‘Game changer’ would prevent removal through early diagnosis
By Stephanie Innes
ARIZONA DAILY STAR 8/19/09
A screening system in development at the University of Arizona is expected to provide a breakthrough in the early detection of ovarian cancer.
By using holograms and merging medical and optical science, UA researchers Raymond Kostuk and Jennifer K. Barton are developing a way of seeing enough varied depth in ovarian tissue to detect microscopic cancer cells in their earliest stages. That’s a huge advance for the fight against an insidious disease that kills most women within five years of diagnosis.
The researchers expect to spend the next five years finetuning a wandlike instrument that’s anticipated to be a “game changer” for medicine if it does what is intended — allow high-risk women to know whether or not they actually have ovarian cancer before having their ovaries removed.
Bolstering Kostuk and Barton’s work is a fiveyear, $2.4 million grant that the federal National Institutes of Health awarded them last month. At the end of the five-year period, the researchers hope to have a laparoscopic screening device — a wand with small lenses and a hologram inside that will work like a high-powered microscope.
Laparoscopy refers to a type of minimally invasive surgery in which a small incision is made in the abdominal wall and an instrument called a laparoscope is inserted to permit structures within the abdomen and pelvis to be seen. Probes or other instruments can thus be introduced through the same opening. In this way, a number of surgical procedures can be performed without the need for a large surgical incision. Most patients receive general anesthesia during the procedure.
“I don’t believe these combinations have ever been tried for this application. I think we’re really making some very new contributions here, both in optical technology as well as this application in the medical field,” said Kostuk, who is the UA’s Kenneth Von Behren Professor of Electrical and Computer Engineering and a professor of optical sciences.
“A hologram is really a grading — it’s like a prism, except it separates wavelengths much more powerfully than a prism.”
The grant money will allow the researchers to do three major things: improve the performance of a prototype of the technology Kostuk and Barton already have developed; package the technology into a laparoscopic system that can be taken into the operating room; and perform a pilot study on women who already are undergoing oophorectomy (removal of the ovaries).
Ultimately, Kostuk and Barton want to help save lives and contribute to a broader understanding of how ovarian cancer progresses.
“Our hope is that it would detect it earlier by providing more information,” said Barton, who heads the UA department of biomedical engineering and is assistant director of the UA’s BIO5 Institute. BIO5 brings together faculty members and other researchers from five disciplines— agriculture, medicine, pharmacy, basic science and engineering — to tackle complex biologybased problems.
“Based on the data that are available, it’s estimated that ovarian cancers spend about four years in an early stage before they become advanced and start causing symptoms,” Barton said. “So we have a pretty big window there to be able to detect it. . . . And in all cancers, you are better off with early detection.”
Kostuk and Barton’s instrument would augment what doctors already see during laparoscopic surgery by allowing them to view simultaneous projections from multiple depths below the surface of the tissue. The images would appear on a computer screen, and doctors would be able to quickly zoom in on suspicious areas. “What they see right now is a picture of the surface of the ovary,” Barton said. “What we can add is information about what is going on below the surface. The problem is that it’s been shown simple laparoscopy does a poor job of identifying cancers.”
There’s a potential to use the technology in detecting cancers in other areas of the body, such as the lungs, bladder and colon, but Barton said the ovary was selected to begin with because of its high mortality and low detection rates. About 20,000 American women are diagnosed with ovarian cancer every year. The National Institutes of Health says there is to date no single effective screening test for ovarian cancer, so ovarian cancer is rarely diagnosed in its early stages.
As a result, more than 50 percent of women with ovarian cancer are diagnosed in the late stages of the disease, when the cancer already has advanced. Just 45 percent live longer than five years after diagnosis.
Though Kostuk and Barton’s instrument likely won’t be used on women with an average risk for ovarian cancer, Barton said there’s a possibility that the screening device over time will develop into something less invasive, such as going through the vaginal wall to access the ovaries rather than through the abdominal wall. Another possibility is making the device smaller.
“If we can make it flexible and 1 millimeter in diameter, you can go through the vagina, uterus and into the fallopian tubes and access the ovary that way — it would be minimally invasive, not having to cut through any tissue at all. You could then start thinking of this as being like a colonoscopy,” Barton said.
“What we’d want to do is come up with criteria so that maybe not every woman in the world should have this procedure, but maybe people who are at a slightly elevated risk rather than just high risk.”
The other unique part of Kostuk and Barton’s project is its collaboration among engineers, scientists and physicians.
“To do something like early detection of ovarian cancer, you need to work with people who have very different languages,” Barton said. “That is one of the things I love about UA — people work so well across boundaries.”
Kostuk and Barton will work on a pilot study with Dr. Kenneth D. Hatch, who is president of the international Society of Pelvic Surgeons and a professor of obstetrics and gynecology and director of female pelvic medicine and reconstructive surgery at the UA College of Medicine. Hatch said the research is extremely significant and may help not only to detect but to prevent ovarian cancer.
“We’d like to be able to put a probe on the ovaries and say, ‘There’s no cancer there,and you can keep your ovaries,’ ” Hatch said.
“The science folks have tested this out to the point where we are excited about it.”
The new imaging system will be tested on high-risk patients who are willing to participate and provide some future benefit to other patients who find themselves in a similar situation, Barton said.
Kostuk and Barton’s aim is to design the imaging system so that it is easy to use, requires very little training and is inexpensive.
The next five years of work will continue research Kostuk and Barton had begun using a two-year federal grant, also from the NIH.
“What we did was prove that we could design and make these holograms — we could build the imaging system,” Barton said. “We proved that you could get images at multiple depths simultaneously and that you also get information about the spectral content of the light being reflected from the tissue.”
Those who would immediately benefit from the UA research are women at high risk for ovarian cancer — people with a family history or those who carry genetic mutations in the BRCA1 and BRCA2 genes, which normally help protect against both breast and ovarian cancer.
With the screening device, a young woman who is at a high risk could be screened, and if her results are negative, she would not need to have her ovaries removed to prevent cancer — a common surgery for high-risk women. That way, a woman could keep her ovaries not only for the health benefits but also in case she wants to have children.
“I think it has definite potential to make a difference, because it would fit right into the normal procedures that would be done, but it provides information you just can’t get right now,” Barton said.
Contact reporter Stephanie Innes at 573-4134 or sinnes@azstarnet.com. Follow Stephanie Innes on Twitter at twitter.com/stephanieinnes
Jennifer K. Barton
A.E. ARAIZA / ARIZONA DAILY STAR
University of Arizona professor Raymond Kostuk is one of the researchers developing a laparoscopic screening device that is expected to provide a breakthrough in the early detection of ovarian cancer.
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