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What is cryosurgery?

A Cryosurgery is a form of treatment that utilizes intense cold to destroy cancer cells. Also called cryotherapy or cryoablation. During a Cryosurgery session, the physician freezes the cancer cells to kill them. All cells contain water including cancer cells. When the cells are frozen by cryotherapy the water turns into ice crystals. Along with the cold itself, these ice crystals destroy the cancer cells.

Cryotherapy is a type of local treatment, meaning it only treats the area you are treated in. For other areas of the body, it does not contain any cancer cells. The body's immune system gets rid of the dead tissue within a couple of weeks after the operation.

What types of cancer can be treated with cryosurgery?

Cryosurgery is used to control numerous forms of cancer and some precancerous or noncancerous conditions.

Cryotherapy is used in the treatment of:

  • Early-stage skin cancers

  • Pre-cancerous skin moles

  • Retinoblastomas (a cancer of the retina in children)

  • Prostate cancer

  • Liver cancer

  • Precancerous conditions of the cervix called cervical intraepithelial neoplasia

  • Low-grade cancerous and noncancerous tumours of the bone.

  • AIDS-related Kaposi sarcoma

Cryotherapy is also used to treat cancer in other areas of the body such as benign breast lumps called fibroadenomas, tumours in the kidneys and lungs.

How a Cryosurgery Is Performed?

Cryotherapy may be applied topically (on the surface of the skin), percutaneously (under the skin), or surgically. In the case of skin and eye infections, topical cryotherapy is usually used. When the lesion is located below the surface of the skin, it is necessary to place a needle-like therapy probe or applicator through the skin. A surgical incision is sometimes required when the tumour is deep inside the body.

When cryotherapy is performed under or inside the skin, one or more small needles, called cryoprobes, directly deliver either liquid nitrogen or argon gas to the cancer tissue. To precisely position, the cryoprobes in the right spot, an ultrasound, CT scan, or MRI scan is used. People who have cryotherapy usually get local anaesthesia or a mild sedative in the area where the cryoprobes will be inserted. When the cells freeze, they die and then the body gradually absorbs and eliminates them.

What are the side effects?

The experience of side effect is different for everyone. Some people do have a lot of side effects. Some people have very less to none. Cryosurgery side effects will mainly depend on:

  • the area treated

  • the size of the tumour

  • damage to nearby tissue

  • your overall health

After cryosurgery, side effects may occur at any time. It may occur immediately after or a few days or weeks after the procedure. Late side effects occasionally develop months or years after the Cryosurgery. Most side effects will go away on its own or can be treated using medications. Complementary and alternative therapies play an effective role in managing the side effects and improving quality of life after Cryosurgery.

The sooner they become aware of any problems, the sooner they can suggest ways to help you cope. If you have these side effects, you think could be from your cryosurgery, notify your health-care team:

  • Pain

  • Bleeding

  • Infection

  • Lower body temperature

References:

  • https://www.breastcancer.org/treatment/surgery/cryotherapy

  • https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/other/cryotherapy

  • https://www.cancer.gov/about-cancer/treatment/types/surgery/cryosurgery-fact-sheet

  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472868/

  • https://www.radiologyinfo.org/en/info.cfm?pg=cryo

  • Shinohara, K., Sarantou, T. & Foshag, L. J. Cryosurgery. Ko, A. H., Dollinger, M., & Rosenbaum, E. (2008). Everyone's Guide to Cancer Therapy: How Cancer is Diagnosed, Treated and Managed Day to Day. (5th Edition). Kansas City: Andrews McMeel Publishing. 12: pp. 101-108.

  • What is Electrosurgery?

    Electrosurgery is the burning of skin tissue with an electric current that runs through a metal instrument or needle. It is a procedure that uses an electric current to cut, remove, or destroy tissue and control bleeding. Electric current is carried through an electrode, which is placed on or near the tissue. Electrosurgery may be used to treat basal cell Skin Cancer or other types of skin problems, such as actinic keratoses, warts, and moles. It may also be used to remove abnormal cells from the cervix and to treat abnormal tissue of the vagina, vulva, penis, and anus that might become cancer.

    What types of cancer are treated with Electrosurgery?

