Ultrasound Is Ushering a New Era of Surgery-Free Cancer Treatment
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The article discusses the emerging use of ultrasound technology to treat cancer without surgery, sparking discussion on its potential applications, limitations, and comparisons to existing treatments.
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> Some researchers have raised concerns about histotripsy potentially seeding new cancer growths as tumours are broken up inside the body, meaning they can be transported to other areas. That fear, however, hasn't borne out in animal studies so far.
Watching Hank Green's YouTube video where he found out that his cloudy pee was cancer leaving his body, he was surprised that doctors don't tell you to expect it. It can be such a morale boost.
He did an evaluation about getting one for my local hospital.
Fun fact: using this ultrasound for prostate cancer treatment reduces the risk of erectile disfunction
I’m not aware of strong evidence in this area (not saying you’re incorrect).
For the liver indications, several elite radiology departments have had very poor outcomes with their patients, despite the strong public data. I would not, with my own prostate, try a new technology until at least a decade out, at least.
This technology is also now used to treat non-cancerous prostate enlargement (BPH).
There are other options besides prostatectomy or the untested histotripsy.
Histotripsy is early in its clinical life but I wouldn't say untested.
People who aren’t in medicine are very susceptible to advertising - this is why I’m writing so stridently
And a review: https://pubmed.ncbi.nlm.nih.gov/36686753/
Yes you can. If you had an array of ultrasonic transducers around the body you could have each of them in phase targeting a single spot. Beamforming is a thing we've been doing for years with RF. It's even more trivial with sound.
You just gotta catch the right wave
https://news.ycombinator.com/item?id=31630679
Apparently, only some tumors have a distinct and unique shape / size. The “trick” is to calibrate the resonance exactly to the size of the cancer cell. So that resonance would “hurt” only that kind of shape / size cell. Which was much harder to do than it sounds. Sadly not all cancer cells are unique and not that “easily” distinguishable by size
But I am not in the medical field and just repeating what I’ve read.
Well said. And it's either terrible or expensive (and sometimes also terrible as well).
Proton therapy for instance is amazing at targeting hard to reach tumors like those in the eye, but costs close to fix figures as it requires a team of people to design the treatment.
For comparison, a liver histotripsy costs $17.5k:
https://histosonics.com/news/histosonics-notches-significant...
Not a bad deal for a non-invasive life-saving surgery.
I looked into it deeper at the time and it's very difficult to untangle the true cause of death in many of these situations. While certainly these treatments are ultimately beneficial statistically, it is concerning that there's not as much discussion around their harm and the real risk rewards behind various treatments. I know from my own (non-cancer) experience that there is a very strong bias towards treatment even in cases where, once you break down all the risk and rewards, there is a strong argument for non-intervention.
Here in Canada, before assisted suicide was legalized, my grandfather (in his late 80s) refused any treatment for his kidney failure. He was ready to die and could barely walk or eat on his own anymore. There was a wink wink situation where as the kidney failure worsened, his morphine was increased to the point where it was fatal. The death certificate still said renal failure, though.
For me, if I ever got terminal cancer, I'd weigh the quality of life of treatment versus non-treatment. I've seen people go both ways and I've seen the results being right and wrong both ways. I don't want to spend my final months semi-alive on a bed or constantly messed up, though.
Not my experience. I have a loved one going through cancer treatment right now and they've been very up front about risks, side effects, and even talked about DNRs with them what they mean and how they can be applied.
People and their loved ones don't want to experience death. It's often as simple as that.
> There was a wink wink situation where as the kidney failure worsened, his morphine was increased to the point where it was fatal.
In the US, exactly because of situations like this, that sort of thing is a lot harder today to pull off.
> I'd weigh the quality of life of treatment versus non-treatment.
Something to consider, it's not a binary and treatment can look entirely different depending on the cancer.
You can, for example, do a lower than effective dose of chemo which will still be effective at slowing the growth of cancer.
Some therapies, such as immunotherapy, can be practically a walk in the park.
I'd suggest strongly in any case that you have a discussion with an oncologist if you ever get to that point. Things in medicine aren't nearly as black and white as people sometimes assume.
People also don't want (their loved ones) to suffer, especially needlessly. (I want to also stress that I'm not advocating terminating life, though I do think it should be an option - just that this is what my grandfather wanted).
> In the US, exactly because of situations like this, that sort of thing is a lot harder today to pull off.
I've anecdotally heard that a huge percentage of US medicare costs is desperately saving elderly people at the end-stages of life instead of a more palliative (and some would argue dignified) end. This was made worse during the Terri Schiavo case when the very idea was put up as anti-life and we were warned that "death panels" would be inevitably setup. DNRs are allowed, but alleviating the suffering leading up to the end is, for both better and worse, heavily restricted.
