Pain-free laser breakthrough in war on cancer

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A NEW patient-friendly surgery which uses beams of light instead of scalpels, leaves no scar and is virtually pain free is being tested in Britain.

The treatment, which uses laser light, either alone or combined with photosensitive drugs, could make current techniques of chopping out diseased tissue seem crude and inhumane and make conventional surgeons redundant.

Trials have been carried out in cancers of the breast, cervix, lung, prostate and mouth. In breast cancer, the technique leaves no scar or cosmetic deformity and can be performed as an outpatient procedure under local anaesthetic, although there is a long way to go before it can be used as a routine treatment.

The technology, which has advanced dramatically in the past few years, is also being tested in heart disease, as a gentle alternative to hysterectomy and as a substitute for antibiotic treatment of infections.

Professor Stephen Bown, director of the National Medical Laser Centre at University College of London Medical School, said: "It is a new world. It is possible it will cut out a lot of conventional surgery. It is more subtle."

Old lasers, in which a concentrated beam of light is used to cut or burn tissue, have been available for two decades, but new generation lasers, some no bigger than a briefcase, are able to deliver light deep within the body via flexible fibres and can be controlled and used in more subtle ways.

With sophisticated imaging techniques, the tip of the laser can be positioned accurately in the diseased tissue and low power used to gently "cook" it. There is minimal damage to the surrounding healthy tissue and the destroyed cells are re-absorbed by the body's natural healing processes.

Previously inoperable cancers may also become treatable. Patients with pancreatic cancer, which has one of the highest mortality rates, have had tumours successfully destroyed using laser therapy.

The use of photosensitive drugs, which are "switched on" by light, could lead to even more revolutionary developments. Many cancers, such as those of the lung, cervix and digestive tract, start in the mucosal lining which forms their internal surface. By giving the photosensitising drug ALA, which is taken up by the mucosa, and shining a light on it, the mucosa dies and sloughs off, taking the cancer with it and avoiding the need for a major operation.

The same technique is used in the treatment of heavy menstrual periods. Instead of a hysterectomy to remove the womb - a major operation with a lengthy convalescence which can cause psychological distress - lasers can remove the endometrium (the mucosal lining) leaving the body of the womb intact.

Professor Bown, said: "Imagine the savings if all you had to do was put a syringe through the cervix to deliver the photosensitive drug and a few minutes later slide an optical fibre in and shine a light on it."

Similar techniques are being used to prevent coronary arteries closing up after the widening procedure known as balloon angioplasty, and to treat hospital infections caused by bacteria such as MRSA, which are antibiotic- resistant. By spraying the infected area with a photosensitive drug and shining a light on it the bacteria are destroyed.

Writing in the British Medical Journal, Professor Bown says the new generation of reliable and cheap lasers will make most of these techniques accessible to all large hospitals. "The evidence is mounting that laser treatments can offer considerable advantages over other options for a range of conditions."