Removing lesions inside the stomach used to mean a large incision and a lot of cutting. But now there's an easier approach. Doctors are removing tumors without a scar!
Cheryl Capitena-Johnson loves to experiment in the kitchen…but when it comes to her health, she's not taking any chances!
Cheryl told Ivanhoe, "Once I hit my 50s, I decided that I was going to be very proactive about my health."
Cheryl's father died of stomach cancer and she was right by his side as the cancer took his life.
"I saw him go through this ugly, ugly disease, and I decided that was not going to be my fate," she said.
But about three years ago, doctors found two suspicious lesions in Cheryl's stomach.
Cheryl explained, "There was really only one option, to get them out, to get them removed."
Instead of traditional surgery to remove part or all of the stomach — doctors at the Cleveland Clinic used a new technique known as ESD.
John Rodriguez, MD, General Surgeon at the Cleveland Clinic told Ivanhoe, "Now what we're actually trying to do is get rid of the incisions all together."
Surgeons place an endoscopic tube down the patient's throat. They use special instruments through that tube to cut the lesions — without cutting the organ. With this technique, they can remove the tumor layer by layer.
"When we go in with the endoscope, we're able to almost peel off these layers without taking a full thickness part of the organ," Dr. Rodriguez explained.
There's no outward incision, which means a quicker recovery. Cheryl was back at work a week later and found out her lesions were not cancer!
"I'm blessed to be alive, I'm blessed," she said.
Cheryl will have a diagnostic scope test every year because she is at high-risk for stomach cancer. The ESD technique can be used to remove gastric, esophageal, and colorectal lesions. If the spots are cancerous, they must be early-stage tumors to be taken out this way. The procedure was originally developed in Japan, but has only recently gained popularity in the U.S.
BACKGROUND: According to the National Cancer Institute, there will be an estimated 24,590 new cases of stomach cancer in 2015 and 10,720 of these patients will die from it. Your stomach is the organ that receives and holds the food you consume and then breaks it down and digests it. Stomach cancer or gastric cancer is cancer that occurs within the stomach. This most often refers to cancer that begins in the mucus-producing cells on the inside lining of the stomach called adenocarcinoma which is the most common type of stomach cancer. Although doctors aren't completely sure about the direct causes of stomach cancer, there has been a strong relationship between a diet in smoked, salted and pickled foods and stomach cancer.
(Sources: http://seer.cancer.gov/statfacts/html/stomach.html, http://www.mayoclinic.org/diseases-conditions/stomach-cancer/basics/causes/con-20038197)
SIGNS AND SYMPTOMS: Some signs and symptoms of stomach cancer can include:
· Fatigue
· Bloating after eating
· Feeling full after eating small amounts of food
· Severe and persistent heartburn
· Severe indigestion
· Persistent and unexplained nausea
· Stomach pain
· Persistent vomiting
· Unintentional weight loss
(Source: http://www.mayoclinic.org/diseases-conditions/stomach-cancer/basics/symptoms/con-20038197)
NEW TECHNOLOGY: Treatment options for stomach cancer depend on the stage of your cancer and your overall health. With traditional surgery, the doctor will remove all of the stomach cancer and a margin of healthy tissue. All surgery carries a risk of bleeding and infection and if all or part of your stomach needs to be removed you may experience digestive problems. Now doctors at Cleveland Clinic are using a new technique known as endoscopic sub mucosal dissection or ESD on stomach cancer patients. ESD is a much less invasive procedure than traditional stomach cancer surgery and uses an endoscope that goes through the mouth. John Rodriguez, MD General Surgeon at Cleveland Clinic said "We're able to almost peel off these layers without taking a full thickness part of the organ." With the ESD procedure surgeons are able to leave the entire stomach intact and there are no incisions which mean a faster and less painful recovery. The risk of infection is also much less.
(Sources: http://www.mayoclinic.org/diseases-conditions/stomach-cancer/basics/treatment/con-20038197, John Rodriguez, MD)
FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT:
Caroline Auger
216-636-5874
John Rodriguez, M.D., General Surgeon at Cleveland Clinic talks about a new minimally invasive surgery to remove stomach tumors.
Interview conducted by Ivanhoe Broadcast News in May 2015
How invasive is the procedure?
Dr. Rodriguez: If you look at the history of how we treat some of these medical problems, years ago, the initial approach was to do these big open operations and we evolved to the minimally invasive operations which were small incisions in the abdomen. Now what we're trying to do is actually get rid of the incisions all together and do it through natural orifices like the mouth, so this is actually in terms of invasiveness, much less invasive than the open operation and it's even less invasive than the laparoscopic operation.
How would you traditionally go about cancers of the stomach and the esophagus?
Dr. Rodriguez: The treatment for cancers both in the stomach and in the esophagus is usually a multi-team approach in terms of the oncologist working with the chemotherapy part, radiation specialists, and surgeons working together. It typically involves removal of part or the entire organ and some sort of reconstruction depending on what the surgery is.
Tell me about how the procedure works.
