The bad news was already back from the pathologist: the 56-year-old woman lying on the operating table is suffering from cancer of the pancreas, and Howard University Hospital Medical Director Vincent Roux and those assisting him could easily see that the cancer had already spread to the liver and other surrounding tissue.
Ordinarily, there would be little surgeons could do. At best, they could remove part of the cancerous tissue. More likely, however, they would simply have closed the incision in her abdomen and referred her to treatment by a radiologist or a clinical oncologists for radiation or chemotherapy.
But that was not the case yesterday. When the verdict of cancer was confirmed, 1 hour and 41 minutes into the operation. Howard radiologist Alfred Goldson stepped up to the table with a plastic cylinder about four inches in diameter and 18 inches long.
Goldson inserted the tube into the open wound so that its bottom covered the cancerous tissue and the top of the tube protruded from the woman's midsection like a clear periscope.
As the media throng - 14 cameramen, soundmen, a still photographer, four television reporters for position, Goldson pushed various organs and tissues out of the way to provide better camera angles of the 18th intraoperative radiation therapy procedure performed in this country.
Yesterday's was the 17th such treatment administered at Howard. One of the experimental procedures, pioneered in this country by Goldson, has been performed at Massachusetts General Hospital in Boston. The treatment, which allows administering, much higher than usual doses of radiation, was developed in Japan.
(Survival statistics for the 17 previous such operations are considered meaningless because of various factors.)
After cameramen finished getting their shots, the operating table was wheeled a few feet, placing the woman directly under the extended arm of massive Varian Clinac 18 linear accelerator, a super voltage piece of X-ray equipment which delivers a beam of electrons to a precisely adjustable depth in the patient's body.
Goldson attached the plastic tube to a slightly larger metal tube which was inserted into the machine, creating direct contact between the tumor and the piece of X-ray equipment.
As the observers and surgical team were ushered from the room, Dr. Martin McLaren, chief of Howard's Department of Anesthesiology, made a final check of the patient's vital signs and respiration before he left the room.
Howard is the only place in the world where the patient is operated on in the lead-lined room containing the $50,000 linear accelerator. Even in Japan, patients must be moved relatively long distances through the hospital from the operating room to the radiology area.
According to Goldson, having the surgery and radiation take place in the same room avoids the added risks entailed in moving a patient with a massive open surgical wound.
McLaren's final checks completed, the door to the room was closed. As all cameras and eyes were focused on a television monitor showing the patient and the machine, a technician turned on the accelerator and gave the patient a dose of 2,000 rads of radiation for about four minutes.
Goldson explained that in normal procedures the patient would be given about 200 rads a day, five days a week, for three weeks after the patient recovered from surgery.
This was, he explained the radiation that can be given "when the tumor is visible and we can feel the margins of the tumor. We can push skin out of the way, or the small intestine or the kidney and we can give higher doses, because the areas (other than the tumor) do not receive direct radiation. We decrease the morbidity," the illness caused by the radiation itself and "we feel that the higher the radiation dose we can get, the higher the tumor kill ratio we can achieve."
It is still too early to know how potent a weapon the new technique will prove in the war on cancer. It is known that it makes possible application of radiation to a tumor apparently without affecting nearby organs.
When the patient, who was in the stable condition yesterday evening, fully recovers from surgery, she will be given conventional radiation therapy and chemotherapy. She will start, however, with the advantage of having had her tumor receive as much radiation at one time as most patients receive in an entire course of radiation treatment.