Valley View Hospital in Glenwood Springs takes aim at lung cancer
November 12, 2013
GLENWOOD SPRINGS — With a recent investment in technology, Valley View Hospital has positioned itself on the cutting edge of early detection of lung cancer and hopes one day to achieve the lowest lung cancer mortality rate in the nation.
Leading the charge toward this ambitious goal is pulmonologist Dr. Akrum Al-Zubaidi, known around the hospital as Dr. Aki. Earlier this week, as the nation marked National Lung Cancer Awareness Month, he enthusiastically demonstrated the hospital's new technology.
Until recently, Al-Zubaidi pointed out, most lung cancer treatment was reactive rather than proactive, as the often deadly disease was usually detected after patients became symptomatic, in Stage 3 or 4, when the mortality rate is difficult to influence.
Now, "We're focusing on early detection," he said, so they can "change the regional diagnosis."
Key to that effort are two pieces of equipment obtained by the hospital in late August. One machine allows Al-Zubaidi to employ electromagnetic navigation bronchoscopy. The other uses confocal laser microscopy in conjunction with the bronchoscopy.
Only 14 hospitals in the United States are using the two procedures together, he said.
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"They can't believe it," he said of former colleagues when they understand this is happening in a market of this comparatively diminutive size.
The inside picture
Electromagnetic navigation bronchoscopy involves using CT scans of a patient's lungs to create three-dimensional images, which are then used to map a pathway into the part of the lungs where suspected cancer resides. Using one of the new machines at Valley View, Al-Zubaidi then guides a steerable probe — a "scope" — through the maze of airways to the precise spot.
The scope can be used to take tissue samples not only of the lung but of nearby lymph nodes, as well, so that an accompanying pathologist can make quick determinations of whether cells are cancerous and if additional samples are needed.
The result is that patients often don't have to be subjected to general anesthesia and the procedure is significantly less invasive than more common diagnostic techniques.
Many lung cancer biopsies today are conducted by inserting a needle into the lungs to extract a tissue sample. The procedure has a complication rate of 30 to 40 percent, Al-Zubaidi said.
In contrast, using electromagnetic navigation bronchoscopy, the complication rate is 2 to 3 percent, he said.
The diagnostic level of certainty also rises and exceeds 90 percent when the confocal laser microscope is inserted into the lung inside the electromagnetic navigation bronchoscopy scope.
"It's like sticking a $300,000 electron microscope into your lungs," Al-Zubaidi said.
The laser's intense blue light transmits data to a computer screen that shows a cellular-level picture inside the lung, providing higher assurance that samples are being taken from the correct areas. Moreover, image libraries from the procedure are being compiled so physicians can more quickly identify different types of cancer by how they appear through the scope.
Since the machines were purchased at a cost of more than $250,000, more than a dozen patients have been treated using them, according to an email from Stacey Gavrell, Valley View's executive director of community relations and development.
Catching it early
"This is just the beginning of early detection of lung cancer," Al-Zubaidi said.
In the works are methods that include a breath test to determine whether a patient is a promising candidate for a CT scan.
Lifestyle factors are considered, as well, as are genetics, as fewer people smoke and new lung cancer cases migrate increasingly to others. In fact, according to a Valley View handout, 80 percent of new lung cancer cases are in former smokers who quit decades before or people who have never smoked.
And while Garfield County has a relatively low rate of cigarette smoking, Al-Zubaidi said marijuana smoking could be a factor in lung cancer rates here.
Contrary to what some believe, "it increases your risk," he said, as does inhaling any kind of foreign substances on a regular basis, including wood smoke.
The key to early detection is that when the right series of indicators coalesce, physicians suggest patients take the first precautionary step and get a CT scan. If that indicates the presence of a suspect area in the lungs, the new diagnostic procedures may be used.
The goal is to catch a far higher percentage of lung cancer cases in the early stages, when treatment outcomes are better.
Al-Zubaidi stressed that he is just a cog in the system aimed at making Valley View's lung cancer mortality rate the lowest in the nation. The multi-disciplinary team includes pathologists on-site while diagnostic procedures take place, radiologists, oncology specialists and thoracic surgeons all working together to produce the best possible outcomes.
In addition, since the region has a relatively small population compared with metropolitan areas where these advanced techniques usually are deployed, this team has a better chance of changing statistical outcomes of lung cancer diagnoses, Al-Zubaidi said.
"I think we have a better opportunity here to change it than anywhere," he said.
As for the goal of achieving the lowest mortality rate nationwide, "It's attainable, I think," he said.