How is technology helping prevent and diagnose a range of cancers?

Researchers at a laboratory that is part of Cancer Research UK’s Cambridge Centre.Photo: CRUK

The earlier cancer is diagnosed, the lower the risk of it spreading and the higher a person’s chances of surviving the disease. Key ways to ensure early diagnosis include encouraging people to respond promptly to symptoms, ensuring healthcare professionals are alert to signs of cancer, expediting referrals and testing, and investing in research and innovation.

Scientific advances over the last 50 years have played a significant role in improving cancer survival. That’s why Cancer Research UK is spending £415 million on research in 2022-23, including funding many scientists researching innovative approaches to early detection and diagnosis. Their vital work, some of which is discussed in this article, is only possible thanks to supporters of Cancer Research UK.

A third of the charity’s funds come from gifts in wills, and those who leave wills can be confident that their generosity will help bring closer the day when every cancer is cured.

Catching esophageal cancer early

Esophageal cancer is difficult to detect early because one of the first warning signs, difficulty swallowing, often occurs in the later stages of the disease.

However, there is the potential for researchers to detect a specific subtype of cancer before a condition called Barrett’s esophagus. Although Barrett’s esophagus itself does not cause symptoms, it can be associated with heartburn and reflux.

Patients showing these symptoms can now be tested for Barrett’s esophagus in a GP surgery, thanks to a rapid and affordable test whose clinical trials are funded by Cancer Research UK. Previously, this condition was diagnosed by endoscopy.

The capsule sponge test and associated laboratory test were developed by Prof Rebecca Fitzgerald from the University of Cambridge. 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 up by an attached string, collecting cells from the lining of the esophagus along the way, which are then tested in the laboratory.

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One trial found that these tests could identify 10 times more people with Barrett’s esophagus than standard GP care. Liz, 75, attended the hearing after her doctor noted her history of indigestion and acid reflux. This led to the identification of Barrett’s esophagus. Further tests found cancerous tissue that doctors removed. “I believe the case 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 fluid

Genetic profiling of tumors from individual patients can help doctors personalize treatment, but surgical removal of samples (biopsy) is invasive and can cause complications. It can sometimes be of limited value because cancers change over time. In recent years, researchers have increasingly focused on the potential of liquid biopsies, which can better understand patients’ responses to treatment, determine the best treatments for them, and potentially detect circulating tumor cells or DNA in blood and other body fluids. It detects cancers more easily.

In 2019, scientists analyzed blood taken from patients just before they underwent surgery to treat lung cancer. Prof Caroline Dive, from Cancer Research UK’s Manchester Institute, and colleagues found that samples containing the most cells shed by their tumors had a higher risk of their cancer returning.

The Dive team traced the origin of a patient’s secondary tumor to specific cells that had escaped from the primary tumor into the pulmonary vein. They hope further research can identify genetic characteristics of tumor cells in the blood that put patients at greater risk of recurrence. The research was part of the Cancer Research UK-funded TRACERx study, which aims to improve understanding of the evolution of cancer and enable more personalized medicine.

Another group at the Cambridge Institute of Cancer Research UK has created personalized blood tests for patients based on analysis of DNA from early-stage lung cancer. The study, led by Prof Nitzan Rosenfeld, currently at Queen Mary University of London, found that people whose tumor DNA was detected in their blood between two weeks and four months after treatment were more likely to have the disease relapse.

Until recently, most personalized liquid biopsies were capable of identifying 10 to 20 DNA variants and could detect a genetic mutation from 10,000 to 30,000 DNA fragments. Rosenfeld’s team developed a way to look for hundreds, sometimes thousands, of genetic variants in a single blood sample and select a few mutant molecules from up to 1 million DNA fragments. Researchers are now using these and other sensitive methods to learn how we can detect cancer earlier in individuals at high risk.

While most liquid biopsies use blood, a collaboration between the University of Birmingham’s Bladder Cancer Research Center and genetic testing company Nonacus has developed a test for bladder cancer that relies 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 with blood in their urine. The test could one day replace many costly and invasive cystoscopy tests, which involve inserting a camera into the bladder.

Another group, led by scientists at Cancer Research UK’s Cambridge Institute, has developed a technique that can identify fragments of tumor DNA linked to brain cancers called gliomas in a patient’s urine, blood and cerebrospinal fluid surrounding the brain and spinal cord. If larger trials are successful, the test could replace regular MRIs used to monitor patients at high risk of brain tumors returning.

Early diagnosis is accelerated

Cancers affecting the upper respiratory and gastrointestinal tracts are some of the most difficult types of cancer to detect early, in part because they have nonspecific symptoms in many cases. For example, as noted in more detail previously, esophageal cancers are often diagnosed late and patients experience some of the worst outcomes; only 12% survive 10 years or longer.

Dr., a general practitioner and researcher at the University of Exeter Medical School. Sam Merriel is part of a team that developed a sensor that can detect molecular biomarkers of upper respiratory tract and gastrointestinal tract cancer in saliva. The team is working on a proof-of-concept device called “Sens or Pass” that GPs will use 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 enable detection of early signs of a range of cancers.

Since 2018, Cancer Research UK has been bringing together interdisciplinary research teams in three-day innovation workshops on early detection and diagnostics. The Sens or Pass concept was discussed at one of these events in 2021 and was awarded up to £230,000 in development funding last year.

I’m flushing cancer down the toilet

Bowel cancer screening is available on the NHS to everyone aged 60-74 in England (the UK has separate bowel screening programs for different countries) and there are plans to offer it to everyone aged 50-59 by 2025. This is based on the use of a fecal immunochemical test, a home kit to detect very small amounts of blood in the stool; This could mean that someone has cancer or small growths in the intestine called polyps that can turn into cancer.

Screening aims to detect cancer at an early stage when treatment is more likely to be successful. But barriers still exist, so new ways to detect cancer earlier are being explored. Dr Lauren Ford has developed a concept design for a device called a smart toilet that can detect chemical signatures of early bowel cancer in urine.

Ford and colleagues at Imperial College London are also testing different smart ceramic materials to find a material that can capture compounds from urine useful for cancer detection.

It’s early days, but a simple device placed in home toilets that can detect bowel cancer quickly and accurately could save many lives.