Pictures of the Future    Spring 2007

Microscopic Miracles

Genetic predisposition testing and a protein-based blood test have shown that Eduardo might have colon cancer. During a scan, molecules that bind only to cancer cells reveal a small growth. An endoscope equipped with microscopic sensors performs a virtual biopsy, confirming that the growth is cancerous. Fluorescent molecules in the tumor indicate exactly which cells are cancerous, allowing a specialist to safely remove them

I’m lucky. I won’t die. In fact, I won’t even have to miss a single episode of my favorite shows.

It all started with an automatically-generated priority e-mail that appeared in the margin of my 3D virtual immersion TV. As usual, I was slouching in my media room shoveling down a bowl of my favorite vanilla ice cream and feeling like the star of the evening interactive quiz shows, when I paused to open the message.

"Dear Eduardo," it read, "A recently established national healthcare database has matched your family history of colon cancer with your lifetime Electronic Patient Record. The National Health Service suggests a visit to one of the following practitioners in your area. These healthcare professionals are authorized to offer a newly approved genetic predisposition test for colon cancer. For your convenience, their addresses have already been downloaded into your vehicle’s navigation system. For details, click…Thank you."

I didn’t need any directions to find Dr. Shackleton’s office. He’s my GP and he lives just a few blocks from my high-rise. "Yes, Ed," he was saying, "This is one heck of a nifty test. They managed to squeeze the ‘quivalent of an entire diagnostic lab into this little cartridge. We’ll have ya profiled in just a sec."

Pretty cool, I thought, as I watched a tiny lab card loaded with a few drops of my blood disappear into the reader on the spotless countertop beneath a restored oil painting of a schooner breaking dramatically through wind-swept waves. Shackleton brushed my Health-e-Card against the machine, allowing the reader to access my EPR. After a few minutes he gave me the news.

"Ed," he said, "No cause for alarm. But the DNA test shows that you have a colon cancer predisposition gene. The test compared your personal medical data—lab tests, family history—with data from millions of other patients, and based on the outcomes of their files, it calculated your lifetime risk. All in all, the test suggests that you should be screened for colon cancer. So with your permission I’ll draw a little more blood and we’ll do a mass spectrometric test."

I’ve since done a little research on these tests and found that what they do is to analyze the levels of disease-related proteins in blood—in this case proteins specifically produced by colon cancer cells.

A few days later an e-mail from Shackleton’s office confirmed that my spectroscopic profile had "revealed an expression level indicative of colon cancer." It said that the data, which had been added to my EPR, had been compared to a population database, and that it correlated with a high probability of cancer. "Dr. Shackleton recommends an MR/PET molecular imaging scan. We have scheduled an appointment for you at…"

"O.K. No need to worry," I told myself as I turned down the volume on a late night quiz show and scooped out the final, delectable spoonful of vanilla-flavored ice cream from a carton. "All they’ve found so far are probability levels. Keep cool."

But when the date for the imaging test rolled around, I have to admit that I was more than a little nervous. The scan was to take place at a major hospital, and my interventional radiologist, Dr. Hyde, told me that if they found "any immediately resectable tumor, they would take it out on the spot."

Before going into the scanner, a technician gave me an injection of a PET tracer—a short-lived radioactive substance attached to a molecule that binds only to cancer cells. The molecule also had a fluorescent element. "If you have any cancer cells anywhere in your body, this tracer will be absorbed by them and the scanner will see where they are," she explained. "Then, if you need surgery, we’ll get an endoscope in there. A microscope at the tip of the endoscope will be able to see every last cancer cell because they’ll fluoresce, and Dr. Hyde is an expert in getting them out."

After that I lay down and tried not to think about what was going on as the big scanner hummed along the length of my entire body.

From that point on my memories are sketchy to say the least. I understand that, as expected, the scan detected a small tumor in my upper colon, at which point I was given a powerful sedative. A computer-aided diagnostic program then quantified the precise dimensions of the lesion and passed them on to another program to support Dr. Hyde during treatment.

Dr. Hyde explained later that a remotely controlled endoscope was threaded into my colon and guided to the tumor using real time magnetic resonance. Equipped with a recently-approved combination of molecular sensors and tools, the endoscope used multiple wavelengths of light as well as a protein array "lab-on-the-tip-of-a-needle" to conduct an in vivo biopsy of the tumor.

Finally, guided by Dr. Hyde, a microscopic visual attachment sensitive to the infrared glow of the cancer cells directed a laser at the tip of the catheter to remove the lesion down to the last cancer cell with the help of an aspirator.

When I swam up out of sedation, Dr. Hyde was all smiles. He explained that the in vivo biopsy had provided information on my tumor’s characteristics and that the prognosis, particularly because of early detection and treatment, looked great.

"For all practical purposes, you’re cured," he said. "All you’ll have to do is participate in a follow-up screening program and watch what you eat!"

"Sure, doc," I said with genuine gratitude. But I was already dreaming about my next carton of vanilla-flavored ice cream.
                                                                                                                  Arthur F. Pease