THE PROBLEM WITH CANCER SURGERY
You’ve been “scheduled” even though you’re not sure you heard everything they said and aren’t sure you made the right choices.
How did this happen? Will everything be okay? Will your kids be orphaned? Nobody answers these questions for you. It’s all about practical next steps.
You’re on a gurney talking to a nice doctor.
Isn’t she a little too young? Shouldn’t she be more reassuring? Less “We’ll know a lot more after we get in there”?
You think she said “We’ll take away the bad stuff and leave the good stuff.”
That must be what she said. That’s what they do right?
The surgeon’s job is to get rid of the diseased tissue. How is that determined?
To see if all of the cancer has been successfully removed, a sample is put into a container with preservative. The sample is sent to the pathologist. After a gross exam , the sample is quickly frozen, stained, and sliced. Other samples go into a cassette for a more complete analysis later. Those samples go into hot paraffin which, after a few hours of cooling, get sliced on a “microtome” for the eventual “thumbs up/thumbs down”.
This process is a cumbersome one. If the pathology lab says the quick frozen sample still has cancer, the surgeon has to take out more tissue, send a new sample, wait for the lab, and maybe even repeat again. When it’s all done, and the patient is supposedly recovering, the lab gets a second vote based on the samples that were saved for further study.
The doctor wants to walk out to the waiting family and say things went great. Good margins. All gone. Its embarrassing for the doctor and dispiriting for the patient and the family to find out that those margins might not have been so great after all.
A BETTER GRIP ON THINGS IN THE OPERATING ROOM
Two tools are trying to make their way to the operating room that could add more certainty and reduce the “standing around” time for the surgeon.
One of them, I mentioned last July. It’s a “hot knife” that does an instant analysis of the vaporized tissue. In early testing, the results were in perfect agreement but there is more testing to be done before the instrument is submitted for regulatory approval.
Another way to get at the problem is a pair of special glasses that make cancer cells visible to the surgeon. Dr. Samuel Achilefu, PhD, professor of radiology and biomedical engineering at Washington University is the project head. The system uses a “heads up” display to see cancer cells as small as one millimeter. The cells look like they are glowing when you look at them with the goggles. The trick is a contrast agent that is injected beforehand into the tissue.
Like the iKnife the googles aren’t ready for approvals. More testing has to be done with humans.
For now, we’re still stuck with the painstaking path lab process but this would seem to be the future of cancer surgery.
The sooner the better, I think.
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The drawing is mine.