> I'd suggest strongly in any case that you have a discussion with an oncologist if you ever get to that point. Things in medicine aren't nearly as black and white as people sometimes assume.
I've been extremely lucky that cancer hasn't been much of an experience I've had to deal with in my circles. I'm mostly pro-modern medicine and I know a lot of progress is also being made. I hope that it never happens, but if it did I'd want to be informed as possible to make my own decisions. The decisions I'd make depend so much on where I'm at. I'd be likely more willing to risk it now as I have a 7 year old to live for, than I would be in my 90s where the odds are a lot less for a comfortable experience.
You might be very surprised how family actions very often are not consistent with this supposed desire. 98 year olds in the hospital with multiple end stage illnesses - full code, happens all the time. Ask any healthcare worker in the US, pretty classic the elderly rotting away in a nursing home, rarely visited, then they get admitted and their healthcare proxy wants “everything done”. Often seems to be a reflection of their own guilt. Sometimes it’s just poor healthcare literacy.
But no, regardless of what you think these people may
> In the US, exactly because of situations like this, that sort of thing is a lot harder today to pull off.
This is basically false. Most large systems have comfort care order set, with opioid drips. Transition to hospice is readily available. Usually the barrier to these are patients themselves or their families.
Also even the US, the principle of double effect prevails in palliative care.
I could be wrong, but it's my understanding that a fair number of laws have been passed tracking opiates specifically to try and stop this from happening. The dosage, amount, and time is pretty closely monitored. (Could be a state by state thing).
Mainly because a lot of people lost their minds about the idea of someone ending their life early. Jack Kevorkian spawned a number of laws against euthanasia.
The crux, to me, is that healthcare isn't as patient centric as it should be, either because of "greedy" healthcare providers, families thinking more about themselves and not the patients, government/politics, combinations of all of the above, etc.
> Most large systems have comfort care order set, with opioid drips. Transition to hospice is readily available.
Most systems do, but some allow the end to be sped up more than others, either informally or formally.
I don’t know what the right answer is for coding death certificates. Maybe the correct answer is to record several so we can see comorbidities and contributing factors more easily when deciding what science to fund, charities to endow, and which treatments to disfavor.
Died of complications of cancer, reaction to chemo. Died of complications of hip fracture, pneumonia.
Their life expectancy upon admission was estimated to be less than a year, so it's hard to pin this on just the pandemic.
Personally I would put "smoking" in the form, because truth be told that was the single largest contributing factor.
What's crazy is that this used to be much worse, but advancements in targeting and new treatments improved things quite a bit.
HIFU for prostate also is a ripe area for grifters as it is advertised and marketed towards low risk cases that would probably benefit from active surveillance.
Unfortunately, I have extensive first hand experience with practices that do this, and you are 100% correct.
The grift is very insidious. If you scan people over a certain age with prostate MRI, you will find suspicious lesions in a large percentage. And using fusion MRI/US guided biopsies, you will inevitable get cancer cells in the sample.
Many (most?) of these people being treated will die WITH prostate cancer, not FROM prostate cancer.
[0] https://youtu.be/3Bwq2YxD9eU
I don’t actually know much about them, I just heard of them because their CEO (Mary Lou Jepsen, she’s quite famous, right?) was on the AMC podcast (months ago, actually, I was just going randomly though the back catalogue).
Tech folks pivoting to medical always throws off some alarm bells to me, but she was fairly compelling on the podcast and the basic idea seemed to make sense. Ultrasonic treatments, using diagnostic-level energies, using focusing and resonance based tricks, I guess. (It is way outside my wheelhouse, sorry if the description is inaccurate).
Same for me. I've been in the medical device industry for 15+ years now and came from "tech". What a lot of techies under/don't appreciate is that the medical device industry is heavily regulated and moves at a muuuch slower pace than other technologies.
There are lots of regulatory and quality/testing hurdles that you must clear (namely verification and validation testing, in addition to your 510(k) clearance or approval, if PMA) before you can market and sell your device.
I tell customers, on average, a Class II medical device project can take 18-24 months and cost $3M to 4M, minimum.
“Our tech-driven approach leverages software, hardware and AI […]
That means we can iterate at the speed of consumer electronics”
Which is kind of scary but also a bit interesting.
How would you go about regulating an open source medical device? The user can just plop whatever software on there that they want, and ultrasound themselves wherever… play with resonance and focusing, right?
The manufacturer will still need to validate their own firmware and subsequent updates. Whether it’s open source or not doesn’t matter because a huge part of the approval process is quality control tied to a specific manufacturer.
