Understanding the
Cryoablation Procedure

Cryoablation (pronounced “Kry-o-a-blay-shun”) is a minimally invasive treatment that uses a needle-like instrument within which liquid nitrogen circulates to treat cancer by freezing cancer until it is dead. The goal of the cryoablation procedure is to kill the cancer as well as a rim of normal tissue surrounding the cancer to ensure that the cancer is treated fully. The cryoablation procedure is similar to the needle biopsy that is typically performed to diagnose a cancer.



Cryoablation is an effective treatment method that has been used for many years to treat various cancers, including prostate, kidney, and cervical cancers, as well as benign breast tumors.  It is a relatively new treatment for breast cancer that has already proven effective for early stage breast cancer, especially estrogen sensitive invasive ductal carcinoma measuring 2 cm or less.  Dr. Holmes is leading the way in using cryoablation for treatment of later stage breast cancers that might otherwise require mastectomy.

STEP 1

Local Anesthesia

Local anesthetic is injected into the skin and into the interior of the breast to numb the area where the cryoprobe will be inserted. This ensures that you remain comfortable during the procedure. The injection might cause temporary pain which is quickly followed by numbness.

STEP 2

Cryoprobe Insertion

A small incision (approximately 3 mm) is made in the skin. The cryoprobe, a needle-like instrument, is then inserted through this incision and guided to the center of the tumor using ultrasound. Precise positioning of the cryoprobe is crucial for effective treatment.

STEP 3

Freezing the Tumor

Liquid nitrogen circulates within the cryoprobe, creating an intense cold at the tip. This freezes the tumor and a surrounding rim of normal tissue to a core temperature of -180º C at the center of the tumor and -40º C near the surface of the tumor. The freezing process involves three cycles: 10 minutes of freezing, followed by a 10-minute thaw, and then another 10 minutes of freezing. Freeze and thaw times might vary based on the situation.

STEP 4

Completion of Cryoablation

After the second freezing cycle, the cryoprobe is warmed and withdrawn from the breast. Pressure is applied to the skin opening to minimize bleeding, and a small bandage is placed over the incision. The entire procedure typically takes less that an hour for a single cryoablation treatment.

How Cryoablation Eliminates Cancer

Osmotic Injury

Dehydration and rehydration of cells cause membrane damage, leading to cell death.

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Osmotic Injury

Rapid and sustained freezing of the tumor initially causes freezing of water and ice crystal formation in the extracellular space (the spaces between cells) at minus 15 Celsius, which dehydrates the extracellular space. Dehydration of the extracellular space concentrates the electrolytes and proteins between cells, which creates an osmotic or concentration gradient that forces water to flow from the interior of the cells (which have yet to freeze) to the extracellular space to restore the water balance outside the cells. Forced withdrawal of water from within the cells causes the cells to dehydrate, shrink or crinkle, creating cracks in the cell membrane or cell wall.  During the subsequent thaw cycle, ice crystals in the extracellular space melt to form water, which then flows back into the dehydrated cells causing them to swell and then rupture because the cell walls have been weakened from earlier cracking. In addition to causing cells shrinkage, the concentration of salts in the dehydrate cells impairs cellular enzyme function and directly destabilizes the cell membrane.

Mechanical Injury

Formation of ice crystals within cells damages cell structures, leading to cell destruction.

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Mechanical Injury

Although ice crystal formation is one of the earliest changes during the freeze cycle, sustained freezing causes formation of larger ice crystals inside of the cells that directly damage the walls of intracellular organelles like the DNA-containing nuclei and energy-creating mitochondria; damage the intracellular skeletons that help to maintain cell shape; and further destabilizes the cell membrane. With each subsequent cycle of freezing, the damaged tissue conducts the freezing with increasing efficiency, which progressively increases the diameter of the cryoablation zone. Intracellular ice crystal formation is most prominent during rapid freezing and during the thaw phase when temperatures reach minus 20-25 Celsius.

Vascular Injury

Damage to blood vessels deprives cancer cells of oxygen and nutrients.