    Electrosurgery is done to:

    • Treat cancers on the outermost skin layer (superficial), especially if they are in an area where appearance is not a concern.

    • Treat a small basal cell carcinoma.

    • Treat a squamous cell carcinoma in its earliest, non-invasive stage.

    How is Electrosurgery done?

    In electrosurgery, high frequency alternating electrical current is passed through the skin at different voltages (200 to 10,000 V) to produce heat. It needs a power supply with one or two electrodes and a hand piece. The mechanism is controlled through a hand piece switch or a footswitch.

    What are the side effects of electrosurgery?

    Side effects of treating Skin Cancer with Electrosurgery include:

    • Changes in skin, such as scarred or tight skin, slightly dented or raised skin, or red or white skin colour.

    • Bleeding.

    • Pain.

    • Infection.

    • Recurrence of Skin Cancer.

    References:

    www.uofmhealth.org/health-library/aa40747

    https://www.cancer.gov/publications/dictionaries/cancer-terms/def/electrosurgery

    What is Endoscopic Surgery?

    Minimally invasive non-robotic Surgery is also known as Endoscopic Surgery. You may also be familiar with terminologies such as laparoscopic surgery, thoracoscopic Surgery or Surgery with a "keyhole." They are minimally invasive procedures that use an endoscope through very small incisions to access the internal organs.

    In endoscopic surgery, the surgeon inserts a long, flexible tube with a video camera, through a small incision or a natural orifice such as the mouth or nostrils. The flexible tube has a channel to operate tiny surgical instruments. The surgeons use these to perform the Surgery while viewing the organs on a computer monitor. This procedure allows the surgeon to see through the patient's body and to operate through a much smaller incision than conventional open Surgery would normally require.

    What are the benefits of endoscopic surgical procedures?

    The benefits of endoscopic surgical procedures are:

    • Small incisions, or no incision

    • Much Less pain

    • Lower risk of infection

    • Shorter hospital stay

    • Quicker recovery time

    • Lesser scarring

    • Reduced blood loss

    What types of cancers are treated with Endoscopic Surgery?

    Some conditions treated using Endoscopic Surgery include:

    • Pancreatic cancer

    • Liver tumours (benign and malignant)

    • Gallbladder cancer

    • Some lung tumours

    • Oesophageal cancer

    • Gynaecologic cancer or benign tumours,

    • Skull base brain tumours

    • Prostate cancer

    How is Endoscopic Surgery done?

    Typically an Endoscopy is not painful but it may be uncomfortable. Most people have only mild discomfort, resembling indigestion or a sore throat. Normally, the operation is performed while awake. You may get a local anaesthetic to numb a particular area of your body. For example, this may be in the form of a spray or lozenge to numb your throat. A sedative may also be offered to help you relax and make you less aware of what is happening around you. The endoscope is inserted into the body with care. An Endoscopy usually takes 15 to 45 minutes, depending on what it is used for. Usually, you can go home the same day and do not have to stay overnight in the hospital.

    What are the side effects of Endoscopic Surgery?

    Side effects due to Endoscopy are very rare, however, there is a minute chance that these may occur:

    • An infection in a part of the body the endoscope is used

    • Piercing or tearing of an organ, or bleeding

    • A bruise or burning sensation where the injection was given

    • Breathing difficulties

    References:

    https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/types-endoscopy

    https://www.hopkinsmedicine.org/minimally_invasive_robotic_surgery/types.html

    https://www.nhs.uk/conditions/endoscopy/

    What is Laser Surgery?

    Laser therapy uses a very small, concentrated light beam to shrink or kill cancer cells. It is used to cut out cancer cells without damaging other tissue. Laser therapy can be utilized to:

    • Remove precancerous tumours and growths

    • Shrink tumours that obstruct the heart, colon or oesophagus

    • Treat cancer symptoms such as bleeding

    • Handle side effects of cancer, such as swelling

    • Seal the nerve endings to reduce discomfort following surgery

    • Seal the lymph vessels to reduce swelling and prevent tumour cells from spreading after surgery

    While laser burning sounds very dangerous, laser operation requires less cutting and damage as it is less invasive than conventional Surgery. For example, the laser can be guided within a natural body opening with fibre optics and special scopes, without having to make a wide cut. The laser then is directed at tumour killing it.

