By Dr. Tejinder Kataria, Chairperson Radiation Oncology & Cancer center, Medanta – The Medicity
Cancer is the second leading cause of death worldwide. Last few decades have seen immense research directed to understand the origin, prevention, early diagnosis and treatment of the cancer disease. There are over a 100 different types of cancer with a variety of stages and grades. However, the basic change that occurs in all cancers is an alteration in the genetic map of the cell that becomes autonomous and starts forming abnormal growth. Cancer affects the physical, emotional, financial health of the individual, family and society. The recent innovations helping an early and accurate diagnosis leading to better outcomes for cancer patients are:
A ) Liquid Biopsy – Fluid biopsy is performed on body fluids like blood. It is postulated that cancer cells can be identified in the circulating blood with special tests. Liquid biopsy has been very helpful for lung cancer patients who show a progression of their disease while on treatment. Instead of a re-biopsy a fluid biopsy from blood can identify the new variant of cancer and its genetic mutation based upon which a different treatment strategy or targeted therapy can be decided.
B) Molecular Diagnostics – it is possible to detect individual biologic molecules for diagnosis, follow up and personalized treatment algorithms for cancer. This has been made possible due to development of user-friendly methods of molecular diagnostics. Polymerase-chain-reaction (PCR) was a major breakthrough for DNA testing and utilizes small amount of biological material for giving a result. Immunohistochemistry (IHC) and receptor analysis (estrogen, progesterone or Her2neu for breast cancer) assists in tailoring specific treatment to patients along with prognostication of the cancer. A variety of DNA, RNA protein circulating tumor cell assays are available besides multiple mutation analysis platforms. The developments in molecular diagnostics have widened the scientific horizon to understand Hereditary Cancer Syndrome (BRCA 1, BRCA 2 genes), predictive markers (BRAF, ALK, ROS for lung cancer), circulating tumor fragments (cDNA , RNA) as well as localizing the cell of origin for Cancers of unknown primary (CUP). All these advances have assisted in improving cancer care and outcomes by early detection reducing toxicity and surveillance for any recurrence especially for hereditary cancers.
c)Technical Innovations – Technological innovations like CRISPR, artificial intelligence, telemedicine, cryo- electron microscopy, robotic radiosurgery, robotic surgery and biologically guided (PET-based) targeted radiotherapy are revolutionizing the cancer treatment and outcomes in the twenty first century
CRISPR is a tool developed by the Nobel laureate Jennifer Doudna and Charpentier that facilitates gene editing. It was developed for viral gene edit and has been already used for development of vaccine against Covid virus. This has given a hope for development of cancer vaccines in future.
Cryo-preserved tissues can be subjected to electron microscopy for detailed understanding of intra cellular changes happening due to cancer and its treatment.
Computer programs for cancer diagnostics, data analysis, and new drug development, reverse engineering and precision medicine are a few components of artificial intelligence (AI) application in the clinic. Computer simulation can create a virtual twin model of a person to explore new and effective treatments and predict outcomes before real world treatment. This can minimize toxicity and maximize control of disease in a shorter span and with less number of patients in contrast to clinical ttrials
Telemedicine has made it possible to have a physician consult from the comfort of a patient’s home reducing travel and financial burden
Robotic Surgery is minimal access treatments for lung, prostate, uterine and colon cancer resulting in short hospital stay with less blood loss resulting in faster recovery post-surgery.
Robotic Radio Surgery is a non-invasive cancer treatment for deep seated, inoperable or recurrent, metastatic cancers. It has not only added to quality of life of cancer patients but added longevity to oligometastatic state in >50% of patients.