Vascular Injury

Cancer cells rely on blood vessels to deliver oxygen, supply nutrients, and eliminate waste. During cryoablation, the small and medium size vessels within and surrounding the tumor are killed in very much that same way that cancer cells are killed.  Intracellular ice crystal formation damages the cells that line the blood vessels. This causes blood clot formation in the vessels feeding the tumor, which deprives the cancer cells of oxygen and nutrients. In addition, restoration of blood flow around the cryoablation zone after thawing releases chemicals called "free radicals" that re-injure the blood vessel lining and cause further clot formation. Taking aspirin or anti-oxidants might inhibit blood clot and free radial formation.  Therefore, it is probably best to avoid aspirin or anti-oxidants 10 days after cryoablation.  Vascular injury is one of the major causes of tissue necrosis near the outer edge of the iceball where the temperature may be sublethal.

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Apoptotic Cell Death

Sub-lethal temperatures activate enzymes that cause programmed cell death.

Apoptotic Cell Death or Programmed Cell Death

The tumor next to the cryoprobe in the center of the iceball reaches the coldest temperature, as low as minus 180 Celsius. The temperature near the outer portions of the iceball and farther from the cryoprobe do not reach such a low, direct-tumor killing temperature. Nonetheless, “warmer” sub-lethal temperatures in the range of 6 Celsius to minus 10 Celsius are capable of activating enzymes within the cancer cells that destroy the intracellular proteins and DNA.  This phenomenon, called apoptosis or programmed cell death, essentially causes the cancer cells to commit suicide typically 8-12 hours after the freezing injury.  Programmed cell death from cold temperature has been exploited as a weight loss method by plastic surgeons who now employ a new technology, called CoolSculpting, that uses cold temperatures in the range of 4 Celsius to induce apoptosis in fat cells.

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Immunogenic Injury

Abnormal tumor proteins stimulate the immune system to attack cancer cells.

Immunogenic Injury

Although the strength of a generalized systemic immune response remains to be fully understood, experimental studies show that abnormal cancer cell proteins are capable of inducing an immune response at the tumor site in two key ways: 1) uptake of abnormal tumor proteins by granulocytes, monocytes, and macrophages that stimulate formation of antibodies (and possible limited immunity) that bind to cancer cells and target them for attack by T-cells, and 2) uptake of abnormal tumor proteins by antigen presenting cells like dendritic cells and macrophages that directly stimulate T-cells to attack the cancer as foreign cells. A third and increasing important immunogenic mechanism is immune checkpoint inhibition, a phenomenon in which cancer cells release "checkpoint" proteins that suppress the immune response. Killing cancer cells with cryoablation stops the release of immune-suppressing "checkpoint" proteins from the cancer cells. This permits the immune system to recognize and attack remaining cancer cells. There is now a whole new field of "immunotherapy" that is focused on developing immune checkpoint inhibitors to prevent cancer cells from suppressing natural immune responses.

Learn more

Benefits of Cryoablation

Minimally Invasive Procedure

Cryoablation involves less surgical intervention, which reduces trauma to the body.

Quicker Recovery Time

Patients typically experience faster recovery compared to traditional surgical methods.

Preserves Breast Tissue

The procedure targets only the cancerous tissue, helping to maintain the breast's appearance and function.

Typically Replaces Surgery

By effectively treating cancer with minimal invasion, cryoablation can lessen the necessity for follow-up surgeries.*

Enhances Immune Response

Cryoablation may stimulate the body's immune system to fight remaining cancer cells, although this effect is not yet proven in humans.

*Cryoablation does not eliminate the need for radiation or anti-cancer medications that might be recommended. Lymph node surgery might still be necessary but can sometimes be avoided for low-risk tumors.

Effectiveness of Cryoablation

Multiple studies show that cryoablation is an effective treatment for early-stage, hormone-sensitive breast cancer. However, its effectiveness for larger tumors, recurrent cancers, or non-hormone-dependent cancers remains under investigation.

Effective for early-stage invasive ductal breast cancer up to 2 cm.
Limited data on effectiveness for tumors larger than 2 cm or with lymph node involvement.
100%

Effectiveness in killing targeted cancer tissue.

