New hope for cancer patients

Tuesday, June 11, 2019 - 12:45

The fu­ture looked grim for Ami­ra Ba­boolal. 

With four tu­mours grow­ing near crit­i­cal parts of her liv­er, it would have been risky per­form­ing an­oth­er open surgery in un­der two years.

But with­in 24 hours af­ter the 61-year-old can­cer war­rior was wheeled in­to the the­atre at the South­ern Med­ical Clin­ic in San Fer­nan­do on Mon­day, she was on her way home with the tu­mours burned dead.

The Mt Lam­bert res­i­dent was the first pa­tient in the Eng­lish-speak­ing Caribbean to un­der­go a mi­crowave ab­la­tion of col­orec­tal metas­tases us­ing rev­o­lu­tion­ary equip­ment called the Em­print Ab­la­tion Sys­tem that de­stroys the tu­mours.

For the first time, the tech­nol­o­gy which was de­vel­oped by in­ter­na­tion­al med­ical equip­ment de­vel­op­er, Medtron­ic was used in T&T.

Prof Shamir Cawich, who spe­cialis­es in liv­er and pan­cre­at­ic surgery, said that not on­ly will pa­tients have a short­er re­cov­ery pe­ri­od, it will sig­nif­i­cant­ly in­crease their five-year rel­a­tive sur­vival rate.

The Be­lize na­tive, who lec­tures at the Uni­ver­si­ty of the West In­dies, said that the pro­ce­dure can al­so be used to kill tu­mours in the kid­ney and lungs that are with­in five cen­time­tres in di­am­e­ter. Based on the lo­ca­tion of the tu­mours in the or­gans, it can ei­ther be done through open surgery or la­paroscopy.

In 2017, Ba­boolal had surgery to re­move tu­mours from her colon. But ear­li­er this year, she re­turned to the Port-of-Spain Gen­er­al Hos­pi­tal (POS­GH) for prob­lems with gall­stones. Dur­ing one of her vis­its, she was in­struct­ed to have a blood analy­sis and fol­low­ing an MRI and CT Scan, it was found that she had four tu­mours in her liv­er. What made her sit­u­a­tion even more damn­ing was that part of her liv­er had al­ready been re­moved.

“With this (pro­ce­dure) it is a much safer way and chances of heal­ing is quick­er be­cause it is not cut­ting and that type of thing. So I fig­ure it is safer than do­ing the tra­di­tion­al way, on top of which, I don’t think they can be­cause I don’t have a whole liv­er.

“I had can­cer surgery done in 2017 for my colon and it metas­ta­sized 18 months af­ter that surgery. But that surgery was still suc­cess­ful; I don’t have can­cer there again. It was re­al­ly sur­pris­ing to hear that it went some­where else. It is al­ways a fright­en­ing thing to have surgery, but there was al­ways a chance,” Ba­boolal said.

Ba­boolal’s pro­ce­dure was an open surgery be­cause her tu­mours were very close to very crit­i­cal struc­tures that if dam­aged, could have caused sig­nif­i­cant prob­lems. Al­though she was ner­vous be­fore the surgery, she joked that as the first pa­tient for the pro­ce­dure, she was a bit of a celebri­ty. How­ev­er, she rel­ished the op­por­tu­ni­ty to have a surgery that would last up to an hour as op­posed to the eight hours it would take us­ing tra­di­tion­al meth­ods.

Her surgery was fol­lowed by an­oth­er pa­tient who un­der­went a mi­crowave ab­la­tion of neu­roen­docrine liv­er metas­tases. Both pa­tients were from the POS­GH and were done pro-bono by the sur­geon and hos­pi­tal.

Med­ical sources said liv­er surgery can cost up to $200,000 pri­vate­ly as it would in­clude a pos­si­ble three-day stay in an in­ten­sive care unit and up to two weeks stay at the in­sti­tu­tion.

Cawich said that both pa­tients were ex­pect­ed to be dis­charged on Mon­day as the pro­ce­dure on­ly re­quired him to make an in­ci­sion that was mere mil­lime­tres in di­am­e­ter.

“I think this is a very good op­tion for pa­tients who have tu­mours in their liv­er. It can al­so be done for tu­mours in the kid­ney, for tu­mours in the lungs but this now adds a whole new tool for these pa­tients, which pre­vi­ous­ly was not avail­able. As you can see which such good sur­vival rates, a low com­pli­ca­tion pro­file, this is some­thing that will ben­e­fit the pop­u­la­tion sig­nif­i­cant­ly,” Cawich said.

Sur­vival rate

Even with the best chemother­a­py avail­able, Cawich said that the ac­cept­ed five-year sur­vival rate was be­tween eight and 10 per cent, but with the en­tire tu­mour be­ing killed, he said this in­creas­es sig­nif­i­cant­ly.

“Once can­cer has spread out­side of the colon to the liv­er, the sur­vival rate, if you do noth­ing, is about a one per cent chance that you will live up to five years. With the best chemother­a­py you have avail­able, the chance is any­where be­tween five and eight per cent, maybe up to a 10 per cent chance that you will live to five years. With mi­crowave ab­la­tion, you can in­crease that to any­where be­tween a 30-40 per cent chance so you can see there it is chalk and cheese. Ob­vi­ous­ly, the best is still surgery. Surgery will give you up to 45 per cent, five-year sur­vival and a chance to sur­vive up to 10 years, which is about 20 per cent. But it again comes at the risk of sig­nif­i­cant com­pli­ca­tions.”

How it works

Medtron­ic prod­uct spe­cial­ist Vic­tor Lizar­di ex­plained that a per­cu­ta­neous an­ten­na which acts as a rod is hooked up to a gen­er­a­tor that emits mi­crowaves. Al­so at­tached is a tube used to pump a cool­ing liq­uid to reg­u­late the heat of the nee­dle that will be in­sert­ed in­to the can­cer­ous or­gan. Just like meat burns in a mi­crowave, the tu­mour is killed in the or­gan. The body then ab­sorbs the dead cells, pass­es it out and re­gen­er­ates tis­sue. Cawich said the liv­er has the ca­pac­i­ty to re­gen­er­ate and af­ter a year, about 90 per cent of the re­moved tis­sue would be re­placed. The equip­ment is be­ing dis­trib­uted by Bry­den Pi. Spe­cial­ist rep­re­sen­ta­tive Nichelle Sookdeo said that while South­ern Med­ical Clin­ic is its on­ly client, the ser­vice is in its tri­al phase in T&T and will hope­ful­ly soon be mar­ket­ed to the pub­lic health sys­tem.

- by Kevon Felmine. Photo by Rishi Ragoonath.