    What types of cancers are treated with Laser Surgery?

    Laser Surgery is used in specific types of cancer because these often have a unique requirement that only lasers can fulfil. For example, the laser can penetrate an area that is difficult to treat, add heat, or cut only a very small area. They can be used to treat cancer of the:

    • Vocal cords

    • Oesophagus

    • Cervix

    • Skin

    • Lung

    • Vagina

    • Vulva

    Laser therapy is also used in palliative therapy. Palliative Surgery makes the person feel better and more relaxed even if cancer has not been cured by the Surgery. An example of this kind of Surgery may involve removing a growth that makes it difficult for a person to eat.

    How is Laser Surgery done?

    The techniques of laser therapy vary according to the procedure. When treating a tumour, an endoscope (a small, lighted, flexible tube) is used to direct the laser and view tissues inside the body. For example, for oesophagus cancer, an endoscope may be inserted through an opening in the neck or the mouth. The surgeon either focuses the laser and shrinks the tumour, or kills it.

    What are the side effects of Laser Surgery?

    Since Laser Surgery is an advance technique using minimal invasion, the side effects are very rare. You might sometimes have slight Pain and high temperature for a few days.

    References:

    https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/lasers-in-cancer-treatment.html

    https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/other/laser-treatment

    https://stanfordhealthcare.org/medical-treatments/c/cancer-surgery/types.html

    What is Mohs Surgery?

    Mohs Surgery is also called Mohs Micrographic Surgery. It is a surgical technique that slowly eliminates a tumour in layers until there is no cancer. The aim is to get rid of the tumour and retain as much healthy tissue as possible.

    Mohs Surgery proves to be the most effective and least invasive Skin Cancer removal procedure, such as basal cell carcinoma and squamous cell carcinoma. This is widely used in some cases of melanoma, too. Melanoma is the most deadly form of Skin Cancer.

    What types of cancers are treated with Mohs Surgery?

    Mohs Surgery can be used to treat various forms of skin cancers, including basal cell carcinoma, squamous cell carcinoma, some forms of melanoma, and other unusual Skin Cancer types. It used for the treatment of:

    • Tumours in areas where it is vital to remove as little tissue as possible (such as the eyelids, ears, nose, lips, genitals, fingers or toes)

    • Tumours that are larger ones (to leave a smaller scar)

    • Tumours that have recurred or are at high risk of returning

    • Tumours that are growing fast

    • Tumours with poorly defined edges or margins

    How is Mohs Surgery done?

    Mohs Surgery is normally performed at a doctor's office or hospital as an outpatient treatment. Local anaesthetics are used for numbing the area. The surgeon uses a scalpel to cut the tumour section that can be seen along with a thin tissue layer underneath. A temporary bandage is placed on the wound. The tissue sample is taken to the laboratory for examination under a microscope to find out whether the tissue still contains cancer cells. If cancer is present in the layer, a further thin layer of tissue is removed and examined. Each round takes an hour to complete. The Surgery takes 20 to 30 minutes, and it requires another 30 minutes to examine the tissue under the microscope.

    These steps are repeated until the last extracted tissue sample reveals no cancer cells and healthy tissue is present in the surrounding margin. After all the cancer is removed the wound is repaired.

    What are the side effects of Mohs Surgery?

    Side effects may occur any time after Mohs surgery, immediately after, or a few days or weeks later. Side effects could include:

    • Pain, tenderness and a burning feeling

    • Swelling

    • Bleeding and bruising

    • Infection

    • Scarring

    • Nerve damage, for example, numbness

    References:

    https://www.mayoclinic.org/tests-procedures/mohs-surgery/about/pac-20385222/

    https://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/tests-and-procedures/mohs-surgery/?region=on

    https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/mohs-surgery

    What is Percutaneous ethanol injection (PEI)?

    For some time scientists have known that ethanol can kill cancer cells. An injection of ethanol (alcohol) injected directly into a tumour through the skin, can kill cancer cells. The needle is directed into the tumour by Ultrasound or a CT scan. This procedure is also known as Alcohol ablation, ethanol ablation, and PEI.

