According to “NIH News in Health” https://newsinhealth.gov, surgeons find removing tumors to be a balancing act. Cut out too much and you risk removing healthy tissues that have important functions. Remove too little and you may leave behind cancer cells that could grow back into a tumor over time.
NIH-funded researchers are developing new technologies to help surgeons determine exactly where tumors and healthy tissue begin. “In many cases, we leave tumors behind that could be safely removed if only we were able to better visualize it,” reports Dr. David Orringer, a neurosurgeon at the University of Michigan https://umich.edu.
Today, pathologists in the operating room can often help surgeons determine if a tumor has been completely taken out. A pathologist may view the edges of the tissue under a microscope and look for cancer cells. If they are found, the surgeon will remove more tissue from the patient and send the tissues again to the pathologist for review.
Orringer is part of a team that is testing a new technology to help surgeons tell the difference between a tumor and healthy brain tissue during surgery. The team developed a special microscope with NIH support that shoots a pair of low-energy lasers at the tissue. This causes the chemical bonds in the tissue’s molecules to vibrate.
Orringer and his team have developed a computer program that can quickly analyze the images and assess whether or not cancer cells are present. So far, Orringer has used the specialized microscope to help remove cancer tissue in nearly 100 patients with brain tumors.
Dr. Quyen Ngugen a head and neck surgeon at the University of California San Diego https://ucsd.edu has developed a fluorescent molecule that is currently being tested in clinical trials. The patient receives an injection of the molecules before surgery.
When exposed to certain types of light. These molecules will cause cancer cells to glow making cells easier to spot and remove so that the surgeon can use a near infrared camera to visualize the glowing tumor cells while operating.
In another research project, Dr Milind Rajadhyaksha, researcher at Memorial Sloan Kettering Cancer Center www.mskcc.org has developed a microscope technique to reduce the amount of time it takes to perform a common surgery for removing non-melanoma skin cancers.
This technique shortens the time it takes to assess the removed tissue to less than five minutes. The tissue is mounted in a specialized microscope that uses a focused laser line to do multiple scans of the tissue.
The resulting image strips are then combined like a mosaic into a complete microscopic image of the tissue. About 1,000 specialized skin surgeries have already been performed guided by this technique
Rajadhyaksha is currently developing an approach that would allow doctors to use the technology directly on a patient’s skin before any tissue has been removed. This would enable doctors to identify the edges of tumors before the start of surgery and reduce the need for several pre-surgical margin-mapping biopsies.