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Ultrasound is ushering a new era of surgery-free cancer treatment
- hans_castorp 1y agoDon't they break up kidney stones using ultrasound as well? Or is that a different type of "ultrasound"?
- herval 1y ago“Lithotripsy” is the name of the kidney stone treatment. My understanding is it’s based on vibration, not ultrasound (I know, vibration is sound - my understanding is the method on the linked article uses higher frequency + intensity + shorter pulses than the kidney stone method - so sorta like microwaving tumors vs using a massage gun on kidney stones?)
- CaptainOfCoit 1y agoI think parent is thinking of "Ultrasonic lithotripsy" which does use ultrasound.
- bamboozled 1y agoI’ve had it, it’s ultrasound but it’s not always effective against hard stones.
- gosub100 1y agoI think that's traditionally done with lasers.
- bamboozled 1y agoThat’s transurethral lithotripsy.
- psunavy03 1y agoHaving had kidney stones, they're both used. I think for the sonic one they put you in a water bath because it conducts better. But as I understand it, the docs can pick whichever one is more optimal, be it shattering the stone sonically or zapping it with a laser.
- billforsternz 1y agoMy surgeon told me my previous kidney cancer surgery (partial nephrectomy) meant my 7/8 size kidney wouldn't handle ultrasound treatment for the big kidney stone I'd developed 10 years after the cancer. So laser instead! Worked well but not much fun at the time.
- molszanski 1y agoAFIKR two facilities do this kind of treatment. One in Canada and one in China. There already was a HN threads with some reporting to have been treated in Canada. https://news.ycombinator.com/item?id=31630679 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.
- hereme888 1y agoyup. If the stone is mineral-based and within certain sizes, you can break it up with a special ultrasound. Except.... in morbidly obese patients, if you can imagine the why.
- sho_hn 1y agoHow's progress on individualized cancer remedies based on mRNA?
- michaeljx 1y agoDon't know about mRNA but individualized remedies based on CAR-T technology have been making significant strides in this area, with major commercialisation expected in the next 1-2 years
- RedShift1 1y agoOnce you've destroyed the tumor, how do you get it out of the body?
- Timsky 1y agoUsually, it suffices to initiate apoptosis, the self-destruction mechanisms of the cells.
- elric 1y agoI doubt ultrasound would trigger apoptosis in cancer cells, one of the reasons they're cancerous is that they refuse to commit suicide when they should.
- snovv_crash 1y agoIt heats them until enough damage is done that they die regardless.
- patall 1y agoSo more like necrosis, not apoptosis. Maybe non-biologists are not aware, but apoptosis is not just cell death.
- hgomersall 1y agoOr just tears them apart in the case of Histosonics.
- xbmcuser 1y agoThe recycling of dead cells is a normal biological process the same thing happens when they use radiation to kill cancer cells
- elric 1y agoIf I interpret the article correctly, the ultrasound energy does two things: it effectively destroys the cancer cells by overheating them, and it physically breaks apart the tumour. Your immune system can further break up and get rid of dead cells the way it deals with normal dead cells.
- isoprophlex 1y agoI remember seeing a demo from people who could slap a raw steak into one of these machines, and with ultrasound, sear their logo into the meat at sub mm precision. But that was long ago & not ready for medical usage yet. Cool that it seems to be used for actually treating people now.
- cogman10 1y agoI just spoke to a oncologist surgeon about this. Even though their facially doesn't have one (they are expensive machines) he said it's looking like it'll be standard care in the future. He did an evaluation about getting one for my local hospital.
- owenthejumper 1y agoThis can also be used for prostate, it's nothing new. But you cannot use this anywhere where the ultrasound would be blocked by other organs. Fun fact: using this ultrasound for prostate cancer treatment reduces the risk of erectile disfunction
- ptsneves 1y agoCan’t the surgery be then with a small probe just to get the ultra sound tip near the cancer? I don’t know the size of the ultrasound tip but seems to me it can be smaller then a hand or tweezers.
- timschmidt 1y agoOften constructive and destructive interference of waves can be used to focus the ultrasound through tissue without any incisions at all. Kidney stones are sometimes broken up this way.
- mattkrisiloff 1y agoSee currentsurgical.com
- bonsai_spool 1y ago> 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.
- owenthejumper 1y agoHere is a trial (2022): https://pubmed.ncbi.nlm.nih.gov/35714666/ https://pubmed.ncbi.nlm.nih.gov/35714666/ And a review: https://pubmed.ncbi.nlm.nih.gov/36686753/ https://pubmed.ncbi.nlm.nih.gov/36686753/
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- Tade0 1y ago> "Cancer is awful," Xu says. "What's making it even worse is cancer treatment." 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-reimbursement-wins/ https://histosonics.com/news/histosonics-notches-significant... Not a bad deal for a non-invasive life-saving surgery.
- roadside_picnic 1y agoAn eye opener for me was when a friend of my was dying of cancer there was a period where he got sepsis, ultimately because of the effects of chemotherapy not directly because of the cancer. But had he passed from sepsis (he survived that incident), the cause of death would ultimately be attributed to cancer and not chemotherapy. 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.
- BurningFrog 1y agoNo one gets paid for non-intervention.
- hylaride 1y agoI suspect the medical industry is so heavily regulated that it is very difficult for doctors to recommend non-treatment or risk being sued into oblivion, though maybe it depends on the country. 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.
- deep_signal 1y agoIt's amazing how we're turning sound waves into healing tools.
