cancer at bay - 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