Signs of cancer can be spotted years before symptoms, says a new research institute
Scientists at a newly opened cancer institute at the University of Cambridge have begun research that maps changes in cells many years before they develop into tumors. The research should help design radically new ways to treat cancer, they say.
The Institute for Early Cancer – which has just received £11 million from an anonymous donor – is focused on finding ways to tackle tumors before they cause symptoms. The research will make use of recent discoveries that have shown that many people develop precancerous conditions that do not develop for a long time.
“The latency period for the development of cancer can last years, sometimes as long as a decade or two, before the condition abruptly manifests itself in patients,” says Prof. Rebecca Fitzgerald, director of the institute.
“Then doctors discover that they have difficulty treating a tumor that has by then spread through a patient’s body. We need a different approach, one that can identify someone at risk of cancer at an early stage using tests that can be given to large numbers of people.”
An example of this is the cytosponge – a sponge on a string – developed by Fitzgerald and her team. It is swallowed as a pill, expands into a sponge in the stomach and is then drawn up through the esophagus, collecting esophageal cells along the way. The cells containing a protein called TFF3 – found only in precancerous cells – then provide an early warning that a patient is at risk for esophageal cancer and needs to be monitored. Crucially, this test can be administered easily and on a large scale.
This contrasts with current approaches to other cancers, Fitzgerald added. “Currently we detect many cancers late and we have to come up with medicines, which have become increasingly expensive. We often extend life by a few weeks, which costs tens of thousands of euros. We need to look at this from a different perspective.”
One approach at the institute – which will be renamed the Li Ka-shing Early Cancer Institute, after the Hong Kong philanthropist who has supported other cancer research at Cambridge – focuses on blood samples. These samples, provided by women as part of previous ovarian cancer screening services and stored in dedicated stores, have now been reused by the institute. “We have about 200,000 such samples and they are a goldmine,” says Jamie Blundell, research group leader at the institute.
Using these samples, researchers have identified changes that distinguish between donors who were subsequently diagnosed with blood cancer ten or even twenty years after providing the samples, and donors who did not develop such conditions.
“We found that there are distinct genetic changes in a person’s blood that occur more than a decade before they start to show symptoms of leukemia,” Blundell said. “That shows that there is a long window of opportunity that you could use to intervene and provide treatments that reduce the chance that you will get cancer.”
Cancers grow in stages and by detecting cancer types with cells that have taken an early step on this ladder, it should be possible to block or hinder further developments. The crucial point is that at this early stage there is time for doctors to take action and avoid having to deal with the cancer at a late stage if it has spread.
A similar strategy is followed by Harvey Dev, another group leader, who has conducted research on men who have had their prostates removed. His team is now developing biomarkers that will provide better ways to pinpoint those likely to experience poor outcomes from prostate cancer, one of the most common tumors in Britain.
“Our pilot data suggests that these tests could be much better than existing PSA tests and will be critical in identifying people with prostate cancer that is likely to progress,” Dev said.
Identifying people at risk of cancer – for example people from families with a hereditary predisposition to tumors – will be an important part of the institute’s strategy. In addition, it will focus on finding ways to reduce the risk of cancer and ensure treatments can be widely applied.
A woman in her 80s had decided to leave the university with £1 million for cancer research, Fitzgerald said. “However, she lived until she was over 100 and only recently passed away, so we have only just received that donation. We want to understand what causes some people to live very old while others get cancer, so that more people can live as long as they do.”