Cancer recurrence – a speedbump on a highway towards cancer-free life


Neelam, a mother of two fought breast cancer for almost three years and survived. After her victory over the disease, she started living her life as a blessing, making each and every moment count. However, when she went to the doctor to check the inflamed skin on her breast, she was shattered after the results came out. She started crying her heart out, because her cancer had come back. Cancer recurrence is indeed a traumatic experience. More than the physical tensions, it attacks patient’s will to live.

Cancer recurrence

Cancer recurrence means that cancer has come back after the treatment and between the times during which the cancer could not be detected. The first cancer has higher chances of coming back. Recurrence starts with cancer cells that were not fully destroyed or removed during the first treatment. However, this does not mean that the treatment was wrong. Neither it means that patient did something which made cancer reoccur. It just means that some cells survived during the treatment at first time. Even though it seems that treatment has got rid of all those cancer cells.

The problem is mainly because the cancer cells those are inactive for many years after the first treatment. But in some cases, suddenly the changes in immune system activate the cells. It can grow and divide to create other cells. Once those cells go on growing and dividing, it becomes big enough for a test to detect it as a recurred cancer. Cancer recurrence is found in one of the five patients. Sometimes, the mutated genes can cause a second type of cancer.

Cancers are more likely to come back if –

  • They are aggressive i.e. fast growing.
  • Advanced cancers i.e. detected in later stages.
  • Cancer is widespread in the body.

Types of cancer recurrence

When the cancer is detected again, it is not necessary that it will be found at a same spot. It can be found anywhere else. Here are the types of cancer recurrence.

  • Local recurrence.

When the cancer appears in the same spot where it was first found, it is called local recurrence. This means that the cancer has not spread to the lymph nodes or other parts of the body.

  • Regional recurrence.

When can cancer reappears in the tissues located close in the surroundings of the earlier cancer, it is called as regional recurrence.

  • Distant recurrence.

Sometimes when the cancer reappears, it is nowhere close to the original cancer spot from where it was removed earlier. It is called as distant recurrence.

When the recurrence occurs, the doctor informs the patient about the type of recurrence and the best possible treatments for the same.

Image credits- Corbis
Image credits- Corbis

When does the cancer recur?  

Cancer can reappear any time after the treatment but breast cancer mostly recurs in the first three to five years after initial treatment.  Breast cancer can come back as a local recurrence i.e. in the treated breast or near the mastectomy scar or as a distant recurrence. The most common sites of recurrence are the lymph nodes, the bones, liver, or lungs.

Genetics and cancer recurrence.

Now medical advancements have made it a little easier to gauge the recurrence of cancer. One of such tests is Liquid Biopsy. It is a very sensitive screening which tests for cancer-free DNAs in body and can thus, accurately monitor cancer recurrence.

Though positive or negative attitude does not control the cancer or its recurrence, it definitely helps the patients to gain more strength to fight the battle against cancer.

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Lung cancer and its causes beyond smoking


In India, lung cancer constitutes more than 7 per cent of all new cancer cases and around 10 per cent of all cancer related deaths. This is applicable for both genders. Lung cancer is the commonest cancer and biggest cause of cancer related mortality in men. Whenever we read about lung cancer, the first thought that comes to our mind is smoking. Indeed, smoking is the biggest cause of lung cancer, however, other factors cannot be overlooked as they too affect both the genders equally. One of those is our genetic make-up.

Lung cancer tops the list of cancers in males – In India and globally.

While smoking is a known risk factor, pollution, passive smoking and hazardous work environment – like asbestos, mica, coal and bauxite mining. 15% of the lung cancer cases in India are often attributed to a combination of genetic factors, radon gas, asbestos, pesticides and air pollution including passive and static smoking.

Second hand smoke

It is one of the important factors in tobacco-related deaths in India. Second-hand smoke is the one that fills enclosed places like restaurants, offices when people smoke cigarettes, cigars, or bidis. Tobacco smoke contains more than 4000 chemicals in out of which at least 250 are harmful and more than 50 chemicals from it are known to cause cancer. This also affects children as many of them regularly breathe polluted air in public spaces which has smoke in it. Around 45% children have either of the parents having smoking habit.
Britain recently made a law that stops anyone from smoking in a car that has passengers below 18 years of age. More than 2 lakh people die because of second hand smoke in India.

Asbestos

Lung cancer is more common in the people who work in sectors like auto mechanics, construction workers, insulation installer, roofers, paper mill workers, etc. Risk of Lung cancer increases from exposure to asbestos every year by 4 percent.

Image credits- liquidarea.com
Image credits- liquidarea.com

Genetic Make up

Genes and genetic variations in our body contribute to the bodily functions and overall health. This also includes the possibility of having various diseases which are hereditary or developed in our body due to changes in the genetic codes. Researchers studied entire genomes of cancer patients as well as healthy individuals and found out a region on chromosome 15 which may have been influential in causing lung cancer. Mutations in CHEK 2 gene also largely affect the risk of lung cancer. Some people inherit a reduced ability or inability to break down certain types of cancer-causing chemicals in the body. E.g. those found in tobacco smoke. This increases their risk of lung cancer.

Datar Genetics Limited offers Hereditary Cancer Screening test which identifies such risk for lung and other forms of cancer. This test can help your doctor to decide further course of treatment.

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Pharmacogenetics – Selecting Right Drugs For the Right Genes


Did you know that 87%of the total patients receiving cancer chemotherapy develop Adverse Drug Reactions (ADR)? It also causes 50 deaths out of 1000 patients in India. These statistics highlight the importance of correct drugs for the treatment.

Depending on your genetic makeup, some drugs may work more or less effectively for you than they do in other people. Likewise, some drugs may produce more or fewer side effects in you than in someone else.