< 45min

Average duration of the cryoablation procedure.

~ 3mm

Approximate incision size, with no breast tissue removal.

1 Day

Typical recovery time before resuming normal activites.

180°c

The temperature of freezing with liquid nitrogen. Tumor killing begins at minus 40 Celsius.

<3%

Local recurrence rate in patients over a 6-year follow-up.Source

Words from Dr. Holmes’ Patients

"
Thank you for your kindness, expert care, and for giving my daughter hope when she needed it most. Your empathetic listening, willingness to raise the standard of care, and the reassurance you provided lifted a weight from our hearts.
"

Nancy T.

Mother

"
Thank you for giving me hope at a hopeless time and for seeing me as a unique individual. Your compassionate, personalized care means the world to me. YOU ARE MY SUPERHERO!
"

Donna

Patient

"
Thank you so much for your help in my fight against this cancer by freezing and killing the tumors. I am thankful everyday for your work and thankful on behalf of all the other women you have and will help and fight for as well.
"

S. Lee

Patient

"
He treated my daughter who had stage one breast cancer. He put us at ease and calmed our fears, he was the perfect surgeon for our situation.
"

Sandra K.

Parent of Patient

"
He has to be one of the most incredible doctor that I've been blessed to have on my survival team. He's saved my life! I'm a proud 28 yr B C survivor.
"

Denise R.

Patient

"
Dr. Holmes is kind, professional, and has a lot of patience answering every question you might have.
"

Einat M.

Patient

"
Great and SMART staff. Great place with ZERO infection rate. I was back to work after surgery way sooner then expected! Awesome place great center.
"

Allissa P.

Patient

"
Thank you so much for being caring and patient with me during this hard transition. I really appreciate your professionalism and dedication.
"

M. M.

Patient

"
God Bless you, your mind, and your hands, so you may continue to help all women with breast cancer! We thank you for everything that you have done!
"

Family of MT

Family of Patient

"
This week I celebrated my 55th birthday. I cannot be thankful enough for your help in giving me another chance to enjoy waking up each day.
"

M. L.

Patient

"
Extremely professional and thorough.
"

Nellie F.

Patient

"
Excellent care - my concerns were taken seriously. I felt heard and well taken care of.
"

Kelly L.

Patient

"
Dr Holmes is top notch! He’s experienced, wise, caring and thorough. He’s busy, but well worth the wait! Highly recommend him.
"

Mary Ann B.

Patient

"
The best doctor ever from all points, he is patient, understanding, answers all questions even the questions you don't ask. I really thank God that I have such a wonderful doctor.
"

Yvonne H.

Patient

"
He was very attentive and listened to all of my questions.
"

Kathleen Q.

Patient

"
I was very at easy with Dr Homes and his staff when dealing with a potentially scary situation. I’m truly grateful for their care.
"

Nicole F.

Patient

"
Dr. Holmes and Alba have been great thru this whole experience. I could not ask for a better team.
"

Alison E.

Patient

"
Every I could want from a breast surgeon and more. Patient, informative, gentle, thorough.
"

Margaret S.

Patient

"
Very good doctor . The best surgeon. He saved my life .
"

Lida M.

Patient

"
Since the day we walked into Dr. Holmes office, my mother and I always felt welcome. Dr. Holmes explains everything to us and he listens to our concerns. His staff our always great.
"

Rachel D.

Patient

"
Dr. Holmes is very nice, gentle and thorough. He took his time with me and and provided me with all necessary information in regards to my cancer. Very appreciative of Dr. Holmes.
"

Nereida S.

Patient

"
He addressed my concerns professionally and compassionately.
"

Debra A.

Patient

"
Dr Holmes was very personable and listened to my needs as well as informed me of my options. I will be referring my friends to him.
"

Barbara H.

Patient

"
Front desk girls are very helpful very polite very understanding and taking care of the patient. This was my first time visit with Dr Holmes and I found him to be very thorough.
"

Terri S.