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- jijji 1y agoThe only thing the article fails to mention is the use of more than one transducer used to focus multiple ultrasound beams to an intersection point in the body, increasing the heating power of all beams
- infinet 1y agoThere was a startup in Shanghai in the early 2000. Their device used multiple transducers. The probe was at least 40 cm in diameter. They did trials on uterine fibroids, among other diseases. One of the difficulties was while it looks good in theory, but the path ultrasound travels in the body is more complicated than, say x-ray or gamma ray. They expected a fine focal zone, but sometimes the focal zone was much larger than expected. This new wave of ultrasound equipment may have discovered better ways to control the sound beam.
- jijji 1y agoit seems like the intesection point can be smaller than a grain of rice, and moved at 0.1mm three dimensionally [0] [0] https://youtu.be/3Bwq2YxD9eU https://youtu.be/3Bwq2YxD9eU
- infinet 1y agoThis is amazing! That HIFU 20 years ago used phase array to steer beam. Don't know the size of transducer. One of the tests I heard of was on a pig leg. The damage was bigger than expected, could be in the range of few centimeters, probably due to the leg has skin, subcutaneous fat, muscle and bone. All have different sound characteristic.
- breppp 1y agoIt's a highly promising direction for many diseases, I specifically remember Alzheimer's as one https://www.fusfoundation.org/diseases-and-conditions/ https://www.fusfoundation.org/diseases-and-conditions/
- bee_rider 1y agoAt the intersection of ultrasound and startups (since this is HN), does anyone have any thoughts about that Openwater project? They are apparently working on open source ultrasonic medical devices. 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).
- ZeroGravitas 1y agoShe has a couple of TED talks on this tech from several years ago. I was aware of her from the OLPC project and the cool Pixel Qi screen tech from that, but haven't watched the talks.
- throwup238 1y ago> 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. 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.
- zomg 1y ago> Tech folks pivoting to medical always throws off some alarm bells to me 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.
- fortran77 1y agoI really hope she didn't damage her (or her colleague's) hearing while doing these experiments!
- backwardsmoo 1y agoI had the absolute pleasure during my engineering undergraduate (Oxford) to take a biomedical module. One of my 'labs' was on nonlinear acoustics, specifically ultrasound applied for therapeutic uses. It was very captivating seeing a very focused point within a block of gel become ablated. A part I found particularly exciting was realising that it was a phased array of ultrasonic emitters, so that the point where the ablation occurred could in fact be placed anywhere you desired in the gel. 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.
- bikeshaving 1y agoOkay, you sold me. Where can I get an ultrasonic massage?
- walrusted 1y agoa high percentage of physical therapists have an ultrasound massage device.
- JumpCrisscross 1y ago> Stride…was very interested in bubbles 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.
- nilslindemann 1y agoI hope for a great future of this therapy.
- 716dpl 1y agoThere was a game in the early '80s called Microsurgeon where you piloted a robot probe into a body to cure it of diseases. It was armed with an array of tools, one of which was ultrasound that you could use to destroy cancer. I wonder how long this idea has been around for. https://en.wikipedia.org/wiki/Microsurgeon_(video_game) https://en.wikipedia.org/wiki/Microsurgeon_(video_game)
- siliconc0w 1y agoYou can get a ultrasonic fat cavitation machine off Ali Express for a few hundred bucks. The technology has gotten surprisingly cheap.
- ncr100 1y agoIt looks like this can be used to burst and liquify body fat, near to the surface of the skin! Wild.
- spockz 1y agoOkay… and is that something that is beneficial? How? Will it flow out from an incision? Will it just target white or brown fat? Any other effects like also liquifying muscle tissue?
- mountainriver 1y agoAlso very very interesting for brain modulation!
- michael1999 1y agoMy mother received ultrasound ablation as brain surgery to treat idiopathic tremors. It was wild.
- zzzeek 1y agoI've got a node in my thyroid that can reasonably only be removed chemically, which has risks of blowing out my whole thyroid. ultrasound treatment is now available for it, however have been going to my endocrinologist every four months for a bloodwork checkup (because I need to take thyroid-suppressing drugs until the node can be removed) and am still waiting for him to have heard about this treatment outside of my own telling him so (even though his larger medical organization, NYU, offers it, it still seems to not be routine within his practice).
- BurningFrog 1y agoThere has to be a way to find a practice that uses this tech?
- zzzeek 1y agoabsoultely but I am in no hurry and I would like it to be Very Boring and Ordinary For My Particular Condition before I go anywhere near it
- verisimi 1y agoIf it can target and kill cancer, how can it also be safe for foetuses?
- f1shy 1y agoYou can vary the frequency, power, energy, focus... is not the SAME ultrasound.
- verisimi 1y agoBut surely it could cause some damage at a lower frequency, power, etc anyway?
- perilunar 1y agoWhy “surely”? 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)
- verisimi 1y agoUsing the example of a laser - you can have a powerful laser that can burn through metal. A far weaker laser (many magnitudes weaker) could still damage eye sight. Alternatively, water erodes mountains eventually. 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.
- themantalope 1y agoA few points based on comments I’m seeing about the article. 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.
- esafak 1y agoHow does it compare with stereotactic radiosurgery (Gamma Knife)? https://en.wikipedia.org/wiki/Stereotactic_surgery https://en.wikipedia.org/wiki/Stereotactic_surgery
- theglocksaint 1y agoGamma Knife is used in brain lesions where focused ultrasound is not a viable treatment option or likely to ever be.
- esafak 1y agoIs ultrasound preferable where it is viable?
- hn_throwaway_99 1y agoThere are already lots and lots of treatments for localized tumors in the liver - radiofrequency oblation, cryo oblation, microwaves, etc. These kinds of articles often tout new treatments as a bold new thing, but they don't really change the state of medicine, and it's not like they would be a replacement for chemo, for example. I'd be very curious how histotripsy compares to these other localized tumor treatments.
- hereme888 1y ago> a hole appeared in the pig heart tissue within a minute of ultrasound application Ok, that's gonna become a secret MI6 weapon.