I have had a dry spell in blog entries recently because of health issues. Not mine, but rather of my partner Portia. Several weeks ago she had a blemish on her face removed, one that had been present for many years, but which aroused concern from her physician. It was excised, the skin discreetly and expertly welded together over the gap and was on its way to becoming an invisible scar when she learned, two weeks later, that the suspicious patch that was removed was actually a tumor, a melanoma, the most concerning of the various types of skin cancer.
The diagnosis launched a rapid response action from the health care system, and within a week she was back in an operating room, this time to locate and extract the “sentinel nodes” of the lymph system, the mechanism by which cancer spreads to other organs. And while she was there, an additional margin of tissue around the original tumor was removed.
It was a week of uncertainty-hell. I learned more about melanoma, and cancer in general than I ever expected or wanted to know. As one who has spent a career on the “bleeding edge” of technology, I was both amazed and aghast at the state of knowledge in the field of cancer. On the one hand I was exposed to decades of research in the “war on cancer” that has been a theme and cause in our culture since I was a child in the sixties. We know so much more than we did a half-century ago.
But I was appalled at the protocols we follow in the battles to conquer it. First, I wondered why after the initial blemish was removed it would take a full two weeks or more for a pathology report to convey the discovery that the tissue contained cancerous cells. In an age where just-in-time inventory, immediate information turnaround, and zero backlog has proven its value in the industrial and manufacturing worlds, why would an examination of tissue take TWO WEEKS to generate a diagnosis? (Later I would find out that pathology reports can take less than two days, and sometimes even within-the-hour response, so I know there is not some intrinsic latency involved).
I learned a little about the world of pathologists, experts in the appearance of normal and abnormal tissue samples. I have been a subscriber to technical journals in image processing and pattern recognition for the last thirty years, and having read their technical articles (admittedly over my head), I fully expected and assumed that examining tissue samples under a microscope had been automated long ago, the technologies harnessed to make objective and quantitative measurements of normal versus abnormal cells, and estimates of the mitotic rate of cell division. But evidently this is not the case. Tissue samples are, today, still manually examined by trained specialists.
A pathologist’s day must be extremely tedious. Thin slices of tissue are prepared and dyed according to a complex technical procedure. A view under the microscope reveals the cells and their structure. Most samples (>80%) are normal. Of the others, many are ambiguous. I don’t know how pathologists work; I would hope that more than one set of eyes reviews the slides in order to make a conclusion, but I can imagine that the sheer volume of samples and the assembly line process involved, could inure a pathologist to the signatures they are looking for. They become weary, fatigued, or distracted, or preoccupied, and a target visual alarm pattern could easily be missed (ala Michael Crichton’s Andromeda Strain).
I was also appalled at what I call the “margin of ignorance”. Even though the original excised blemish of a few millimeters was examined and found no cancer cells at its periphery, the protocol for the cancer’s cure called for a full 4-centimeter diameter surgical margin. This is a large fraction of Portia’s face, and even though her life and well-being are worth far more than a disfiguring cut of this dimension, I was surprised that it was removed immediately, without the additional information of the state of the sentinel lymph nodes. (Is this the result of some insurance-driven cost efficiency of operating room expense?)
In her case it will result in a long scar, a badge of honor in winning the battle against melanoma, but as I thought about others, including a sister-in-law, who on finding a tiny lump, undergo a complete removal of their entire breast and sometimes even both, I cannot help but think of Star Trek’s Dr McCoy’s reaction to 20th century medicine as “barbaric”. Surely there is a better solution than this!
At the very least, computer vision and image processing algorithms can be put to bear on the detection and diagnosis aspects of the problem. I will be researching more into why when today we have Siri and Shazam, and Facebook-friend face recognition, we do not also have automated cancer cell measurement.
Portia had a clean pathology report on her excised lymph nodes. We celebrated, we laughed, we made love, and we made plans for our life together, including more projects for This Odd House.
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