    Percutaneous ethanol injection is the first-choice therapy following a relapse of cystic nodules after surgical removal. Also, it is an effective therapy for patients with nodular lesions that have contraindications for Surgery and others who have a high risk from Surgery.

    What types of cancers are treated with Percutaneous ethanol injection?

    Sonographically directed Percutaneous ethanol injection therapy is commonly used in the treatment of hepatocellular carcinoma (liver cancer) and thyroid cancer.

    How is Percutaneous ethanol injection given?

    In this procedure, 100 per cent sterile Alcohol is injected into cancerous growths, or tumours, to destroy cancer cells. Using a very thin needle, the Alcohol is inserted into the tumour (percutaneously) through the skin, using Ultrasound or CT visual guidance. Alcohol induces tumour death by removing water (dehydration) from tumour cells and thereby altering (denaturing) the structure of cellular proteins.

    What are the side effects of Percutaneous ethanol injection?

    The most common side effect of Alcohol injection in the treatment of Liver Cancer is Alcohol leakage to the liver surface and into the abdominal cavity, causing Pain and fever as a result. It is important to identify the location of the tumour, the adjacent blood vessels and bile ducts. The reason these structures need to be identified is to prevent damaging them during the operation, and cause infection, inflammation of the bile duct, or bile leakage.

    References:

    https://www.cancer.gov/publications/dictionaries/cancer-terms/def/percutaneous-ethanol-injection

    https://link.springer.com/chapter/10.1007/0-387-28674-8_15

    What is Radiofrequency Ablation?

    Radiofrequency ablation (RFA) uses radio wave heat to kill cancer cells. Radiofrequency is a form of electric energy. Ablation means destruction. You have RFA through a probe (electrode) which goes into the tumour through your skin. The electrical current from the electrode exposes the cancer cells to high temperatures, which kills them. The body then eliminates the dead cells.

    What types of cancer are treated using Radiofrequency Ablation?

    Radiofrequency ablation is most commonly used to treat a cancer spot that causes complications such as Pain or other irritation. It is not typically used as the main treatment for most cancers.

    Radiofrequency ablation may be used for the treatment of tumours in:

    • Adrenal gland

    • Breast

    • Bone

    • Kidney

    • Liver

    • Lung

    • Pancreas

    • Thyroid

    Radiofrequency ablation is usually considered a treatment option only if, for some reason, you are not a good candidate for Surgery С like your overall health or the presence of numerous small tumours in an organ. RFA could also be a remedy for managing precancerous cells in the oesophagus that are involved with Barrett's oesophagus.

    How is Radiofrequency Ablation done?

    First, you will be given an intravenous medication to relax. You will then lie on your stomach or a table. The doctor will numb the spot on your skin with anaesthesia. Then, he or she will:

  • Insert a thin needle into the area where the Pain is felt; an X-Ray can help your doctor identify the exact area.

  • Inject a microelectrode through a needle; your doctor will ask if you are having a tingling sensation; this will help your doctor find the correct treatment area

  • Send a tiny amount of radiofrequency current to heat the nerve tissue through the electrode

  • It typically takes 30 to 90 minutes to complete the procedure. After the treatment, you will be advised to go home.

    What are the side effects of Radiofrequency Ablation?

    After RFA, some people may get a few insignificant side effects. The most important of these are:

    • Mild Pain or a mild discomfort

    • Feeling unwell for a few days with an elevated temperature

    • Infection, however, this is rare

    The side effects can be taken care of by using medications or following complementary and alternative medicine.

    References

    www.mayoclinic.org/tests-procedures/radiofrequency-ablation/about/pac-20385270

    https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/other/radiofrequency-ablation

    https://www.ucsfhealth.org/treatments/radiofrequency-ablation

    https://www.nice.org.uk/guidance/ipg92

    What is Robotic Surgery?

    Robotic Surgery is a type of laparoscopic (or thoracoscopic) Surgery where the doctor uses precise robotic arms to control some of the surgical instruments. The advantages of this type of Surgery are largely the same as laparoscopic and thoracoscopic surgery: it can help reduce blood loss during Surgery and Pain afterwards. It can also shorten hospital stays and let people heal faster.

