Cancer in Women: Detection is now just a test away!


A woman’s body is likely to change with age, time and environmental factors. Sometimes, the changes that seem normal can be signs of cancer, though.

Some of the cancers that most often affect women are breast, endometrial, ovarian and cervical cancers. Knowing about these cancers and what you can do to help prevent them or find them early may help save one’s life.

The symptoms may be easy to overlook and are usually diagnosed at a late stage when they are generally more difficult to treat. Efforts should be made to detect cancer at a very early stage by educating population about the risk factors.

There are several methods of diagnosing cancer. With advances in technologies that understand cancers better, there is a rise of number of diagnostic tools that can help detect cancers. Once suspected, diagnosis is usually made by pathologists, onco-pathologists and imaging radiologists.

There are a few limitations of attempting to diagnose cancers with conventional biopsy techniques guided by ultrasound or CT, like rupture of the cystic mass when a biopsy needle is inserted with possible spread of the tumor to other sites, or missing cancerous cells since some parts of the cyst may not contain cancer.

At Datar Genetics Scientists have studied innovative methods to detect cancer by identifying markers specific to the disease present in the blood. This method is called ‘Liquid biopsy’, which is simple, safe, sure and works on a highly sensitive platform.

In liquid biopsy, fluid or blood drawn from the individual is examined to find cancer cells and other biomarkers within the blood. The test utilizes gene sequencing to compare genetic markers within the person’s blood sample. Those markers are then contrasted with genetic markers found in common cancers such as ovarian, breast, lung, endometrial and colon cancers. If there are genetic markers that match, then the test has found evidence that the patient is at risk of contracting said cancer in the future. It is particularly helpful when a tissue biopsy can’t be done easily or if tissue is unavailable for any reason or if the original starting point (primary) of cancer is not known.

Liquid Biopsy can be used at various stages – for Cancer diagnosis, for early detection, for guidance on therapy management and for recurrence monitoring. It can also provide therapy guidance and helps monitor therapy success. It also helps to predict the response of patient to a drug and also if tumor has developed resistance to the treatment.

In the field of oncology, where innovations come and go without lasting impact, this novel non-invasive liquid biopsy is a life saver.

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Liquid Biopsy and its role in fighting cancer


Wrong diagnosis and wrong medications can lead to fatal results in person’s health. According to September 2014 bulletin of Sample Registration System (SRS), India has an infant mortality rate of 40 per 1,000 live births.Wrong drugs cause 50 deaths out of 1000 patients in India. Most of the times, a regular disease can exaggerate and become fatal because of the wrong diagnosis and medications. Same was the case with Mr. Deshpande (name changed) – which almost took a toll on his life.

When Mr. Deshpande, a 74 year old retired banker started suffering from abdominal pain, weakness, and fatigue, his wife was alarmed because he had always been very careful about his diet and exercise regime. Neither did he miss his regular check-ups. He wanted to lead his retirement exactly the way he had planned. However, all his plans were short lived because of his constant health issues after the retirement.

On the contrary, he also lost his weight drastically. When his wife took him to their GP, he referred them to an expert in the city where he was first diagnosed with adenocarcinoma of colon in November 2013.

After the diagnosis, the doctors suggested surgical resection which would be followed by chemotherapy. Doctors also advised a Positron Emission Tomography (PET) scan. This scanning is basically to check how the tissues and organs in the body are working. A year later,in November 2014, while testing, a mass measuring 2.1 x 1.7 cm was detected in the lung with speculated margins. The doctors assumed it as a metastasis from colon cancer and started with Capecitabine – a chemotherapeutic agent.

After the prescriptions, he was being continuously monitored with PET scans. However, despite of the chemotherapy which was ongoing since a year, the mass was continuously increasing in size.

Doctors were not sure if it was indeed a metastasis of colon cancer, or it was a result of tuberculosis or in a worse case, primary lung carcinoma?

After looking after a varied possibilities and options, he was referred for a liquid biopsy. However, Mr. Deshpande was reluctant because of general perception of the biopsies. He was only relieved when the doctors explained that the procedure is as easy as a simple blood test.

Liquid Biopsy showed mutation burden 4.4 % of total cell free DNA. It was an indication of active primary lung carcinoma. The Liquid Biopsy indicated therapeutic response to targeted anti EGFR therapies such as Afatinib, Gefitinib and Erlotinib.

Here, Gefitinib was prescribed to the patient. This drug is only effective in cancers with mutated and overactive EGFR. It started showing its results and the tumor began to shrink gradually. Repeat PET scan showed reduction in tumor size by 70%. That meant a great success of the accurate diagnosis and correct medications.

Liquid Biopsy after three weeks
Liquid Biopsy after three weeks

Five weeks later, detectable mutation burden in the cell free DNA obtained from plasma was negative. The mutation burden was reduced even more as compared to the previous analysis possibly due to Gefitinib therapy.

Mr. Deshpande is completely hale and hearty now. It’s interesting how one correct step towards the course of treatment can leave a huge impact on patient’s well-being.

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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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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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