Knowing whether a tumor could grow or spread to other parts of the body could be the key to survival, research suggests.
Scientists say they are now one step closer to unlocking the ability to predict just that.
In a series of seven papers published in Nature and Nature Medicine, Cancer Research UK-funded researchers describe how changes in the DNA of cancer cells allow them to anticipate how cells will behave in the future.
According to research, this includes where and when the cancer will spread throughout the body.
Scientists suggest the findings could one day allow doctors to use a blood test to predict how a patient’s cancer may grow and spread.
This would allow them to monitor the disease and quickly adjust treatment in real time.
Studies also suggest that it offers a possible route by which doctors could analyze the risk of disease recurrence after surgery.
Although lung cancer patients were the focus of the study, the scientists say their findings could also apply to other types of cancer, such as skin cancer or kidney cancer.
These studies are the culmination of nine years of research from Cancer Research UK’s £14 million TRACERx study, the first long-term study into the evolution of lung cancer.
The nationwide study involves more than 800 patients in clinical trials and a community of 250 researchers based at 13 hospital sites across the UK.
Lead researcher based at the Francis Crick Institute in London, UCL and lead clinician of Cancer Research UK, Professor Charles Swanton, said: “TRACERx recognizes that cancer is not static and the way we treat patients should not neither be.
‘What makes the TRACERx project particularly powerful is that it treats cancers as ever-changing ‘ecosystems’ made up of diverse populations of cancer cells.
“By looking at the tumor as a whole, we can see how these cell populations interact and even compete with each other, which is helping us gain valuable insights into how likely a tumor is to come back and when that might happen.
“We can also see how cancer is likely to evolve over time, spread and respond to treatment, offering hope to millions of patients in the future.”
In the seven studies, the Crick and UCL researchers have followed 421 of 842 TRACERx-treated patients with non-small cell lung cancer (NSCLC) – the most common type of lung cancer – since they were diagnosed to monitor how their tumors have changed over time.
Through the papers the researchers made a number of discoveries, including that tumors can be made up of many different populations of cancer cells that carry constantly changing sets of genes.
The more diverse these tumors are, the more likely it is that the patient’s cancer will return within a year of treatment.
They also found that certain patterns of DNA changes in a patient’s tumor indicate what his cancer might do next.
These patterns could tell doctors which parts of a tumor could grow and spread to other parts of the body in the future.
Blood tests could be used to monitor these changes in tumor DNA in real time, helping doctors catch early signs that the cancer is returning or unresponsive, say the researchers.
The scientists also investigated whether they could track changes in the tumor and characteristics of its genetic diversity without the need for surgery or biopsies.
By analyzing the DNA released into the bloodstream by cancer cells, known as circulating tumor DNA (ctDNA), they found that the presence of ctDNA in the blood before or after surgery suggested that the patient’s cancer was very likely to return in the future. .
Furthermore, the researchers also found that the microscopic patterns created by the arrangement of cancer cells are linked to the risk of cancer recurrence.
Executive director of research at Cancer Research UK, Dr Iain Foulkes, said: ‘A blood test that reads ctDNA could allow doctors to monitor someone’s cancer in real time, allowing them to tailor treatments for that patient. .
“Currently, the best option we have for monitoring a patient’s tumor is to extract the tissue through a biopsy or during surgery. Both are invasive and time-consuming options that provide us with a limited snapshot of how that tumor is performing at any given moment.
“Analysis of ctDNA would give us a more complete picture of how the tumor is changing over the course of a patient’s disease using minimally invasive blood tests. It would allow doctors to treat people more proactively, stepping in quickly to change a treatment plan that isn’t working.”