The priorities for this theme are diagnosing cancer early and preventing existing cancers from progressing. We aim to achieve this by identifying those patients at highest risk.
Half of the UK population will be diagnosed with cancer during their lifetime and cancer care costs the NHS more than £10bn a year. If the disease is diagnosed early, it means effective treatments, such as surgery, can be carried out, resulting in better outcomes for patients and reduced treatment costs.
Immunotherapies are an effective treatment that harness the patient’s immune system to control the growth of cancers. However, currently 45 percent of cancers are diagnosed at late-stage and immunotherapies are mainly applied to late-stage cancers. We want to assess how effective immunotherapies are if we detect cancers at an early stage – or predict those people most likely to develop them.
There are a number of conditions that predispose individuals to getting cancer. We are focusing on three: Barratt’s oesophagus, which has a five percent chance of leading to oesophageal cancer; primary sclerosing cholangitis, which can lead to liver cancer; and some precursors to blood cancers, such as MGUS (Monoclonal gammopathy of undetermined significance) and MBL (Monoclonal B lymphocytosis).
Currently, we cannot tell which people with these conditions will go on to develop cancer. We must simply monitor them regularly and then act if they do get cancer. We want to be able to identify the people most at risk of going on to develop cancer, and we are doing that by looking for the biomarkers – molecular changes identified by imaging or in blood or tissue biopsies – that indicate a patient is transiting to cancer, enabling us to act at the very earliest signs of cancer.
This entails observing what changes take place as the pre-cancerous condition progresses to cancer through biopsies and blood samples. We assess how the cells are communicating with each other, particularly how the immune system is communicating with other tissue and how that relationship changes as we go from, for example, Barrett’s oesophagus to cancer. We believe the immune system is key to understanding what is happening in that tissue. [sub themes 2 & 3 )
As well as those who do not yet have cancer but who are at high risk of developing it, we are focusing on those who have operable early cancer and are at high risk of metastasis, when the cancer spreads to other parts of the body.
We are also looking for new biomarkers. We want to identify new targets that we can implement at an early stage, before the cancer arises or at the very earliest signs of cancer. This includes looking for better antigens – which can prompt an immune response – that might be used in the future for vaccination.
We are working closely with colleagues in other BRC themes, such as Inflammation across Tissues, Imaging, Surgical Innovation Technology and Evaluation, Metabolic Experimental Medicine, Gene and Cell Therapy and Life Saving Vaccines.
We have four sub-themes
- Sub-theme 1: Targeted surveillance in high-risk cohorts for early cancer diagnosis
Led by Professor James East
- Sub-theme 2: Tissue-tumour microenvironment
Led by Professor Tim Elliott
- Sub-theme 3: Clinical markers of inflammation and immune dysregulation
Led by Professor Anna Schuh and Professor Tim Elliott
- Sub-theme 4: Early intervention
Led by Professor Mark Middleton and Professor Anna Schuh)
We anticipate that the findings of our research will be the basis for new clinical pathways for millions of people currently attending NHS surveillance clinics. By understanding the risk better, we will reduce anxiety for people at low risk of developing cancer and improve the care and treatment of those at high risk by being able to intervene earlier. This will also reduce the NHS burden of following up people for pre-cancerous conditions and treating patients presenting with late-stage cancer.
Learn more about our work in early liver cancer detection.