Patient

"
Dr. Holmes and his staff are in a class all by themselves. Exceptional in every way. I am so grateful to Yahovah for an amazing doctor and staff. God bless you all!
"

Robin W.

Patient

"
Presented options I was not aware of and gave me hope
"

Pamela K.

Patient

"
Dr.Holmes is an amazing caring and knowledgeable person. I trusted him and now I am cancer free. Thank you Doc. God bless you
"

Asya A.

Patient

"
Excellent and he listens well and advices options.
"

Kimberly B.

Patient

"
Well explained and take cared
"

Mary Ann F.

Patient

"
Dr. homes and staff were very helpful and careing, specific Alba, she is amazing with patient and undrestanding.
"

Siman B.

Patient

"
Courteous staff, excellent doctor. He took his time with me, which I greatly appreciate.
"

Martha H.

Patient

"
Very Caring physician made me feel SAFE
"

Clara C.

Patient

"
Very thorough in detail, professional, excellent surgeon. And has a great team alongside him.
"

Alana O.

Patient

"
You are organized, humble, kind, knowledgeable, and give us such great confidence that we are in great hands!
"

Kim P.

Family of Patient

"
I can’t thank you enough for the special, excellent care you have provided and for the unique gift you are to your patients.
"

S. L.

Patient

"
Thanks for being so responsive and I am glad that I could trust your wisdom and skill.
"

N. N.

Patient

"
They were so helpful, efficient, professional, detailed, and kind!
"

D. N.

Patient

"
Thank you for your kindness, expert care, and for giving my daughter hope when she needed it most. Your empathetic listening, willingness to raise the standard of care, and the reassurance you provided lifted a weight from our hearts.
"

Nancy T.

Mother

"
Thank you for giving me hope at a hopeless time and for seeing me as a unique individual. Your compassionate, personalized care means the world to me. YOU ARE MY SUPERHERO!
"

Donna

Patient

"
Thank you so much for your help in my fight against this cancer by freezing and killing the tumors. I am thankful everyday for your work and thankful on behalf of all the other women you have and will help and fight for as well.
"

S. Lee

Patient

"
He treated my daughter who had stage one breast cancer. He put us at ease and calmed our fears, he was the perfect surgeon for our situation.
"

Sandra K.

Parent of Patient

"
He has to be one of the most incredible doctor that I've been blessed to have on my survival team. He's saved my life! I'm a proud 28 yr B C survivor.
"

Denise R.

Patient

"
Dr. Holmes is kind, professional, and has a lot of patience answering every question you might have.
"

Einat M.

Patient

"
Great and SMART staff. Great place with ZERO infection rate. I was back to work after surgery way sooner then expected! Awesome place great center.
"

Allissa P.

Patient

"
Thank you so much for being caring and patient with me during this hard transition. I really appreciate your professionalism and dedication.
"

M. M.

Patient

"
God Bless you, your mind, and your hands, so you may continue to help all women with breast cancer! We thank you for everything that you have done!
"

Family of MT

Family of Patient

"
This week I celebrated my 55th birthday. I cannot be thankful enough for your help in giving me another chance to enjoy waking up each day.
"

M. L.

Patient

"
Extremely professional and thorough.
"

Nellie F.

Patient

"
Excellent care - my concerns were taken seriously. I felt heard and well taken care of.
"

Kelly L.

Patient

"
Dr Holmes is top notch! He’s experienced, wise, caring and thorough. He’s busy, but well worth the wait! Highly recommend him.
"

Mary Ann B.

Patient

"
The best doctor ever from all points, he is patient, understanding, answers all questions even the questions you don't ask. I really thank God that I have such a wonderful doctor.
"

Yvonne H.

Patient

"
He was very attentive and listened to all of my questions.
"

Kathleen Q.

Patient

"
I was very at easy with Dr Homes and his staff when dealing with a potentially scary situation. I’m truly grateful for their care.
"

Nicole F.

Patient

"
Dr. Holmes and Alba have been great thru this whole experience. I could not ask for a better team.
"

Alison E.

