What is at stake?

Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells and is the second leading cause of death worldwide. In the year 2000 there were 10 million new cases of cancer reported worldwide. This resulted in 6 million deaths and approximately 22 million people living with cancer worldwide. It is likely that by 2020, there will be 15 million new cases of cancer and 10 million deaths each year worldwide. (Source: Journal of Lancet Oncology).

This simple definition of cancer makes it quite clear that cells play a key role in the stages of development cancer development. These grim statistics prove that something must be done to improve cancer diagnosis. Some 90 percent of cancers are preceded by a curable, pre-cancerous/non-invasive stage that progresses without symptoms over a period of years before reaching a cancerous/invasive stage. The figure below shows schematically the very first steps of a cancer in the eptithelium, the superficial layer of the tissue.

Anomalous cells appear in the deepest layer of the epithelium, directly above the basal membrane that separates the epithelium from the deeper layers of the tissue and provides very strong and effective protection. Because there are no blood vessels in the epithelium, epithelial cells cannot spread to other parts of the body, hence the importance of detecting an anomaly at a very early stage – before the cancer becomes invasive (once the basal membrane is broken, corresponding to the case shown on the right of the figure).

A ProFlex optical microprobe, designed and developed by Mauna Kea Technologies, is represented here to show how performing a microscopic examination of the epithelium in vivo and in situ, can enable early and precise diagnosis of a cellular anomaly, which in turn could be a precursor of cancer. Although such anomalies can be located by other technologies, such as autofluorescence imaging, they are not able to provide precise determination.

Because cancer is a disease that affects cells, its diagnosis requires the visualization of the tissue at the cellular level. For epithelial cancers (most cancers affecting solid organs), the procedure is to take a tissue sample (biopsy) and to have it examined under the microscope by a pathologist. Most of these biopsy procedures are performed via endoscopy.

An endoscope allows for visualization of the tissue’s surface at the macroscopic level. It can neither see below the surface nor provide a microscopic view of the tissue. Because of this default, biopsies have to be performed without a relevant visual guide. An instrument that could provide a local sub-surface, microscopic vision of the tissue could serve as a guide during the biopsy. This is precisely what Mauna Kea’s Cellvizio is designed to do.

It is also a fact that the earlier a cancer is diagnosed, the higher the survival rate. Theoretically, if diagnosis occurred before the cancer became invasive, the survival rate could approach 100 %. This leads to the conclusion that performing in vivo cellular imaging below the tissue surface is key to improving the cancer detection chain process.

The histological examination of biological tissues in vivo and in situ can be referred to as “optical biopsy”, and the advantages of performing an optical biopsy are widespread.
• Biopsy guidance: immediate improvement of diagnosis reliability.
• Earlier diagnosis of cancers, better treatments, improved life expectancy.
• Improved patient comfort and quality of life through painless, minimally invasive procedures.
• Cost effectiveness: reduces the overall number of exams (all-in-one procedures) and biopsies

An instrument capable of in vivo cellular imaging, such as those developed by Mauna Kea, brings an immediate answer to the need for enhanced visual information in biopsy guidance for cancer detection.

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