On the Spot Cancer Diagnosis -- In Depth Doctor's 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.
END OF INTERVIEW
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