Dr. Rodriguez: The procedure works by using the endoscope which is a flexible hose with a camera at the tip that we have been using for a very long time for diagnostic purposes. We go through the mouth and when we find these small lesions the goal is to use some special instruments and techniques to cut these lesions off without taking a big part of the organ.
Can you tell me the difference between when you do the surgery with a small incision versus a minimally invasive surgery?
Dr. Rodriguez: Sure, if you try to understand how cancer typically grows especially in the gastrointestinal tract, it grows by layers and it typically starts at the most superficial layer which is called the mucosa. What we have been trying to do is catch some of these cancers in a very, very early stage and using the endoscope, we're able to almost peel off these layers without taking a full thickness part of the organ. When we do the operations with other techniques, we have to remove the whole segment of the stomach that's involved by the cancer. These are not very common in this country. It's more common in some of the eastern countries like Japan and China. It's been difficult to identify patients that would benefit from this kind of procedure, but the good thing is that now we're developing these techniques and trying to give it different approaches.
Is there a lot of difference in the time that it takes to do the procedure?
Dr. Rodriguez: It's very similar to when we started doing minimally invasive techniques.
As we get more proficient, with the procedure we tend to shorten our operative times. I think at this point it's very similar to laparoscopy, but the goal is to make it even shorter so to expedite the recovery time.
And about how long are we talking?
Dr. Rodriguez: It depends on the lesions. They can take anywhere from an hour to 4 or 5 hours.
Are there any side effects that are different when you do the procedure through the mouth?
Dr. Rodriguez: The typical risks that we talk about for surgery like infection and bleeding are a little bit different, so we haven't really seen any risk of infection because we're working through the normal regular orifices. The risk of bleeding is less than with standard operations, but it's not zero. And the biggest risk is perforation which would sometimes could require an additional procedure to fix,
And that would be like a tear somewhere going down?
Dr. Rodriguez: It would be a hole right where we cut the tumor out.
Do you ever have any response when you say I'm going to do the surgery through your mouth and take part of your stomach out?
Dr. Rodriguez: I think when patients go through the diagnosis they're looking for guidance and help. I think they're excited to learn that we have less invasive ways to take care of them and especially if it's going to help expedite the recovery and they're going to have less pain after surgery, so they're always excited to hear about this new way of doing things.
I bet. It makes a big difference if you don't have to have a big incision somewhere.
Dr. Rodriguez: It does absolutely.
Are there any additional risks to doing it this way?
Dr. Rodriguez: I don't believe so. I think the biggest risk that we're concerned about is making sure that the tumor we are trying to remove is amenable to this kind of therapy because every time you treat a tumor, especially malignant ones, you're worried about the risk of them coming back. You have to make sure that you select patients and identify the ones that are really going to benefit from this.
Do you think you'll be doing more surgeries like this and less open surgeries in the future?
Dr. Rodriguez: Well I think that's been the tendency in our field. One of the things that we've done, especially for these kinds of techniques, is to team up with some of our colleagues from other specialties like our gastroenterologist and try to work together to get the best of both worlds in terms of advancing these techniques. I think a lot of the applications that we're trying to do is hopefully going to help patients in a less invasive way. I hope that we are able to develop newer techniques and evolve from this way of treating cancer.
So what's next?
Dr. Rodriguez: That's the big question. I think what we're trying to do is learn from doing these procedures and try to give it a more broad application especially because we don't see a lot of these early gastric cancers here in the United Sates. And typically by the time we diagnose them, they're beyond the phase where they can be treated with this approach. So, what we're trying to do is use these techniques to treat other problems, some of them are benign, some of them are not so benign. But, hopefully try to learn from the techniques and give it a more broad application.
Are a lot of these minimally invasive surgeries done with a surgical robot?
Dr. Rodriguez: These kinds of surgeries are not because this is mostly endoscopic approach. I think a surgical robot has been used as a tool to assist with some other minimally invasive techniques, but this is not something that at this point benefits from the robotic technology that we have for other applications.
Would the limitation for this type of procedure be that it has to be early stage cancer?
Dr. Rodriguez: Yes. That's actually the biggest limitation because the problem in this side of the world is that cancer does not typically evolve in that manner, so by the time that we diagnose patients, they're beyond the point where they would benefit from this kind of approach. That's why I think identifying risk factors and trying to catch these tumors in an early phase would be the ideal situation to be applied to these techniques.
Does it matter if the tumor is malignant or benign?
Dr. Rodriguez: It does matter. We have to try to catch malignant tumors in a time where they haven't spread beyond the superficial layers of the stomach or the esophagus. When it's a cancer, it's always concerning that a cancer might have advanced beyond the point where it's treatable by this, so it does matter. I think we can be a little more aggressive with nonmalignant tumors. But with malignant tumors, we have to try to maintain the principles of therapy because our goal is to ultimately help the patient in the best possible way.
And does insurance usually cover the procedure?
Dr. Rodriguez: We're starting to work with some of our specialists in terms of coding and billing to try to help some of the insurance companies understand that these procedures do offer a huge benefit. So as of now, I think we've gotten good collaboration so it is covered by insurance.