Cryosurgery is increasingly becoming popular especially in the removal of tumors. Cryosurgery involves the administration of liquid nitrogen at very low temperature to remove tumors and cancerous tissues by cell death. This method is also called as cryogenic cell death. Cryosurgery is also used in the treatment of precancerous tumors in cervical cancer.
Cryosurgery is usually performed when the patient is in a conscious state. Different types of cryoprobes are used to treat cancers or tumors associated with specific regions in the body. Once the cry probe is introduced in the body, the compressed liquid nitrogen with a temperature ranging from -20°C to -50°C is passed into it to freeze and destroy the unwanted tissue through contact. The cells are subject to osmotic pressure changes because of the increased fluid content caused by the cry probe. Cryosurgery is done at regular intervals to promote thawing of the tissue and subsequently freezing it to destroy the layer of cells that are not required.
Precautions and side effects of Cryosurgery
In most cases, an interval of three minutes is given throughout the procedure. The probe inactivates the nerve endings touching the adjacent cells to inhibit the sensation of pain caused by the abnormal tissue. Vascular changes also occur during the procedure such as initial numbness and flushing sensation during the thawing process. Cryosurgery is most suggestive in case of precancerous stages as it enables treatment of the cancerous tissue effectively. It is predominantly used in the treatment of Neuroma, prostate cancer, cervical cancer and skin cancer. Patients generally complain cramping sensation during the procedure which usually subsides on its own.
Other complications include infection and swelling. Since cryosurgery does not require major invasion, the side effects are minimal. Cryosurgery can be done both as external and internal procedure. The healing patterns after the procedure vary from one area of the body to another. In case of skin cancers or melanomas, the deterioration of the unwanted warts and subsequent tissue rejuvenation may take up to six weeks. Malignant melanomas are not treated by using cryosurgery.
Cryosurgery cannot be performed for all types of cancers and on all organs, because of the probability of normal tissue damage and formation of unwanted scarred tissues. Careful analysis is done by the physician to identify the form of tumor and the type of cells associated. Biopsy is performed to detect any form of malignancy or metastases of the respective cancer. Salicylic acid is applied on the warts prior to cryosurgery to reduce the size. In some cases cryospray is used directly on an external growth for a period of 20 to 30 seconds.
Although cryosurgery is one of the most preferred techniques, elderly persons are not suitable for this procedure. Most patients undergoing cryotherapy experience blisters, itching and oozing for a short period of time. Precautions are taken to avoid any form of secondary infection. Cryosurgery associated with skin cancers such as basal cell carcinoma, have side effects such as hypo pigmentation and hyper pigmentation. In some rare cases nerve damages have been reported. Studies indicate that patients who have a history of human papilloma virus infection also prefer cryosurgery for the removal of genital warts.
Skin Cancer Pill
The choice of treatment for basal cell carcinoma includes surgical removal of the affected area by excision, cryosurgery or radiation therapy. The contemporary method of treatment introduced is through the administration of skin cancer pills called as Erivedge approved by United States food and drug administration society. Erivedge pills are designed to treat advanced levels of basal cell carcinoma. This drug was designed to prevent surgical or radiation associated intervention in sensitive areas such as the nose regions of the face where the carcinoma predominantly occurs.
Erivedge the revolutionary pill for the treatment of advanced basal carcinoma is chemically known as vismodegib. This oral medicine is associated with the prevention of overactive signaling of the Hedgehog pathway by binding to a trans membrane protein occurring in basal cell carcinoma. The continuum of the Hedgehog pathway may result in the metastases of the carcinoma.
Vismodegib (erivedge) is highly permeable and has low aqueous solubility. The plasma protein binding in patients is very high. It binds to albumin and alpha- 1acid glycoprotein. The metabolic pathways associated are oxidation, glucouronidation and also pyridine ring cleavage. The excretion of the drug predominantly happens through the hepatic route. The absorption and retention of the drug occurs in feces and urine.
Dosage and administration
The recommended dosage of erivedge is 150mg taken orally once a day. The duration of medication has to continue until the complete prophylaxis of the disease. Discontinuation of erivedge is only advisable under the incidence of drug toxicity. Additional doses of erivedge are not recommended in case of missing a dose; the next dose has to be resumed. Erivedge intake does not depend upon food intake.
Contraindications and adverse effects
Erivedge is considered as teratogenic, embryo toxic and fetotoxic drug and hence it is not recommended for pregnant women. If administered, the effects include severe birth defects such as craniofacial anomalies, absent or fused digits and also open perineum. Erivedge is also not advisable for nursing mothers as it may be excreted in the milk.
Erivedge consuming patients are advised not to donate blood for a period of seven months. Many adverse effects were reported in the clinical trials conducted on erivedge some of which are muscle spasms, arthralgia, fatigue, diarrhea, weight loss, alopecia, constipation and also decreased appetite. Erivedge intervenes with other drugs such as clarithromycin etc. in leading to adverse reactions. Erivedge usage is not recommended in children as it intervenes in the epiphyseal growth plate affecting the bones; causing damage to the teeth by necrosis, cysts in the dental pulp and also ossification of the root canal.
Geriatric use of erivedge is also not recommended. The other conditions under which the use of erivedge is not recommended is in patients having hepatic and renal impairments.
Acrochordon, also known as skin tag is an overgrowth of the skin hanging loose from the surrounding area and is connected by a stalk (peduncle). Acrochordons are normally benign growths; they are soft wrinkled protrusions and appear in flesh or light brown color. They are filled with collagen fibres and blood vessels with a thin layer of skin covering them.
They do not cause any pain and small growths may just fall off unknowingly. Slightly bigger acrochordons do not fall on their own and need to be removed using various methods. Though they can occur anywhere on the body, the areas like under arms, eyelids, upper chest, neck, and groin are more prone to develop skin tags as the skin here rubs against the clothing or with the adjoining skin. Acrochordon occurs in both men and women and the frequency of the condition increases as we age.
What causes Acrochordon?
Skin tags are caused by the constant rubbing between the skins of adjacent sites. Obesity is one of the very obvious causes that lead to acrochordon. These people tend to develop more skin tags simply because they have more skin folds on their body. Research also shows that this condition is inherited: people with close relatives having acrochordons have higher chances of developing this skin condition. Pregnant women also have a tendency to develop skin tags due to the hormonal changes taking place in their bodies. Diabetic patients are also prone to skin tags. Wart virus or human papilloma virus also cause skin tags.
Clinical examination is sufficient to diagnose the acrochordon. Yet in case of suspicion, doctor may advise skin biopsy. This procedure involves removal of small piece of skin to be examined in laboratory. This is done to rule out any malignancy of the growth.
Treatment of Acrochordon
Typically acrochordons do not require any treatment and they need not be removed. But the bearer may choose to get it removed either for cosmetic reasons or if the tags become bothersome. A word of caution here, if the skin tags are changing color or growing too quickly it is advisable to show it to your physician to rule out any further complications. Cryosurgery is used extensively, where the skin tag is removed by freezing it using the liquid nitrogen. Cauterization is one more method which involves burning of the skin tag using electrolysis (heat). Skin tags are also removed by surgical excision.
Bibliography / Reference
Collection of Pages - Last revised Date: January 16, 2019