Researchers in a laboratory part of the Cancer Research UK Cambridge Centre. Photo: CRUK
The earlier cancer is detected, the lower the risk that the disease will spread and the greater the chance that a person will survive the disease. Key ways to achieve earlier diagnosis include encouraging people to respond quickly 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 fifty years have played a key role in improving cancer survival rates. That's why Cancer Research UK has spent £415 million on research in 2022-2023, including funding many scientists investigating innovative approaches to early detection and diagnosis. Their vital work, some of which is discussed 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 assured that their generosity brings closer the day when every form of cancer will be cured.
Detect esophageal cancer early
Early detection of esophageal cancer is challenging because one of the first warning signs, difficulty swallowing, often does not appear until the later stages of the disease.
However, there is an opportunity to detect a certain subtype of the cancer early, as researchers have found that it is preceded by a condition called Barrett's esophagus. Although Barrett's esophagus itself does not cause any symptoms, it can be associated with heartburn and reflux.
Thanks to a fast and affordable test - clinical trials of which were funded by Cancer Research UK - patients with these symptoms can now be tested for Barrett's oesophagus by a GP. Previously, the condition was diagnosed by endoscopy.
The capsule sponge test and a related laboratory test were developed by Prof. Rebecca Fitzgerald of the University of Cambridge. In the test, a patient swallows a pill wrapped in a coating that dissolves in the stomach and releases a compressed sponge. This expands and is then pulled back up by an attached string, collecting cells from the lining of the esophagus along the way, which are then tested in the laboratory.
The story continues
One study found that these tests could identify ten times more people with Barrett's esophagus than standard GP care. Liz, 75, took part in the trial after her GP noticed her history of indigestion and acid reflux. This led to the identification of Barrett's esophagus. Further tests found cancerous tissue, which doctors removed. "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 fluid
Genetic profiling of tumors from individual patients can help doctors personalize treatments, but the surgical removal of samples - biopsies - is invasive and can cause complications. It is also sometimes of limited value because cancers change over time. Researchers in recent years have increasingly focused on the potential of liquid biopsies, which can detect tumor cells or DNA circulating in the blood and other body fluids, to better understand patients' responses to treatment, identifying the best treatments for them and, potentially making cancer easier to detect.
In 2019, scientists analyzed blood taken from patients just before they were scheduled to undergo surgery to treat lung cancer. Professor Caroline Dive and her colleagues from the Cancer Research UK Manchester Institute found that those whose samples contained the most cells shed by their tumors were at greater risk of their cancer returning.
Dive's team traced the origin of a secondary tumor in one patient to specific cells that had escaped from the primary tumor into the pulmonary vein. They hope that further research can identify the genetic signatures of tumor cells in the blood, putting patients at greater risk of relapse. The research was part of the Cancer Research UK-funded TRACERx trial, which aims to improve understanding of cancer evolution and create more personalized medicine.
Another group, from 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 Prof. 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 were more likely to relapse .
Until recently, most personalized liquid biopsies could identify 10 to 20 DNA variants and pick up one genetic mutation from 10,000 to 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 1 million stretches of DNA. The researchers are now using these and other sensitive methods to learn how we can detect cancer earlier in high-risk individuals.
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 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 the Cancer Research UK Cambridge Institute has developed a technique capable of identifying fragments of tumor DNA linked to brain cancers, called gliomas, in the urine, blood and cerebrospinal fluid of a patient, which surrounds the brain and spinal cord. If larger studies are successful, the test could replace regular MRIs used to monitor patients at high risk of brain tumor recurrence.
Brushing up on an early diagnosis
Cancers that affect the upper respiratory tract and gastrointestinal tract are among the most difficult types of cancer to detect early, in part because in many cases they have nonspecific symptoms. For example, as previously mentioned in more detail, esophageal cancer is often diagnosed late and patients experience some of the worst outcomes, with only 12% surviving 10 years or more.
Dr. Sam Merriel, a GP and researcher at the University of Exeter Medical School, is part of a team developing a sensor capable of detecting molecular biomarkers of upper respiratory and gastrointestinal cancers in saliva. The team is working on a proof-of-concept device called 'Sens of Pass', which can be used by GPs as a screening tool to identify people who need urgent referral to specialists. If the sensor ultimately proves accurate and cost-effective, it could be built into toothbrushes to enable early signs of a range of cancers.
Cancer Research UK has been bringing together interdisciplinary research teams during three-day innovation workshops on early detection and 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 to everyone aged 60 to 74 in England (there are separate bowel cancer screening programs for different countries in Britain), and there are plans to offer this to everyone aged 50 to 59 by 2025 . It is based on the use of the fecal immunochemical test, a kit used at home to detect small amounts of blood in the poop, which could mean someone has cancer or small growths in the intestine called polyps that can become cancerous .
Screening aims to detect cancer at an early stage, when treatment is more likely to be successful. But barriers still exist, so further ways to diagnose cancer earlier are being explored. Dr. Lauren Ford has developed a concept design for a device called the IntelligentToilet, which could pick up chemical markers of early colon cancer in urine.
Ford and her colleagues at Imperial College London are also testing several smart ceramic materials to find one that can extract compounds useful for cancer detection from urine.
It's still early days, but a simple device placed in household toilets that can quickly and accurately detect bowel cancer at its early stages could save a large number of lives.
Financing the future
A promise of a gift in your will can lead to investments in research that further changes outcomes for people affected by cancer, helping them live longer and better lives. These legacies enable Cancer Research UK to commit to large-scale, long-term research projects that deliver the biggest breakthroughs.
Gifts in wills are essential to accelerate progress and fund a third of Cancer Research UK's work, making life-saving breakthroughs possible. To find out how you can help fund the next 50 years of progress by pledging a gift, visit cruk.org/giftsinwills