    Potential benefits of Robotic Surgery for patients include:

    • Reduced pain

    • Lower risk of infection or complications

    • Less blood loss (fewer transfusions)

    • Shorter hospital stays

    • Less scarring due to smaller incisions

    • Faster return to normal activities (e.g., sexual function, urinary continence)

    What types of cancers are treated with Robotic Surgery?

    • Oesophageal surgery

    • Gastric (stomach) surgery

    • Pancreatic surgery

    • Liver surgery

    • Colon and Rectal surgery

    How is Robotic Surgery done?

    Robotic Surgery combines advanced computer technology with the surgeon's skills and experience. This technology provides a 10x magnified, high-definition, 3D-image of the elaborate anatomy of the patient's body. The surgeon uses controls in the console to manipulate special surgical instruments that are smaller, as well as more flexible and manoeuvrable than the human hand. The robot replicates the hand movements of the surgeon while minimizing the tremors of the hand. In this way, even during the most complex procedures, the surgeon can operate with increased precision, dexterity and control.

    What are the side effects of Robotic Surgery?

    Robotic Surgery is designed to minimize side effects, but you will likely experience some side effects from your procedure. Side effects may depend on the type of cancer Surgery performed, the extent of the surgery, your overall health and other factors. Side effects of Robotic Surgery may include:

    • Pain

    • Bleeding

    • Difficulty swallowing

    • Loss of appetite

    • Fatigue

    • Sexual side effects

    • Infection

    References:

    https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/surgery/special-surgical-techniques.html

    https://ccr.cancer.gov/clinical-trials/foregut-team/team/minimally-invasive-surgery

    What is Stereotactic Radiosurgery?

    Stereotactic radiosurgery, or SRS, is a means of administering radiation to brain tumours. It is used for treating tumours that begin in the brain as well as brain metastases (cancer that has spread from other parts of the body to the brain).

    The procedure uses advanced imaging techniques coupled with advanced computer guidance to deliver a highly targeted and intense dose of photon radiation. The radiation follows the tumour's three-dimensional shape and size, resulting in reduced exposure to the rest of the brain and fewer side effects compared to traditional methods of radiation.

    What types of cancers are treated with Stereotactic Radiosurgery?

    Stereotactic radiosurgery for patients with small brain tumours has become an increasingly popular technique. Other Stereotactic Radiosurgery candidates also include those patients whose disease is not surgically accessible or too advanced for neurosurgery, as well as those who cannot tolerate anaesthesia.

    Stereotactic radiosurgery is not appropriate for everybody. It is performed on the following types of cancer:

    • Vestibular schwannoma

    • Meningioma which started at the base of the skull

    • Pituitary gland tumour

    • Cancer that has spread to the brain from elsewhere in the body

    How is Stereotactic Radiosurgery done?

    A radiation oncologist uses a computerized system to shape the radiation beam to align with a three-dimensional tumour outline. MRI and CT scans produce this outline which taken before the treatment. Radiation is then directed at the tumour.

    What are the side effects of Stereotactic Radiosurgery?

    Side effects of Stereotactic Radiosurgery may include:

    • Fatigue

    • Skin problems

    • Hair loss in the treatment area

    • Difficulty in swallowing

    • Nausea and vomiting

    • Headaches

    • Swelling, especially of the brain

    References:

    https://www.cancerresearchuk.org/about-cancer/brain-tumours/treatment/radiotherapy/side-effects

    https://www.mskcc.org/cancer-care/diagnosis-treatment/cancer-treatments/radiation-therapy/what-stereotactic-radiosurgery

    https://www.cancercenter.com/treatment-options/radiation-therapy/external-beam-radiation/stereotactic-radiosurgery

    What is Video-assisted thoracoscopic surgery?

    VATS (video-assisted thoracic surgery) is a type of minimally invasive thoracic Surgery performed with a thoracoscope. The thoracoscope transmits images of the operating area to a monitor located next to the patient. It is particularly used to minimize trauma by using small incisions and special instruments. This process is also known as thoracoscopy, thoracoscopic surgery, or pleuroscopy. About three tiny (1-inch) incisions are made during thoracoscopic surgery, compared to one long 6 to 8-inch chest incision, which is used for conventional, "open" thoracic Surgery. These tiny incisions are used to insert surgical instruments and the thoracoscope.