Patient

"
Every I could want from a breast surgeon and more. Patient, informative, gentle, thorough.
"

Margaret S.

Patient

"
Very good doctor . The best surgeon. He saved my life .
"

Lida M.

Patient

"
Since the day we walked into Dr. Holmes office, my mother and I always felt welcome. Dr. Holmes explains everything to us and he listens to our concerns. His staff our always great.
"

Rachel D.

Patient

"
Dr. Holmes is very nice, gentle and thorough. He took his time with me and and provided me with all necessary information in regards to my cancer. Very appreciative of Dr. Holmes.
"

Nereida S.

Patient

"
He addressed my concerns professionally and compassionately.
"

Debra A.

Patient

"
Dr Holmes was very personable and listened to my needs as well as informed me of my options. I will be referring my friends to him.
"

Barbara H.

Patient

"
Front desk girls are very helpful very polite very understanding and taking care of the patient. This was my first time visit with Dr Holmes and I found him to be very thorough.
"

Terri S.

Patient

"
Dr. Holmes and his staff are in a class all by themselves. Exceptional in every way. I am so grateful to Yahovah for an amazing doctor and staff. God bless you all!
"

Robin W.

Patient

"
Presented options I was not aware of and gave me hope
"

Pamela K.

Patient

"
Dr.Holmes is an amazing caring and knowledgeable person. I trusted him and now I am cancer free. Thank you Doc. God bless you
"

Asya A.

Patient

"
Excellent and he listens well and advices options.
"

Kimberly B.

Patient

"
Well explained and take cared
"

Mary Ann F.

Patient

"
Dr. homes and staff were very helpful and careing, specific Alba, she is amazing with patient and undrestanding.
"

Siman B.

Patient

"
Courteous staff, excellent doctor. He took his time with me, which I greatly appreciate.
"

Martha H.

Patient

"
Very Caring physician made me feel SAFE
"

Clara C.

Patient

"
Very thorough in detail, professional, excellent surgeon. And has a great team alongside him.
"

Alana O.

Patient

"
You are organized, humble, kind, knowledgeable, and give us such great confidence that we are in great hands!
"

Kim P.

Family of Patient

"
I can’t thank you enough for the special, excellent care you have provided and for the unique gift you are to your patients.
"

S. L.

Patient

"
Thanks for being so responsive and I am glad that I could trust your wisdom and skill.
"

N. N.

Patient

"
They were so helpful, efficient, professional, detailed, and kind!
"

D. N.

Patient

Cryoablation does not substitute for other recommended cancer treatments.

It's important to note that while cryoablation is a substitute for breast surgery, it does not eliminate the potential benefits of other treatments such as:

Radiation Therapy

Often recommended after cryoablation to further reduce risk of recurrence

Anti-Cancer Medications

Recommended for managing cancer that is hormone receptor-positive.

Lymph Node Surgery

May be required but can sometimes be avoided for low-risk tumors.

Who is Eligible for Cryoablation?

Eligibility for cryoablation is determined on a case-by-case basis guided by three key factors:

Tumor Size

Though ideally suited for tumors < 2cm, multiple ablations can be utilized to treat larger tumors on a case-by-case basis

Cancer Type

Though ideally suited for estrogen-sensitive invasive ductal cancers,  other types of cancers may. be treated on a case-by-case basis

Visibility

Though ideally suited for ultrasound visible tumors, special ultrasound-visible markers may be inserted to guide treatment of non-ultrasound visible tumors

Receive your treatment in Los Angeles, California.

Dr. Dennis Holmes performs cryoablation procedures at his office located in Glendale, California, within Los Angeles County. The office is situated on the campus of Adventist Health Glendale Medical Center.

Patients from across the country and internationally travel to Glendale for consultations, procedures, and follow-up care with Dr. Holmes. The office is conveniently located near major freeways and airports, making it accessible for out-of-town patients.

Submit Your Case

We invite you to submit your case for a free case preview with Dr. Dennis Holmes. Our goal is to make the process as easy and accessible as possible, ensuring you get the information and support you need.