Advances in Technology | New Diagnostic and Surgical Techniques Help Doctors and Patients Fight Most Common Cancers

Tests to Diagnose Cancer

There are a variety of state-of-the-art tests available locally that are used by physicians throughout Concord Hospital health system to diagnose the presence of cancer in the colon, prostate, breast and lungs. A colonoscopy is used to screen for the presence of colon cancer. “Colon cancer screening and prevention are extremely important as the majority of colon cancers originate from polyps. Doctors are able to identify and safely remove them, so they don’t turn into cancer,” said Dr. Anne Granfield, a surgeon with Concord Hospital Surgical Associates.

A prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in the blood and is used to test for cancer in the prostate. The Concord Hospital Urologic Institute has advanced diagnostic capabilities using fusion biopsy, which combines the pictures from an MRI scan and an ultrasound to create a detailed 3-D image of the prostate.

To screen for breast cancer, a 3D digital tomosynthesis, or digital mammogram, is used as a routine screening tool for women beginning at age 40. A breast MRI (magnetic resonance imaging) may be used for select patients. A lumpectomy may also be used to collect a tissue sample for closer evaluation as well as to remove cancerous tissue. “When performing a lumpectomy, not only are we able to cure a patient, we now have the ability to leave their breast as close to the way it looked before the procedure,” says Dr. Sharon Gunsher, a surgeon with Concord Hospital Surgical Associates.

To effectively diagnose the presence of cancer in the lungs, a state-of-the-art endobronchial navigation system known as an ION machine is used to perform biopsies by surgeons to collect tissue samples. Using this technology, physicians are able to navigate from inside the lung with a bronchoscopy to an area containing a lesion to collect a tissue sample for biopsy. Concord Hospital Pulmonary and Critical Care practice also has a lung cancer screening program as a preventative measure to proactively screen individuals between the ages of 55-79 who either smoke, have stopped within the past 15 years, or had a history of smoking for a period of 30 years. As part of this program, patients receive a low-dose chest CT (computed tomography) annually as a surveillance strategy. If abnormalities are discovered, a regular CT will be performed on a patient followed by a visit with a pulmonary specialist or a primary care provider.

Surgical Advances Improve Patient Outcomes

In 2023, approximately two million people in the United States will be diagnosed with cancer, of which nearly 50 percent will be for cancers of the colorectal, prostate, breast and lung. The Payson Center for Cancer Care is helping people fight these most common forms of cancer surgically using both traditional methods and more advanced robotic-assisted surgery.

At the turn of the century, surgeons began using a new surgical technique called sentinel lymph node biopsy to precisely target and remove lymph nodes in the armpit area where breast cancer has advanced. Dr. Tajammul Shafique, a surgeon at Concord Hospital Surgical Associates - Laconia, said, “Through the use of these novel techniques, we are now able to minimize healthy tissue, resulting in cosmetic preservation of the breast, resulting in successful outcomes for both the patient and doctor. This has been a significant milestone over the past 20 years.”

Robotic-assisted surgery is a state-of-the-art technology surgeons use to perform complex procedures with precision, flexibility and control. It is considered to be minimally invasive because procedures are performed using small incisions.  Surgeons are able to perform delicate, complex procedures to treat cancer that may have otherwise been difficult with other conventional methods.

Benefits of minimally invasive surgery include:

• Less pain and blood loss;
• Shorter hospital stay and quicker recovery;
• Fewer post-operative complications, such as surgical site infections;
• Smaller, less noticeable scars;
• Conservation of healthy tissue, particularly by using diagnostic procedures involving the breast. 

As an example, twenty years ago, a colon or resection surgery would have required an overnight hospital stay to prepare a patient for the procedure, which would have been a complex, open surgery with a weeklong recovery. This technique is commonly used to treat patients with colon cancer because of the ease with which it enables surgeons to navigate the abdominal area with ease and precision. Through the use of minimally invasive surgical techniques, surgeons use smaller incisions, resulting in less discomfort and the need for pain medication along with faster recovery of bowel function.

Another advantage with robotic-assisted surgery is it takes less time to perform a procedure, such as in the case of prostate cancer where the typical length of surgery can be between three to six hours.  Patients treated for prostate cancer using minimally invasive surgery are able to leave the hospital the day after and have a quicker recovery, often returning to work within four weeks. 

 “From a surgeon’s point of view, there is less blood loss along with magnified views, so it is easier to identify the nerves on either side of the prostate,” said Dr. Amichai Kilvechy, a urologist at Concord Hospital Urologic Institute.

Robotic surgical systems are equipped with a camera arm along with mechanical arms containing surgical instruments controlled by a surgeon using a computer console near an operating table. Thoracic surgeons use this cutting-edge technology to surgically remove tumors in the lungs using small incisions. “With a robot, surgeons are able to remove more lymph nodes as well as perform a more accurate dissection, resulting in a superior quality specimen that can be sent to pathology for review,” said Dr. Alexandru Vaida, a thoracic surgeon in Cardiothoracic Surgery at Concord Hospital.

Future of Technology

Based upon the advancements in surgical treatment options to diagnose and treat the most common forms of cancer, what will the future hold? Dr. Anne Granfield, whose specialties include colon and rectal surgery, predicts advancements in minimally invasive surgery will continue, as such incisions will become smaller in size, which will minimize the appearance of scars. As robotic surgery continues to revolutionize treatment options and outcomes for doctors and patients, a long-term goal to treat prostate cancer will enable surgeons to preserve certain portions of the prostate instead of removing it altogether. Dr. Sharon Gunsher, who specializes in breast surgery, anticipates newer techniques in the future that will assist radiologists with identifying cancers earlier and smaller in size, particularly in younger women with dense breast tissue. Likewise, new developments in surgical techniques to diagnose and treat breast cancer will focus on localizing lesions that cannot be felt. As for treating lung cancer, robotic surgery will continue to revolutionize successful treatment outcomes for patients. Through the use of this state-of-the-art technique, surgeons will be able to offer surgical treatment options to sicker patients with lung cancer who could not have been successfully treated using other methods. In addition, surgeons will have the ability to effectively mark and extract lesions from the lung that otherwise could not have been removed.

Cancer Stats Facts: Common Cancer Sites, National Cancer Institute.