How to test whether or not you have cancer; and which treatments might or might not work on your cancer!
Sophisticated tests can now measure minute traces of cancer tumour DNA, (ctDNA) or circulating tumour cells (CTC) in your body AND this real time measurement can show the effectiveness of the treatments you are having. This really is the start point for personalised cancer treatment and ’precision medicine’.
So, do you have cancer, or not? And is the drug working?
“Well done. You are all clear”
How many times have patients heard this from a surgeon who has just removed a lump, a breast or a section of cancerous colon? What would make him even say it? How could he possibly know if cells had already been fired off from the tumour, or even released by his surgery into the blood or lymph? Yet at CANCERactive, we have patients who now don’t want to take the drugs because their doctor has said they are all clear! It’s modern medicine at its worst.
And think about the opposite event. If the cancer really was caught early and there are no cancer cells on the loose in the body, why would you need that forthcoming chemotherapy with all its damaging side-effects?
Fortunately, accurate tests now exist to see if you have cancer cells circulating in your body - but they have actually been around for about 20 years! It’s just that few people in the UK know about it because doctors don’t use them. They prefer to work by guesswork; (they call it experience).
Testing for the presence of circulating cancer cells and tumour DNA
Now this is all changing. We have the advent of ’Precision Medicine’. The Liquid Biopsy has arrived. Previously used to measure the risk for Down’s Syndrome in the foetus, Liquid Biopsy can now measure whether you have any remaining cancer by looking for higher levels of Circulating Cancer Cells in the blood.
Go To: Liquid Biopsy Testing with lung cancer patients
The really clever part - it can also measure circulating tumour DNA, ctDNA, - pieces of DNA thrown off by the current tumours, and so show in the very early moments of treatment, a real time picture of whether the drugs are working or not, and whether the tumour is fading or becoming more aggressive.
In the UK, Professor Charlie Swanton of the Francis Crick Institute has completed a Liquid Biopsy test on Lung Cancer patients and found it 92 per cent accurate.
An American Government paper on real time Liquid Biopsies becominga reality states,
"Certain fragments of DNA shed by tumours into the bloodstream can potentially be used to non-invasively screen for early-stage cancers, monitor responses to treatment and help explain why some cancers are resistant to therapies. For most tumours, a tissue biopsy is quite challenging in that it is costly, painful, or potentially risky for the patient. All these are good reasons to learn about cancer through blood and to get excited about the possibility of carrying out liquid biopsies".
Also in America, The Mayo Clinic has launched CellSearch; more correctly The CellSearch Circulating Tumour Cell (CTC) test. This test is FDA approved and each result at the Mayo Clinic is confirmed by a Cyto-technologist and a pathologist. It is used across a number of cancers and measurements are predictive of potential survival.
But a quick Google Search finds various tests and training - the Parsotix test, OncoDNA, Qiagen, even an advertisement from the UK NHS to go a ’Precision Medicine Course’.
In fact, ordinary CTC tests are getting a bit old fashioned now that ctDNA has come along. But CTC tests can detect the presence of metastatic cancer long before standard imaging can show up any problems. Having a blood test could predict you have cancer long before a scan would show anything.
CellSearch has now expanded beyond the Mayo Clinic in the USA, and advertises itself as "The first and only clinically validated, FDA-cleared blood test, for enumerating circulating tumour cells".
At the moment in Spring 2017, the NHS in the UK offers none of this. Privately funded CTC tests are all a UK patient has. So, we will see how fast the NHS adopts the ctDNA Liquid Biopsy tests and starts the new era of Precision Medicine with its non-invasive biopsy. Excuse us, but we won’t be holding our breath.
The RGCC test for circulating cancer cells
Next there’s the Research Genetic Cancer Center (RGCC) in Greece run by Dr. Ioannis Papsotiriou and using the RGCC test. This is now being used by a number of top hospitals including MD Anderson, Sloan Kettering and Dana-Faber, who say it works with all cancers.
RGCC laboratories claim to be able to pick up the existence of cancer cells at minute, molecular levels way before standard hospital tests show anything. And they claim their tests can show static cells, circulating tumour cells and even cancer stem cells.
At CANCERactive, we have thought CTC tests have been an important development for years! For example, we recently talked with two ladies with HER+ breast cancer. In both cases they had had lumpectomies. And in both cases they had refused Herceptin. Why? Because the surgeon had told them that he had removed everything and that there was no cancer left in their body. Crazy! We could not persuade them to have a CTC test. It would have provided much needed objectivity.
AND, RGCC tests show what might work (or not) against your cancer
But there is another reason for using the RGCC test. The Liquid Biopsy will test your blood for pieces of tumour and these will show exactly what is happening to the cancer as a result of the drugs you have just taken. The excitement comes because doctors might see that the drugs are not working and so can switch you quickly to an alternative.
You could be forgiven for thinking that this is like locking the stable door after the horse has escaped. Many women would like to know if their cocktail of 4 breast cancer drugs was going to work BEFORE one even entered their body. Given the notoriety of side-effects, the majority don’t want to be used as human guinea pigs.
And the RGCC tests can sort this out. They claim that once they have circulating cancer cells isolated, they can then do sophisticated ‘chemosensitivity testing’, checking what compounds work, and importantly what do not, against your particular cancer cells in a test tube - in advance of you being given them. This is not just limited to drugs; they can test natural compounds too. Chemosensitivity testing measures the sensitivity of the cancer cells to the drug or natural compound BEFORE you are treated with it.
GO TO: CANCERactive article on Chemosensitivity testing
You might think this is a better idea - especially when FEC-T breast cancer treatment has now been shown to be completely unnecessary in 15 per cent of cases by a new Belgian test called the ‘Mamaprint’.
Doctors don’t like chemosensitivity testing. "Just because it works in the test tube doesn’t mean it will work in real life," is the mantra. True. But if it DOESN’T work in the test tube it almost certainly won’t work in real life either!
In Europe, blood tests are sent to the centre in Greece, as they are from Melbourne, Australia. Skeptics disparagingly call this ’the Greek Test’. They also don’t know of Hippocrates.
Other sophisticated cancer tests
In the USA, America Metabolic Laboratories offers sophisticated cancer profiling using a range of blood and urine markers including the PHI test and sensitive HGC test. To view details, go to www.Americanmetaboliclaboratories.net.
In Germany, the Biofocus Institute for Laboratory Medicine has a very similar testing system to that of RGCC checking for ‘chemo-resistance, circulating tumour cells and ‘alternative agent’ performance (See: www.biofocus.de)
Then there’s a brand new test as of January 2016 called the Oncoblot – being used by Dr. Garry Gordon, co-founder of the American College for Advancement in Medicine (ACAM). This test can tell if someone has cancer cells in their body years before CAT scans or PET scans show anything (www.oncoblotlabs.com).
Other relevant links include
Belgium ‘Mamaprint’: https://www.canceractive.com/cancer-active-page-link.aspx?n=3805&Title=Mamaprint%20test%20saves%20unnecessary%20chemo%20use
Denmark: www.humlegaarden.com