Pharmacogenetics is the study of inherited genetic differences in drug metabolism which can affect individual responses to drugs, both in terms of therapeutic effect as well as adverse effects. It plays an important role in Oncology.

Now, doctors are able to use information about your genetic makeup to choose the drugs and drug doses that are helpful to you.

For example, if a patient asks for extra amount of codeine to relieve the pain, it can come across as a sign of an evading patient seeking narcotics. However, that patient can be breaking down the codeine within minutes of swallowing it and therefore not be able to create the intermediate molecule that relieves the pain. With this conclusion, the physician can suggest the suitable drugs.

image credits- static1.squarespace.com/
image credits- static1.squarespace.com/

Pharmacogenomics also help to save you time and money as the “best-fit” drug for you can be chosen from the beginning of the treatment to avoid the trial-and-error approach of giving you various drugs.

Besides pharmacogenomics, other factors may influence how a person reacts to a drug. These include:

  • Person’s age and gender.
  • How advanced the cancer is.
  • Person’s lifestyle habits, such as smoking and drinking alcohol.
  • Other diseases that they have and the medications they are on for these conditions.

FDA Guidelines for Pharmacogenetics

The U.S. Food and Drug Administration (FDA) has listed many drugs that need genetic testing before introducing them in the treatment. Some of them are Mercaptopurine and Irinotecan. FDA recommends genetic testing before giving the chemotherapy drug mercaptopurine (Purinethol) to patients with acute lymphoblastic leukemia. It also advises doctors to test colon cancer patients for certain genetic variants before administering irinotecan (Camptosar), which is part of a combination chemotherapy regimen.

Let us see some case studies so that we can understand how pharmacogenetic analysis helped patients with better drugs, and thus, treatment.

  1. A 62 year old male patient with colon cancer was started with a standard dose of FOLFOX and after 6 weeks, Irinotecan and Cetuximab were introduced. However, after the first cycle, sever Myelo-suppression was developed. It delayed the chemo for 3-15 days every cycle. At DGL, comprehensive pharmacogenetic analysis consisting of tumour mutation analysis was advised which confirmed ADR to Irinotekan and 5FU and capsitaben was recommended.
  1. 52 year old male Chronic Smoker diagnosed with adenocarcinoma of the Right Lung with liver metastasis was given Pemetrexed and Carboplatin- 6 cycles which showed partial response. He was advised comprehensive pharmacogenetic analysis at DGL consisting of Tumor mutation analysis for efficacy evaluation and Pharmacogenetics for toxicity profile that showed KRAS mutation which explains partial response to Pemetrexed. Other mutations detected suggestive of personalized targeted therapy.

Geneshield Test at DGL

This test at DGL requires sample of whole blood/ saliva and turnaround time is 2 weeks. The report will give you the information of the genetic mutations you carry that would affect the efficacy of drugs. This test also gives you information about the toxicity of these drugs on your body at the same time.

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It’s always better to maintain a good rapport with the doctor. Here are the few things which you should discuss with your doctor before starting a treatment.

  • Would you explain my treatment options?
  • Which treatment or combination of treatments do you recommend? Why?
  • What are the possible side effects of this treatment?
  • Is there a way to predict how the cancer will respond to this drug or whether I might experience severe side effects?
  • What are my options if the cancer does not respond to the drug or if I suffer from severe side effects?

Detecting the ill-effects of drugs and replacing them with proper ones under expert advice definitely help to give the treatment a right direction.

 

 

 

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Liquid Biopsy – A Path Breaking Weapon Against Cancer


Liquid Biopsy

As the medical field is making great advancements with regards to technology and treatments, the tests are narrowing down to more easier yet micro level. Cancer tests have also become more specific and advanced and the perfect example is Liquid Biopsy.

Liquid Biopsy is a new, non-invasive technique that detects disease biomarkers released by tumour in blood, urine or other bodily fluids. When cancer spreads,it sheds cells and DNA fragments in the blood. Datar Genetics Ltd. has developed this technique for finding cancer cells, RNA from exosomes and tumour DNA fragments in the blood. In this method, you get similar information from a simple blood test which you would have to otherwise get from a tissue sample obtained from the regular invasive biopsy. Conventional biopsies taken from tumor sites may suffer from biased results due to tumour heterogeneity whereas liquid biopsy is free from such biases.

Liquid Biopsy targets one of the following:-

  1. Free circulating nucleic acids.
  2. RNA expression and fusion transcripts.
  3. Circulating tumour cells.
  4. Multiple DNA abnormalities
  5. Tumour Emboli
  6. Insertions and deletions
  7. Trans-locations and chromosomal abnormalities
  8. Point mutations

LB2

You should consider Liquid Biopsy when:-

  1. Enough tissue cannot be obtained from the initial invasive biopsy.
  2. Cancer starts in a place that is difficult to access by surgical biopsy.
  3. Cancer spreads to brain, bone,lung or other difficult to biopsy locations.
  4. Recurrence of cancer post initial tumour removal.
  5. Patient isn’t responding to treatment the way you expect.
  6. The patient doesn’t want a repeat biopsy.

In Cancertrack – Liquid Biopsy by Datar Genetics Limited, capturing and detecting CTCs, exosomes, ctDNA and other bio-markers has an important predictive and therapeutic implication. Detection of tumor DNA has clinical utility in risk stratification in early cancer, in early detection of relapse and in monitoring the response to treatment.

This test has two types- A prognostic test may indicate the outcome and course of a disease. A predictive test suggests likely response to the particular therapy. It is also devised to screen for cancer. It will inform you about your current status of cancer and is intended to provide clinicians information on the presence of specific biomarkers in the CTCs.

The major advantage being cancer treatments getting more personalised and micro-level, Liquid Biopsy proves very helpful and indeed a boon for us.

 

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