Q&A Topic: Endoscopic Cancer Screenings
Edward Lebovics, MD, FACP, FACG, AGAF, FAASLD
Q: What is endoscopy? Can you describe the procedure?
A: Gastrointestinal endoscopy is the examination of any part of the GI tract with an endoscope, which is a flexible instrument that has a video chip at its end. It can be navigated either through the mouth into the esophagus, stomach and small intestine, or via the anus, which is called colonoscopy, through the colon and into the lower part of the small intestine.
With our current technology, we can access just about anywhere within the entire GI tract, as well as into the bile duct, and into the pancreatic duct, for direct video examination. Once one makes a diagnosis of some suspicious area, one can also take biopsies or remove tissue during the procedure.
Q: How do you address patient concerns about endoscopic procedures—for example, the concern of sending a tube down their throat?
A: Both upper endoscopy and colonoscopy are routinely done under deep sedation, under the care of an anesthesiologist, so the patient is completely unaware of the procedure. They have no discomfort whatsoever. Generally, a short-acting sedative is used, and they’re awake before they leave the room. So they’re asleep and they wake up, really, within the moments after the procedure is completed and go home the same day.
Q: What types of cancer can you screen for using endoscopy?
A: In terms of endoscopic cancer screening, most commonly, people think of colonoscopy, which is recommended for the entire population, even at average risk, at age 50. [We] look for premalignant polyps that can be removed and prevent these from progressing in the future to cancers.
There are other areas that in recent years have been a kind of a paradigm shift in how we prevent cancers. One is Barrett’s Esophagus, a change in the lining of the esophagus that is a result of chronic acid reflux and is associated with an increased risk of esophageal cancer. We can identify the patients [at risk] and do surveillance to follow them. If there are changes towards cancer, we can then perform endoscopic treatments to remove the abnormal tissue.
Another area is for patients with colitis, who are at risk for developing colon cancer. This colon cancer is different than the colon cancer we were talking about before in that it may not go through a stage of a premalignant polyp. At colonoscopy, we stain the tissue with a dye, and that allows us to identify areas of suspicion that can be biopsies or resected.A third example is a condition called sclerosing cholangitis, which is associated with a significant risk of cancer of the bile duct. We now have something called a spyglass device, a miniature scope that is passed through the standard scope into the bile duct, and provides a direct picture of the bile duct. Through that tiny scope we can pass a tiny biopsy forceps for taking directed biopsies in the bile duct. That significantly increases the yield of picking up abnormalities that may allow surgeons to intervene.
Q: How do these procedures improve early detection and treatment of these cancers?
A: Years ago, in the case of colitis patients, we would perform random biopsies, sometimes 40 or more biopsies throughout the colon, looking for changes called dysplasia [pre-cancer]. Those patients would be considered for colectomy or removing the colon. With our current technology, we do a colonoscopy and stain the tissue with a dye that allows us to identify areas of suspicion. So, we can remove the specific areas of abnormality, prevent the cancer and allow the patient to keep his or her colon. Also, years ago, for Barrett’s Esophagus, if it progressed to dysplasia, the patient would be a candidate for a surgery to remove that segment of the esophagus, which was an intervention that carried significant morbidity and some mortality. Now we are able, with our endoscopic technology, to identify the sites of dysplasia and resect just the abnormal tissue through the scope. This has really changed the management of Barrett’s Esophagus in a way that we can prevent cancer without the major surgery that was required in the past.
Q: Stopping the cancer before it starts?
A: That’s the goal.
Edward Lebovics, MD, FACP, FACG, AGAF, FAASLD
Westchester Medical Center, flagship of the Westchester Medical Center Health Network (WMCHealth)
19 Bradhurst Ave, Suite 2550S
Hawthorne, NY 10532
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