Tucked away in the Endoscopic Unit of The Scarborough Hospital is a small team that is making a big difference in cancer staging using advances in medical imaging technology.
One physician and four nurses comprise the only clinical team in the Central East LHIN and one of few in Ontario to perform Endoscopic Ultrasounds (EUS), a minimally invasive procedure that captures images and collects tissue samples for examination and analysis.
“The main application is for cancer staging,” says Dr. Elaine Yeung, Gastroenterologist at The Scarborough Hospital. “For gastrointestinal cancers, oncologists frequently require more detailed imaging beyond what a CT or MRI scan can provide to determine accurately what stage the cancer has reached before developing a treatment plan.”
Staging has evolved over time and continues to change as physicians learn more about cancer, but what we know is that the process is vital in understanding how cancer progresses, estimating its severity and verifying whether or not the disease has spread throughout the body.
“We are very fortunate to have EUS available to help optimize our treatment plan and obtain tissue through a minimally invasive approach,” says Dr. Jeff Rothenstein, a medical oncologist who provides treatment to patients with lung cancers and gastrointestinal cancers. “Dr. Yeung provides an exceptional service to our hospital and our LHIN.”
Using EUS technology, Dr. Yeung guides a scope into and around various areas of the body to visualize the layers of the intestinal wall as well as adjacent structures.
“Essentially, it’s an endoscopy, but there is an ultrasound probe at the tip of the endoscope to examine carefully the layers of the esophageal, stomach or rectal wall,” says Dr. Yeung as she draws a diagram to better illustrate how the scope can also visualize areas beyond the surface of the organs. “It makes a difference which layer of the wall the tumour is located, and its location can determine whether a patient should go straight to surgery or first receive chemotherapy.”
Patients are sedated rather than given a general anaesthetic so recovery time is usually within half an hour – a benefit that averts major surgery.
“(Patients) are amazed they can have this procedure as quickly as they do,” says Lorraine Majcen, Registered Nurse at The Scarborough Hospital.
Lorraine is one of four RNs who received specialized training to support EUS. The nursing team assists in setting up the equipment including the endoscopic ultrasound processors. They also monitor the patient during the procedure and ensure their health care needs throughout the entire process are met.
EUS is an efficient and cost-effective method in gathering tissue samples. In the past, physicians would perform major surgery to access the internal organs.
Since cancer can spread through the lymphatic system, another important feature of EUS is the ability to biopsy lymph nodes. A special needle is advanced into the wall of the GI tract under ultrasound guidance to sample lymph nodes or tumours in previously difficult to reach areas, such as the pancreas.
“EUS is one of the best imaging tools for the pancreas,” explains Dr. Yeung. “We can see the pancreas very well with the endoscope placed in the stomach or duodenum. The biopsy procedure itself is safe and also painless.
Dr. Yeung sees between three to six patients a week, and while many are from the GTA, TSH accepts referrals from physicians and oncologists across the province.
“It’s beneficial for patients because cancer staging is so important,” says Gloria Hanna, RN at The Scarborough Hospital and part of the EUS team. “We have had patients travel from as far as Wawa, a small town in Northern Ontario, for the procedure, and I’m proud to be part of a team that can provide such a specialized service.”
The TSH EUS program was first proposed by Dr. Theodore Shapero, a senior Gastroenterologist at The Scarborough Hospital. Dr. Shapero together with Jacqueline Ho, Patient Care Manager of the endoscopy unit, came up with the business plan for the initiative.
“The Scarborough Hospital is a centre for cancer care and we are proud to offer this unique service to enhance our oncology program,” says Jacqueline. “EUS not only provides our patients with the opportunity to receive timely and efficient access to specialized care, but supports our vision to be recognized as Canada’s leader in providing the best healthcare for a global community.”
The equipment was purchased with funds donated by Kenneth and Daisy Lee, who received care at TSH for many years and are long-time supporters of the hospital.
“The outstanding generosity of the Lee family has enabled The Scarborough Hospital to stand out as a leader in innovation,” says Michael Mazza, President of The Scarborough Hospital Foundation. “We are so grateful that with their support, we can utilize technology to expand the scope of practice for our clinicians and provide a valuable service for patients across the province.”