Anyone who plops their own software will be liable for the consequences and I doubt malpractice insurance would allow it in the vast majority of cases.
The best way to evaluate biotech startups from the outside is to look at their investors. If they’re full of VCs specializing in biotech, chances are someone did the bare minimum due diligence on the science.
Theranos for example didn’t have a single one because biotech VCs steered clear of that mess entirely.
I was aware of her from the OLPC project and the cool Pixel Qi screen tech from that, but haven't watched the talks.
They showed us results of HIFU applied to real patients to non-invasively ablate tumours and treat prostate issues. As far as I can tell the probe creating the ultrasonic waves needs to be relatively close.
A thought I had at the time was if you knew all of the material properties of all of the tissues inside someone and their locations (say with an MRI) you could in theory apply this even deeper in someone than is currently possible - with a larger stick-on patch of actuators as a phased array.
Finally, another memorable thing that was discussed was what another researcher was doing with ultrasonics. Stride (who I am delighted to say was a fantastic lecturer) was very interested in bubbles. She would construct tiny bubbles where the surface (or interior?) was made of a chemotherapy drug. These bubbles could then be injected into someone's blood stream and would be ruptured using ultrasound to allow for extremely targeted application of chemotherapy (the jet formed from rupture would be so strong it would inject the drug into nearby tissue).
Fascinating, fascinating stuff but of course developed over many years of hard work.
This reminds me of Feynman s spinning plates.
It also drives home the serendipity of science. One can easily pander a researcher spending their days thinking about bubbles from a place of ignorance. Yet this is what basic research often looks like—play.
Is prostate size reduction possible?
Most things that are harmless or even necessary at one level are deadly at another: heat, light, water, food, air… pretty much everything really.
“Dosis sola facit venenum” (only the dose makes the poison)
I don't think you can argue that ultrasound imaging is harmless or a treatment/dose. It might be that it does nothing. It might also be that it does something (like when it destroys cancer cells) only its far milder, and not an obvious observation.
PS I know there are mild ultrasound devices to aid muscle recovery. These devices do something, presumably. If mild devices are acknowledged to impact muscles etc, some (mild probably) effect is occuring. Given there are occasions where these devices are known to have an impact on adults, why should we presume that there is no impact on the technology when it is looking at a developing foetus?
PPS Even in studies that say there is 'no effect' from ultrasound imaging, there is a tolerance of up to 10% difference between the control and the subjects.
PPPS And of course, sometimes the control is 'children who have only had 1 ultrasound' vs 'children who have 2 or more ultrasounds' - ie the control is not 'children who have who have had no ultrasounds' - ie we do not get true control studies.
This is the summary I get from chatgpt - comparing Histotripsy and ultrasound imaging
| Property | Strongest Diagnostic / Imaging Ultrasound | Histotripsy (Therapeutic Ultrasound |
| Frequency | 2 – 10 MHz (obstetric: 2–5 MHz; high-res imaging up to 15 MHz) | 0.25 – 3 MHz (sometimes up to 6 MHz) |
| Pressure (Peak Negative) | Up to ~5–6 MPa (mechanical index limit ≈ 1.9) | 10 – 100 MPa (depending on type: intrinsic vs. boiling histotripsy) |
| Intensity (Spatial Peak, Temporal Average) | Typically < 0.1 W/cm²; upper safe limit ≈ 0.72 W/cm² (FDA/AIUM) | 100 – 10,000 W/cm² (very high peak intensities) |
| Pulse Duration | Microseconds (∼1–5 µs typical) | Microseconds to milliseconds (short bursts for mechanical disruption) |
Its kind of hard to know what this means - some of the numbers seem pretty close/crossover - but I don't think saying the difference is akin to a laser and a light.
https://en.wikipedia.org/wiki/Stereotactic_surgery
This method of ultrasound treatment is called histotripsy. The underlying mechanism it uses to treat tumors is by focused ultrasound beams that mechanically disrupt cell membranes . It basically turns the lesion into soup. It does not treat the lesion by heating, although there are other techniques that do use ultrasound to ablate tissue with thermal energy.
Where I have seen it used and discussed is in the liver, whether that be metastatic disease to the liver or primary liver tumors.
One challenge is that in the liver you can’t use it for lesions that are near the capsule of the liver. It can also be difficult to keep the ultrasound beam focused on the lesion with respiration, especially if the tumor is small.
It’s an interesting technique and I think more people will use it over time. Whether it will be better than other established techniques like microwave ablation or radioembolization (for liver tumors) remains to be seen. I’m an interventional radiologist.
https://en.wikipedia.org/wiki/Microsurgeon_(video_game)
Ok, that's gonna become a secret MI6 weapon.
https://www.fusfoundation.org/diseases-and-conditions/