Researchers at a laboratory that is part of the Cancer Research UK Cambridge Centre.Photo: CRUK
The earlier cancer is detected, the lower the risk of it spreading and the higher the chance of surviving the disease. Key approaches to earlier diagnosis include encouraging people to respond promptly to symptoms, empowering health professionals to be alert to signs of cancer, speeding up referrals and testing, and investing in research and innovation.
Scientific advances over the past 50 years have played a key role in improving cancer survival. That’s why Cancer Research UK is spending £415m on research in 2022-23, including funding many scientists investigating innovative approaches to early detection and diagnosis. Their vital work, some of which is explored in this article, is only possible thanks to the supporters of Cancer Research UK.
A third of the charity’s funds come from gifts in wills, and those who leave a legacy can be sure that their generosity is helping to bring the day that cures all cancer closer.
Catching esophageal cancer early
Early detection of esophageal cancer is a challenge because one of the first warning signs, trouble swallowing, is often only seen in the later stages of the disease.
However, a specific subtype of the cancer may soon be discovered as researchers have discovered a pre-existing condition known as Barrett’s oesophagus. Although Barrett’s esophagus itself does not cause symptoms, it can be associated with heartburn and reflux.
Thanks to a quick and affordable test – whose clinical trials were funded by Cancer Research UK – patients with these symptoms can now be tested for Barrett’s esophagus at a GP surgery. Previously, the condition would be diagnosed by endoscopy.
Professor Rebecca Fitzgerald of the University of Cambridge developed the capsule sponge test and a related laboratory test. The test involves a patient swallowing a pill wrapped in a coating that dissolves in the stomach to release a compressed sponge. This expands and is then pulled back with an attached wire, collecting cells from the lining of the esophagus along the way, which are then tested in the lab.
A trial found that these tests could identify 10 times more people with Barrett’s esophagus than standard DG care. Liz, 75, took part in the trial after her GP noted her history of indigestion and acid reflux. This led to the diagnosis of Barrett’s esophagus. Additional tests revealed cancerous tissue, which doctors discovered. “I believe the trial saved my life,” says Liz. “I will always be grateful for Cancer Research UK’s involvement in funding research into the development of the capsule sponge.”
The future is liquid
Genetic profiling of tumors from individual patients can help doctors personalize treatments but surgical removal of samples – biopsies – is invasive and can cause complications. It is also sometimes of limited value, as cancers change over time. In recent years, researchers have increasingly focused on the ability of liquid biopsy, which can detect tumor cells or DNA circulating in the blood and other body fluids, to better understand patients’ responses to treatment, the best treatments for them to identify and, which may exist. , detect cancers more easily.
In 2019, scientists analyzed blood taken from patients just before undergoing surgery to treat lung cancer. Professor Caroline Dive and her colleagues from Cancer Research UK Manchester Institute found that those whose tumors lost the most cells were at greater risk of their cancer returning.
The Dive team traced the origin of a secondary tumor in one patient to separate cells that had escaped into the pulmonary vein from the primary tumor. They hope that further research can identify the genetic characteristics of tumor cells in the blood that put patients at greater risk of relapse. The research was part of the Cancer Research UK-funded TRACERx study, which aims to improve understanding of cancer evolution and bring about more personalized medicine.
Another group, at the Cancer Research UK Cambridge Institute, created personalized blood tests for patients based on analysis of DNA from their early stage lung cancer. In research led by Professor Nitzan Rosenfeld, now based at Queen Mary University of London, they found that individuals with tumor DNA detected in their blood between two weeks and four months after their treatment.
Until recently, most personal liquid biopsies could identify 10-20 DNA variants, and could pick up a single genetic mutation out of 10,000-30,000 pieces of DNA. Rosenfeld’s team developed a way to look for hundreds and sometimes thousands of genetic variants in a single blood sample and pick out a few mutant molecules from up to 1m pieces of DNA. These researchers are now using more sensitive methods to learn how we can detect cancers earlier in high-risk individuals.
While most liquid biopsies use blood, a collaboration between the University of Birmingham’s Bladder Cancer Research Center and the genetic testing company Nonacus has developed a test for bladder cancer based on identifying tumor DNA in urine. In results published last year, the group, part-funded by Cancer Research UK, found that the test could correctly identify 87% of cases in people who had experienced blood in their urine. The test could one day replace many expensive and invasive cystoscopy tests, which involve inserting a camera into the bladder.
Yet another group led by scientists at Cambridge Research Cancer Institute UK has developed a technique that can identify fragments of DNA from tumors linked to brain cancer called gliomas in the patient’s urine, blood and cerebrospinal fluid, which surrounds the brain and the spinal cord. If larger trials are successful, the test could replace the regular MRIs used to monitor patients at high risk of brain tumor recurrence.
Download the early diagnosis
Cancers affecting the upper respiratory and gastrointestinal tracts are some of the most difficult types of cancer to detect early, in part because they often have non-specific symptoms. For example, esophageal cancers, as previously mentioned in detail, are often diagnosed late and patients often have some of the worst outcomes, with only 12% surviving for 10 years or more.
Dr Sam Merriel, GP and researcher at the University of Exeter Medical School, is part of a team developing a sensor that can detect molecular biomarkers of upper respiratory and gastrointestinal tract cancer in saliva. The team is working on a proof of concept device called “Sens or Pass” to be used by GPs as a screening tool to identify people who need urgent referral to specialists. Ultimately, if the sensor proves to be accurate and cost-effective, it could be incorporated into toothbrushes to detect early signs of a range of cancers.
Cancer Research UK has been bringing together an interdisciplinary research team at three-day innovation workshops on detection and early diagnosis since 2018. The Sens or Pass concept was discussed at one of these events in 2021 and was awarded development funding of up to £230,000 last year.
flushing cancer down the toilet
Bowel cancer screening is available on the NHS for all 60-74 year olds in England (there are separate bowel screening programs for the different countries in the UK), and plans are in place to offer it to everyone between the ages of 50-59 by 2025. It is based on the use of the faecal immunochemical test, a kit used at home to detect small amounts of blood in milk, which could mean cancer or growths small growths in the womb called polyps, which may be cancer.
Screening aims to detect cancer at an early stage when treatment is most likely to be successful. But barriers remain, so other ways to diagnose cancer earlier are being explored. Dr Lauren Ford developed a concept design for a device called the IntelligentToilet, which could pick up chemical markers of early bowel cancer in urine.
Ford and her colleagues at Imperial College London are also testing different smart ceramic materials to find one that can absorb useful cancer-detecting compounds from urine.
It’s early days, but installing a simple device in household toilets that can quickly and accurately detect bowel cancer could save many lives.
Funding the future
A gift pledge in your will can lead to investments in research that further change outcomes for people affected by cancer, helping them live longer and better lives. These legacy gifts enable Cancer Research UK to commit to the long-term, large-scale research projects that lead to the greatest.
Gifts in wills are vital to speeding up progress, funding one third of Cancer Research UK’s work, enabling life-saving progress. To find out how you can help fund the next 50 years of progress by pledging a gift, visit cruk.org/giftsinwills