"Cancer is a demonic pregnancy." Susan SontagMy friends,Tiresias...

"Cancer is a demonic pregnancy."

Susan Sontag

My friends,

Tiresias has written much on the role of Optiscan Confocalfocal Laser Endomicroscopy (CLE) in its role in cancer surgery. His interest in Optiscan was first stimulated by the potential role of this technology and treatment of malignant brain tumour (glioblastoma multiforme ). This tumour which affects young and old and which has a mean survival of 6 to 12 months. In spite of all the developments in neuroimaging, neurosurgery, radiotherapy and chemotherapy in the last 60 years, the prognosis has not improved at all. The survival, or shall Tiresias, the non-survival remains the same. The deaths are the same, young and old. The cost per death however, has exploded. The "breakthroughs'(not) are touted weekly and breathlessly on your TV's news. But there is no change! Why is this thus?

The main reason this is thus of course, is that the neurosurgeon is unable to tell when he is in tumour and when he is in normal brain and is unable to tell how much normal brain or tumour he's resecting and whether he is leaving cancer cells behind, which he usually is. Tiresias foresaw that CLE enabled real-time, in-vivo, digital histopathology, and that it must revolutionise malignant brain tumour surgery, and finally for the first time in the 60 years, it improve the prognosis for this devastating cancer.

Although the prognosis for breast cancer has improved, the same issues in breast cancer surgery are a major problem, and a major impediment to progress in breast cancer. Just as in brain surgery, the breast surgeon cannot tell whether there are cancer cells left behind. As a result, in 30% of breast cancer patients, a second surgery has to be performed and in all those who, because postoperative imaging shows there is actually a macroscopic mass of tumour left behind. But then when this is re-operated, there is no intraoperative microscopic examination for tumour cells, at the microscopic level, and therein is the big problem and the reason for the "relapse". But of course it's not a relapse. Relapse suggests the demon has returned. But of course it was there all along. The cancer cells were never looked for intraoperatively and have just multiplied again. Other macroscopic techniques being touted for this problem, macroscopic techniques, other than cellular level in-vivo real-time digital microscopy miss the point. They will not change these outcomes. This is where Opitscan comes in and how it can revolutionise breast cancer treatment, a disease far more common than malignant brain tumour. Therefore my friends, there should not be any brain or breast cancer surgery done now without the Optiscan endomicroscope in the operating theatre.

But there is more and bigger. Brain and breast cancer, each one on their own, is a huge advance, which will transform cancer surgery. Each on their own is a company makers. Further applications in other cancers will undoubtedly come and should be routine for all cancer surgery. But this is still small beer when we consider the application outside the operating theatre. The far bigger application is cancer screening and cancer detection in the clinic. The immediate application, just awaiting regulatory approval is oral cancer. And Then even bigger gastrointestinal cancer. With oral cancer, the current screening of oral lesions, cancer, precancer, and non-cancers, given is obsolete. There is no justification for patients with oral lesions, any lesions, and especially precancerous lesions such as leukoplakia, present in 5% of the population not being examined and monitored with our CLE endomicroscope. Every oral surgeon and oral physician should have an Optiscan endomicroscope when seeing these patients. Similarly with gastroenterology. All endoscopy units should examine endo-microscopically suspicious lesions seen in the gastrointestinal tract. Every Endoscope suite will have a CLE unit to examine any suspicious lesions immediately, in vivo, in real-time, with the digital endo-microscope. These two areas will be orders of magnitude bigger than the intraoperative scanning. But of course, that's still not all. This is just the beginning of screening for cancer with live in vivo digital histopathology. Then there is the skin. The same will apply to skin cancers for screening and for edge detection. Tiresias previously discussed Mohs surgery. This is a nice earner for the dermatologists and dermatological surgeons. With CLE it is of course already obsolete. There is no rational medical reason for the time it's taking to bring this technology to the clinic and the operating theatre. No rational medical reason, but of course we have the FDA approval process, and this bureaucracy has process and method beyond all reason. Against such bureaucracy and stupidity even the gods immortal battle in vain. Nevertheless, this is still a formality, nothing but a formality, and it is coming.