To Cut or Not to Cut: That’s a Cancer Surgeon’s Question

In a series I’m continuing to develop, I talk about why it’s so difficult to treat cancer. (To catch up, follow these links: Part 1, Your Tumor is Not a Clone. Part 2, Cancer Cells are Still Cells. Part 3, Resistance is Not Futile. Part 4, There is No Google Translate for Science. Part 5, Is This Thing On?

Most current cancer treatments involve one or more of the following types of treatment: BURN the tumor cells using radiation therapy, CUT out the tumor with surgery, or POISON the cancer cells (but hopefully not the healthy cells) by a treatment like chemotherapy. These three treatment strategies represent the best that we have so far, but innovative researchers are continually developing new strategies to revolutionize the treatment of cancer.

What are intraoperative devices? And how can they improve cancer surgeries?

Any surgery is a major event, but cancer surgeries carry the added weights of fear and hope, for the patient as well as for the patient’s care team. When a cancer surgeon is operating to remove a tumor, there are several considerations to be made. Among them are the location and the size of the tumor. For example, if a tumor is relatively small and in an organ where taking some “extra” tissue is not detrimental to the patient, this can be an option to try to ensure that all of the cancer cells have been removed. For example, if a patient has a relatively small tumor in the liver, a surgeon may decide to remove a bit of tissue surrounding the tumor mass, to make sure that any tumor cells that maybe were not visible are also removed.

What about in an organ where removing “extra” tissue can be dangerous? Or life-threatening? Imagine that for a patient with brain cancer, it is really important to remove all of the tumor cells so that the tumor doesn’t start to grow again. But the brain is a really complex landscape, with each brain region having a very important part to play in making up who you are. There’s not a lot of “wiggle room” to remove extra cells around the tumor.

With a fluorescent spray, a surgeon can much more clearly identify which cells are tumor cells. Image courtesy of Gooitzen van Dam.

Now imagine that the doctor has a hand-held device (s)he can use in surgery. With this device, (s)he could visualize the tumor cells, so that the tumor cells are removed and the non-tumor, healthy cells are left behind. This could have a huge impact, not just on cancer surgeries in sensitive areas, but in all cancer surgeries as well. This would allow surgeons to precisely remove the tumor, with no need to take large amounts of surrounding cells to “be sure,” and without fear of leaving behind some tumor cells that are difficult to see during the surgery.

How can a surgeon be sure ALL of a tumor is gone?

One recent advancement, a partnership between the University of Tokyo and the National Cancer Institute, is a spray. Doctors can directly spray this solution onto a tumor while the surgery is taking place, and characteristics of the tumor will cause a reaction that causes the tumor cells to glow. In this way, surgeons can look for these glow-in-the-dark areas to remove cells that might be small metastases.

Another advancement, published this week in Science Translational Medicine, is a pen-like device. Different areas could be touched with the pen, and the readout will tell surgeons whether that tissue is normal (non-cancer) tissue or cancer tissue.

What’s next?

These new technologies could mean big changes for the way cancer surgeries are performed in the future, but there are still some questions that need to be addressed first. Does using these surgeries lead to a better patient outcome? Do these technologies need to be used in all types of cancers, or do some cancer surgeries benefit more than others from this type of guided surgery?


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