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| Cancer diagnosis |
Endoscopy procedures | |
The emergence of optic fibres and cold light has revolutionised the endoscopic approach to tumours. Examinations, which in the past were painful, are now easy to perform, well tolerated and allow the clear exploration of airways (laryngoscopy, bronchoscopy), digestive tract (oesophagoscopy, gastroscopy, colonoscopy, rectoscopy), urinary tract (cystoscopy, ureteroscopy), genital apparatus (hysteroscopy), under local or general anaesthesia which can be repeated if necessary.
All of these examinations enable a precise description of the tumour but, more importantly, offer the possibility of performing biopsies to obtain pathological diagnosis before any radical treatment. In combination with an ultrasonographic probe, they study the extent of tumour invasion (which is necessary for most classifications) and look for nearby satellite nodes.
Other more complex examinations require general anaesthesia and are performed to obtain a biopsy sample in a less traumatic manner than via surgical exploration: mediastinoscopy, pleuroscopy, laparoscopy, arthroscopy.
The use of a television camera allows a better description of the lesion and offers the possibility of involving several physicians in the endoscopic exploration.
Abdominal surgery through laparoscopy has not yet totally proved its worth in oncology, except for very limited tumours or in a diagnostic setting (such as lymphadenectomy by coelioscopy). It requires a very well trained surgeon and team. The risk of cancer diffusion along the puncture openings is promoted by intraabdominal hyperpressure and clear, carcinologically satisfactory surgery may be difficult to prove (cf. definition of complete carcinological surgery). The use of a robot could be of great interest for other laparoscopic surgical acts (urology, gynaecology) although its cost-effectiveness has not yet been demonstrated.
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