Under the Knife

An experimental surgical knife (left) can help surgeons make sure they've removed all the cancerous tissue, British doctors have reported; and, as a former and current cancer patient, this is very good news to hear for this writer.

Surgeons typically use knives that vaporize tumors as they cut, producing a sharp-smelling smoke. The new knife analyzes the smoke and can instantly signal whether the tissue is cancerous or healthy. 

This writer was recently  diagnosed with an Acral Lentiginous Melanoma on my left foot which was surgically removed but I have to wait for several days for my Surgical Oncologist to receive word from Pathology that he had gotten it all; otherwise, I would have been scheduled for another surgery.  This waiting around was mentally exhausting for me.

Dr. Zoltan Takats of Imperial College London suspected the smoke produced during cancer surgery might contain some important cancer clues. So he designed a "smart" knife hooked up to a refrigerator-sized mass spectrometry device on wheels that analyzes the smoke from cauterizing tissue.

The smoke picked up by the smart knife is compared to a library of smoke "signatures" from cancerous and non-cancerous tissues, information appears on a monitor: green means the tissue is healthy, red means cancerous and yellow means unidentifiable.

To make sure they've removed the tumor, surgeons now send samples to a laboratory while the patient remains on the operating table. It can take about 30 minutes to get an answer in the best hospitals, but even then doctors cannot be entirely sure, so they often remove a bit more tissue than they think is strictly necessary. If some cancerous cells remain, patients may need to have another surgery or undergo chemotherapy or radiation treatment.

"(The new knife) looks fabulous," said Dr. Emma King, a head and neck cancer surgeon at Cancer Research U.K., who was not connected to the project. The smoke contains broken-up bits of tumor tissue and "it makes sense to look at it more carefully," she said.

The new knife and its accompanying machines were made for about >250,000 ($380,486) but scientists said the price tag would likely drop if the technology is commercialized.

The most common treatment for cancers involving solid tumors is removing them in surgery. In the U.K., one in five breast cancer patients who have surgery will need further operations to get rid of the tumor entirely.