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Tool Can Find And Diagnose Cancers Earlier

Tool Can Find And Diagnose Cancers Earlier

North Shore Hospital, Waitemata DHB, is introducing a new Auckland-wide regional service that will allow more accurate diagnosis of the extent of cancers for hundreds of patients.


North Shore Hospital gastroenterologist Russell Walmsley and staff.

The new service, using Endoscopic Ultrasound (EUS), is the first in Auckland and will be available regionally with Auckland, Waitemata and Counties Manukau DHBs expected to refer the majority of patients. The only other similar service is in Tauranga.

EUS will be used in the diagnosis of upper gastrointestinal (UGI) cancers in the oesophagus, stomach, bile ducts, pancreas and lung. Dug 1995 to 1997 there were 170 oesophageal cancers, 410 gastric cancers and 312 pancreatic cancers diagnosed in the Auckland area. North Shore Hospital gastroenterologist Russell Walmsley will be the first doctor in Auckland to train in the technique using the EUS device, which provides 3-D imaging of lesions and growths.

He says the new technology surpasses other imaging tests providing the physician with a detailed picture of the lining of the bowel and the tissues close by to help more accurately determine whether or not a patient should have surgery or other treatments like chemotherapy and radiation.

“More patients will now have access to the best technology to assist in the early detection, management planning and staging of cancer.”

EUS has also been shown to save on bed days, and in well-defined clinical situations be the most cost effective investigation over CAT scanning and other diagnostic procedures for UGI cancers.

“CAT scanning provides accurate readings of UGI tumours in about 50-60 per cent of cases. The EUS provides more detailed information on the position, size, depth and shape of tumours, increasing accuracy to 80 to 90 per cent.”

The system uses an interface between an endoscope and ultrasound machine, providing the best picture of how to handle cancerous growths. It can also be used to take samples without the need for surgical intervention.

Many changes in cancer growths can be very subtle until they reach the size where they become unmanageable. EUS is able to identify these changes early and accurately, in many instances eliminating the need for surgery.

Earlier this year Dr Walmsley travelled to Hong Kong for training in the use of EUS but was forced to return early due to the outbreak of SARS. As part of that continuing training Dr Yuk Tong Lee from the Prince of Wales Hospital, Hong Kong will be at North Shore from September 22-26 assisting Dr Walmsley in an intense week of EUS lists.

Dr Walmsley says the EUS service will provide a focus for the co-ordination of UGI cancer care in Auckland.

Waitemata DHB CEO Dwayne Crombie says it is also hoped that North Shore Hospital will become the national training centre for the technique, so that up and coming specialist registrars will be able to set up similar units in other major cities in New Zealand.

MEDICAL BACKGROUND: EUS is an imaging technique, developed over the last 20 years, which allows better staging of gastrointestinal tumours, especially of the oesophagus, stomach and pancreas. It is now recognised as a valuable, and in some countries (e.g. the UK), an obligatory tool in deciding between the therapeutic options for these malignancies. In addition EUS has roles in biliary imaging, allows aspiration cytology of mediastinal and celiac lymph nodes, accurate treatment of pancreatic pseudocysts and celiac axis block for pain relief. Through more appropriate use of investigative modalities EUS has now been shown to save on bed days, and in well-defined clinical situations be the most cost effective investigation over CT and ERCP (Am J Gastroenterol 2002;97:452, and 2001;96:2900) Worldwide, cancer services are being organised into special interest groups to provide the best outcomes possible for patient populations. In Auckland the Regional Upper Gastro-Intestinal Interest Group was established in 2000 as a first step in coordinating the care of patients with these pathologies. There is now a world-class hepato-biliary unit at Auckland Hospital, and Professor Iain Martin was recently appointed as Professor of Upper GI Surgery based at Middlemore Hospital. The time is therefore right to develop an EUS service for the population of the Auckland Region. North Shore is an appropriate place in view of our recent acquisition of digital radiological services, MRI, expanded expertise in the Gastroenterology Unit and the ease of patient access. It is also appropriate that the largest Health Board in Auckland play a role in the joint provision of high-class care to the people of the region.

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