Technology: The opening of a dedicated endoscopic ultrasound centre in Beaumont Hospital, Dublin early next year will give a major boost to the diagnosis and treatment of lung, stomach, pancreas, oesophagus and rectal cancer, which account for almost four out of 10 of all cancer deaths in Ireland.
Although still in its infancy in Ireland, endoscopic ultrasound (EUS) technology is recognised as the most accurate method of gauging the extent of cancers of the gastrointestinal tract and lung and has become the routine standard of care in many countries.
Medical research indicates that gauging the extent of cancer, or staging, by EUS leads to a reduction in tumour recurrence rates in patients with oesophageal and rectal cancer and increased survival rates in patients with oesophageal cancer. It has also proven to be cost-effective in the management of these patients.
Currently, there is only limited availability of EUS in Ireland, with the majority of patients being seen in the Mater Hospital in Dublin.
The development of EUS technology in Ireland brings enormous potential to improve the care and outcome of patients in Ireland with the most commonly encountered malignancies, according to Dr Gavin Harewood. Dr Harewood studied medicine in NUI, Galway and is returning to Ireland from the Mayo Clinic in Rochester, Minnesota, to establish the new service in Beaumont.
EUS is used to examine the lining and walls of the upper and lower gastrointestinal tract and nearby organs such as the pancreas and gall bladder. It involves passing a thin, flexible tube called an endoscope through the mouth or the rectum to the area to be examined. The endoscope is equipped with a small ultrasound transducer that produces sound waves that create an image of the area. Unlike an ordinary endoscope, the ultrasonic properties of this instrument allow medical practitioners to look behind the lining of the intestinal tract as well as at the surrounding structures such as the lungs and pancreas. It can also "visualise" and sample lymph nodes with abnormal appearances.
The technology allows for more accurate assessment of the extent of cancer, which leads to better care, improved patient outcome and reduced cancer recurrence, according to Dr Harewood. It also translated into overall cost savings in patient management, he added.
In the context of both oesophageal and rectal cancers, research has demonstrated that accurate determination of tumour extent by EUS allows more appropriate treatment decisions to be made by the patient's physician.
Medical research has shown that the use of EUS in guiding treatment decisions leads to a reduction in recurrence rates of oesophageal and rectal cancers and, in the case of oesophageal cancer, it actually leads to an improvement in the patient's overall survival.
A study carried out by Dr Harewood at the Mayo Clinic indicated that oesophageal cancer patients evaluated with EUS had a 60 per cent survival rate two years after treatment compared with the 40 per cent survival rate of patients evaluated without EUS.
EUS could also help avoid unnecessary expense in the assessment of patients with cancers of the lung, rectum, pancreas and oesophagus, said Dr Harewood. Research has shown that the ability of EUS to accurately detect more advanced disease, which is not treatable by surgery, avoids the expense and morbidity of an unnecessary trip to the operating theatre.
An important application of EUS technology is in the treatment of patients with pancreatic cancer, who often encounter difficulties with abdominal pain.