Scientists at a recently opened cancer institute at Cambridge Universities have begun work to detect changes in cells many years before they develop into tumors. The research should help design radically new ways to treat cancer, they say.
The Early Cancer Institute – 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 exploit recent discoveries which have shown that many people develop pre-cancerous conditions that lie dormant for long periods.
“The latency for a cancer to develop can go on for years, sometimes for a decade or two, before the condition suddenly manifests itself in patients,” said Prof Rebecca Fitzgerald, the institute’s director.
“After that, doctors find themselves struggling to treat a tumor that has by then spread throughout a patient’s body. We need a different approach, one that can detect a person at risk of cancer early using tests that can be given to large numbers of people.”
One example of this is the cytosponge – a sponge on a string – developed by Fitzgerald and her team. It is swallowed like a pill, expands into a sponge in the stomach and is then pulled up through the esophagus collecting esophageal cells along the way. Those cells that contain a protein called TFF3 – which is only found in precancerous cells – then give an early warning that a patient is at risk of developing esophageal cancer and needs to be monitored. It is extremely important that this test can be administered simply and on a wide scale.
This contrasts with current approaches to other cancers, Fitzgerald added. “At the moment we detect many cancers late and we have to come up with medicines, which have become more and more expensive. We often extend life by a few weeks at a cost of tens of thousands of pounds. We have to look at this from a different perspective.”
One approach is being followed by the institute – which should be renamed the Li Ka-shing Early Cancer Institute after the Hong Kong philanthropist who supported other Cambridge cancer research – focus on blood samples. These samples, provided by women as part of previous ovarian cancer screening services and kept in special stores, have now been reused by the institute. “We have around 200,000 such samples and they are a gold mine,” said Jamie Blundell, a research group leader at the institute.
Using these samples, researchers identified changes that distinguished the donors who were later diagnosed with a blood cancer 10 or even 20 years after providing samples from those who did not develop such conditions.
“We find that there are clear genetic changes in a person’s blood more than a decade before they start showing symptoms of leukemia,” Blundell said. “It shows there is a long window of opportunity that you can use to intervene and give treatments that will reduce the chance of going on to get cancer.”
Cancers grow in stages and by spotting those with cells that have taken an early step on this ladder, it should be possible to block or impede further developments. The crucial point is that at this early stage there is time for doctors to act and avoid having to deal with a late-stage cancer when it has spread.
A similar strategy is followed by Harveer Dev, another group leader, who investigated men who had their prostates removed. His team is now developing biomarkers that will provide better ways of identifying those likely to suffer poor outcomes from prostate cancer, one of the most common tumors in the UK.
“Our pilot data suggest that these tests may be much better than existing PSA tests and will be crucial in detecting those with prostate cancer who are likely to progress,” said Dev.
Identifying those at risk of cancer – for example, people from families with an inherited predisposition to tumors – will form an important part of the institute’s strategy. In addition, it will focus on finding ways to reduce cancer risks, as well as ensuring that treatments can be widely administered.
A woman in her 80s decided to leave the university £1 million for cancer research, Fitzgerald said. “However, she lived to be over 100 and only recently died, so we only now got that donation. We want to understand what makes some live to a very old age while others get cancer, so that more people can live as long as she did.”