Once upon a time, in a lab, a PhD student was annoying her colleagues with a noise problem and while doing so, accidentally invented a way to dismember tumors using nothing but very loud, very focused sound.
That student was Zhen Xu, who as a University of Michigan grad student in the early 2000s discovered what’s now called histotripsy — an ultrasound trick that pulverizes tissue with microsecond pulses until a tiny hole appears in pig heart tissue.
“I thought I was dreaming,” Xu recalled of that first, jaw-dropping result.
Fast-forward decades: doctors are now using that same idea to treat liver tumors without cuts, scalpels, or long hospital stays.
Histotripsy is part of a growing family of sound-based oncology tools that are quietly remaking the notion of “surgery.”
In October 2023 the FDA approved histotripsy for liver tumors; the U.S. commercial rollout followed research — including a HistoSonics-funded study reporting technical success against 95% of liver tumors.
In June the UK became the first European country to approve the approach and put it on the NHS pilot track.
What actually happens?
Think of the histotripsy beam as a robotic coloring pen with a two-by-four–millimeter focal zone, Xu says — “basically, the tip of your colouring pen.”
A robotic arm holds a transducer that fires very short but intense ultrasound bursts into that precise spot.
Those pulses seed microscopic bubbles that grow and then collapse in microseconds; the result is mechanical shearing — tissue turns to cellular confetti, and the immune system sweeps the mess away.
Procedures typically last one to three hours, often under general anesthesia so patients sit still, and many folks go home the same day.
“People think of ultrasound as imaging,” says Julie Earl, a principal investigator at the Ramón y Cajal Institute for Health Research, “but a growing body of research suggests it can also destroy tumors, subdue metastatic disease and boost the efficacy of other cancer treatments — all without putting a patient under the knife.”
Fair point: ultrasound is doubling as a surgeon, delivery truck, and immunotherapy cheerleader.
It isn’t magic.
There are limits: bone and gas block sound, ruling out some tumor locations; gaseous organs like lungs pose risk; and long-term recurrence data is still limited.
There’s theoretical worry histotripsy could “seed” cancer cells as it breaks tumors apart, but animal studies so far haven’t borne that out.
Another sound weapon in the oncologist’s toolbox is HIFU (High-Intensity Focused Ultrasound), which uses focused sound to generate heat and “cook” tissue.
Richard Price, co-director of the Focused Ultrasound Cancer Immunotherapy Center at UVA, explains the intuition: “If you take a magnifying glass and you hold it outside on a sunny day over a dry leaf, you could actually start the leaf on fire.”
HIFU is sometimes as effective as surgery (the prostate example is promising) — but because it produces heat, it can also damage nearby structures.
Where things get especially futuristic is sound + drugs.
Inject microbubbles into a patient, stimulate them with ultrasound, and you can open the blood-brain barrier briefly — a once-impossible gate for many chemotherapy drugs.
“The non-invasive part is awesome, but the [drug-delivery component] is really unmatched anywhere,” Price says.
Deepa Sharma at Sunnybrook Health Sciences Centre points out that ultrasound-enhanced delivery can let clinicians use lower doses of chemo or radiation while achieving the same or better results.
“Radiation therapy does cure cancer, but it does also cause a lot of long-term side effects,” Sharma says.
If ultrasound helps lower those doses, that’s win-win.
There’s also reason for optimism about immunotherapy pairings.
Focused ultrasound appears to make treated tumors more visible to the immune system — essentially dragging a shy tumor into the spotlight so the body’s defenses can recognize and attack similar cancer cells elsewhere.
Price has floated the tantalizing idea that treating one tumor might prime the immune system to hunt down metastases across the body — a hypothesis still early in trials, but a potential paradigm shift if it pans out.
Reality check: histotripsy and HIFU aren’t cures for every cancer.
They’re tools — powerful, noninvasive tools — that could replace or complement painful surgeries, toxic chemo cycles and months of recovery.
“Cancer is awful,” Xu says. “What's making it even worse is cancer treatment.”
If the future of oncology means less cutting, less poison, and more targeted sound waves, then a little dream born of laboratory noise complaints may wind up saving a lot of patients from the worst parts of treatment.
And yes — your next ultrasound appointment might be the last time you hear the word “incision.”
Any treatment that can move us towards a better and more sustainable system for medical treatment of the human body is a positive step forward.
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