On the spot cancer diagnosis

Scope can also detect other GI tract problems

NEW YORK (Ivanhoe Newswire) - Twelve million cases of cancer will be diagnosed this year.

People getting biopsies for various reasons may have to wait days or more than a week to find out if they're one of them, but a new kind of biopsy is changing that.

"I started painting five years ago," Niloofar Shamloo said.

But Niloofar Shamloo's painting was interrupted. "I was very sick, so I couldn't continue to go to classes."

In fact, she could barely move.

"I had to quit my job. I had no energy. I was in bed all the time," Niloofar said.

It was the inflammatory bowel disease ulcerative colitis.

Doctors feared it could be the sign of something even worse.

"Most of the time we diagnose pancreatic cancer already too late, when there is no cure," Michael Kahaleh, M.D., Professor of Clinical Medicine, Chief of Endoscopy and Medical Director of the Pancreas Program, Division of Gastroenterology & Hepatology, Department of Medicine at Weill Cornell Medical College, explained.

Diagnosis involves an invasive biopsy, then a stressful waiting period. Using what's called a confocal endomicroscope, doctors can diagnose cancer cells while in the operating room, without the need for laboratory biopsies.

"A normal cell will appear under floroscene, very clear and organized, but if it's cancer it will be very dark and completely disorganized," Dr. Kahaleh said.

The images, magnified up to a thousand times more than a traditional endoscope, are sent to a computer where doctors can see each cell. "The patient will leave knowing if they have cancer or not," Dr. Kahaleh said.

Niloofar woke up from surgery and was told immediately she did not have cancer. "For me it was like a miracle," Niloofar said.

She's back to painting with peace of mind.

Doctors are also using the scope to detect other GI tract problems, cancers in the abdomen, and colon problems.

The doctor believes within the next ten years the new approach could replace traditional biopsies.

RESEARCH SUMMARY

BACKGROUND: Cancer begins in your cells, which are the building blocks of your body. Normally, your body forms new cells as you need them, replacing old cells that die. Sometimes this process goes wrong. New cells grow even when you don't need them, and old cells don't die when they should. These extra cells can form a mass called a tumor. Tumors can be benign or malignant. Benign tumors aren't cancer while malignant ones are. Cells from malignant tumors can invade nearby tissues. They can also break away and spread to other parts of the body. Most cancers are named for where they start. For example, lung cancer starts in the lung, and breast cancer starts in the breast. The spread of cancer from one part of the body to another is called metastasis. (Source: www.nlm.nih.gov)

TYPES/SIGNS: Symptoms and treatment depend on the cancer type and how advanced it is. Some of the most common types of cancer are prostate cancer, breast cancer, lung cancer, and colon and rectal cancer. To qualify as a common cancer on the National Cancer Institute's list, the estimated annual incidence (how many estimated numbers of new cases) had to be 40,000 cases or more. (Source: www.cancer.gov) BIOPSIES:A biopsy is when a small piece of tissue is removed for examination in a laboratory and is often used to determine if a tumor or mass is cancerous. Biopsies can be performed on various areas of the body and different organs. There are several different types of biopsy:

  • Needle (Percutaneous) Biopsy - Removes tissue through a syringe and the doctor is usually guided by a CT scan or ultrasound as to the right location to take the tissue from.
  • Open Biopsy - This is a surgical procedure where the doctor will make a cut in the affected area and remove the tissue. General or local anesthesia is used on the patient so they will not experience pain during the procedure.
  • Closed Biopsy - This is also a surgical procedure but the cut made is typically smaller than that in the open biopsy, and a small camera-like instrument is inserted to help guide the surgeon to the right place to take a tissue sample. (Source: www.nlm.nih.gov)

NEW TECHNOLOGY: NewYork-Presbyterian Hospital/Weill Cornell Medical Center's Dr. Michel Kahaleh threads a tiny microscope into the narrow bile ducts that connect the liver to the small intestine to hunt for cancer. He also uses the device to minutely explore the pancreatic duct as one of a few doctors in the country to use such technology in this way. Using what's called a confocal microscope, doctors can diagnose cancer cells while in the operating room, without the need for laboratory biopsies. Images taken inside the body can be magnified up to 1,000 times more than a traditional endoscope. These images are then sent to a computer where doctors can see each cell and diagnose their patients before they leave. So, there's no more waiting weeks for results.

INTERVIEW

Michel Kahaleh, M.D., Chief of Endoscopy at Weill Cornell and a gastroenterologist, talks about a new kind of biopsy and how it may help patients.

How often do you deal with pancreatic cancer?

Dr. Kahaleh: Probably on a daily basis. I have patients referred to me with even suspicion of pancreatic cancer.

If I remember correctly, pancreatic cancer is a really hard cancer to deal with.

Dr. Kahaleh: Correct. It is extremely difficult.

Why is that?

Dr. Kahaleh: Well first of all it can mimic so many other diseases. It can mimic inflammation, it can mimic weight loss due to ulcers, it can mimic inflammatory bowel disease, and even some people can confuse it with chronic disease or chronic rheumatology disease. So, it is very important to take a step back and remember that this is actually a big mimicker.

Is it because the organ itself is just in a very bad place in the body?

Dr. Kahaleh: Correct. It is basically located against the spine. Some people will come with abdominal pain. People will also come with back pain and this is why you have to think, that maybe there is something else going on in the abdomen.

What was it used for before?

Dr. Kahaleh: It was used to look inside the eyes, and now we are using it to look at the cells themselves.

When they would look inside the eyes, what would it be for?

Dr. Kahaleh: They were looking at the retina to see if there is any issue with the retina, but in this case, we are looking at the cells of the gut, the bile or pancreas themselves. So, we actually have live histology or live biopsy.

When you first did this, were you amazed at how easy it was to see the difference?

Dr. Kahaleh: I was amazed. The patient came to me because he had negative biopsy somewhere else. We injected him and we immediately saw that the patient actually had cancer.

When you see that the patient has cancer, what are the options for them?

Dr. Kahaleh: Well, dependent on the stage of the cancer, if the patient is detected early enough you can actually send him for a curative resection; he goes to surgery to have the cancer removed. Now if the patient is at a later stage we can then offer him right away palliation such as placing a stent or ablation, by burning the cancer from the inside.

What was Patricia like when she came to see you?

Dr. Kahaleh: She came to see me because she has a question about pancreatic or ampullary cancer.

What does that mean?

Dr. Kahaleh: That means at the level that drains the bile duct and the pancreas, there was a growth that could have been pancreatic cancer or cancer of the ampulla, which is the area that drains the bile duct and the pancreatic duct. So the deal with her is, instead of sending her straight up to surgery or start resecting this area without knowing what it is, we decided to do this examination. When we injected the cells, we noticed that the cell would take in the fluorescein very nicely and they were normal. That made us feel that we were not dealing with cancer, but we were dealing with something else, like inflammation for instance. So we preserved her from an unnecessary surgery.

Would this be good for any patient?

Dr. Kahaleh: Absolutely. I think anybody with any GI tract lesion in the esophagus, in the stomach, into the pancreas, the bile duct, the rectum or the colon can actually benefit from this. It is the ability to give them an immediate impression which actually will replaces, slowly but surely, the current biopsy. So basically, the patient leaves with an idea if he has cancer or not.

Do you find this amazing?

Dr. Kahaleh: It is amazing. However, we need to confirm our long term data with this novel technology by keeping track of our current biopsy result, in the next 10 years probably or maybe even earlier, we might demonstrate that virtual biopsy or live biopsy is as good as regular biopsy with a microscope.

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