    What types of cancers are treated with Video-assisted thoracoscopic surgery?

    Surgeons use VATS to perform procedures such as:

    Ґ Diagnostic Biopsy of lung cancer, mesothelioma and other chest cancers

    Ґ Cure lungs cancer and procedure to reduce the volume of the lungs

    Ґ Procedures for removing excess fluid or air from the lungs

    Ґ Surgical procedure for removing part or the entire oesophagus (Oesophagectomy)

    Ґ Treatment for removal of the thymus gland (thymectomy)

    How is Video-assisted thoracoscopic surgery done?

    Usually, VATS is done with general anaesthesia which makes you sleep so that you are unconscious during the procedure. A tube is put down your throat after the anaesthesia takes effect to help you breathe. This tube can be used by your anesthesiologist to make you breathe through only one of your lungs. This allows the other lung to be completely deflated and allows the surgeon to view your chest cavity in full on that side during the procedure.

    You spend the procedure lying on your side. About three very small (less than one inch long) incisions are made, usually between your seventh and eighth ribs. Carbon dioxide gas may flow through this opening into your chest, while your lung on that side may collapse partially or completely. A tiny camera on a tube is then inserted through the opening. It is called a thoracoscope. The doctor uses a video screen to see the work he or she is doing.

    What are the side effects of Video-assisted thoracoscopic surgery?

    Side effects are rare and may include:

    • Fever

    • Pleural tears and/or subcutaneous emphysema causing air leakage

    • Haemorrhage

    • Perforation to the lung

    • Gas embolism

    Patients are also at risk of general anaesthetic complications.

    References:

    https://www.msdmanuals.com/en-in/professional/pulmonary-disorders/diagnostic-and-therapeutic-pulmonary-procedures/thoracoscopy-and-video-assisted-thoracoscopic-surgery

    https://www.health.harvard.edu/diseases-and-conditions/video-assisted-thoracic-surgery

    https://mmcts.org/tutorial/77

    https://my.clevelandclinic.org/health/treatments/17617-video-assisted-thoracic-surgery-vats

    https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/video-assisted-thorascopic-surgery

    What is High-intensity focused ultrasound (HIFU)?

    High intensity focused Ultrasound (HIFU) is a treatment that tries to destroy cancer cells with high-frequency sound waves. HIFU does not pass through solid bone and air; therefore, it is not a suitable treatment for every cancer. This treatment is given by a machine, which emits high-frequency sound waves. These waves deliver a strong beam to a specific part of a cancer. The high-intensity Ultrasound beam is focused directly onto the cancer, which heats the cells and destroys them.

    What types of cancers are treated with High-intensity focused ultrasound (HIFU)?

    HIFU is useful only for treating a single tumour or part of a large tumour. It can not be used for treating more widespread tumours. This means that HIFU is not suitable for cancer patients whose cancer has spread to more than one place in their body. It can be used to treat the following cancers:

    • Prostate cancer

    • Breast cancer

    • Liver cancer

    • Kidney cancer

    • Pancreatic cancer

    • Primary and secondary bone malignancy

    • Trans-cranial HIFU therapy for brain tumour

    How is High-intensity focused ultrasound (HIFU) done?

    HIFU procedure needs a couple of hours to complete. You will receive anaesthesia and will not feel any Pain or discomfort during the procedure. Your doctor will use an Ultrasound probe. The probe may have one or two crystals inside. Sound waves emitted from one crystal will bounce back to form an image of the tumour, on the computer. This will show the location where the sound waves should be aimed at. Another crystal sends focused sound waves into the tumour. An MRI may be used to keep track of the treatment. After the procedure is complete and the anaesthesia effect wears off, you can go home.

    What are the side effects of High-intensity focused ultrasound (HIFU)?

    Side effects due to HIFU are rare and may include:

    • Discomfort or Pain for 3 to 4 days after the procedure.

    • Soreness or difficulty in passing urine in case of Prostate Cancer.

    References:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4747875/

    https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/other/high-intensity-focused-ultrasound-hifu

    https://pubmed.ncbi.nlm.nih.gov/21103296/