Colon cancer calculated: Metabolic profiling

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  • Published: Aug 15, 2013
  • Author: David Bradley
  • Channels: NMR Knowledge Base
thumbnail image: Colon cancer calculated: Metabolic profiling

Fingerprinting bowel cancer

Credit: Ann Surg/Nicholson et al/Imperial College - Rapid Diagnosis and Staging of Colorectal Cancer via High-Resolution Magic Angle Spinning Nuclear Magnetic Resonance (HR-MAS NMR) Spectroscopy of Intact Tissue Biopsies

Nuclear magnetic resonance (NMR) spectroscopy can be used to obtain a metabolic fingerprint of cancer of the bowel and so determine how far advanced the disease is, according to UK researchers.

Bowel cancer is the third most common type of cancer around the world, with over one million new cases diagnosed every year. Early diagnosis is often critical to a positive outcome and with modern surgical techniques, chemotherapy and radiotherapy, the five-year survival rate is as high as 60% in the developed world. Nevertheless, more people might survive the disease if more accurate "staging" of a colorectal tumour were possible quickly and without preliminary surgical intervention. The stage to which a tumour has developed strongly influences the chosen treatment regime as well as prognosis.

Augmenting imaging

Researchers at Imperial College London are experts in the field of metabolic fingerprinting and have turned their attention to how profiling the many different metabolites present in bowel cancer might be used to identify the stage at which the cancer has reached based on changes from normal and known profiles for the different points in the tumour progression. Metabolic fingerprinting could be used in parallel with imaging technology - such as magnetic resonance imaging (MRI) and computerized tomography (CT) and ultrasound - to obtain a much improved diagnostic in this potentially lethal form of cancer. Imaging relies on subsequent visual estimation of the size and position of a tumour and is not necessarily sensitive or specific especially if benign growths are also present or the patient's body shape and size obscures the view. Unfortunately, scanning alone often reveals a new tumour to be more advanced than it is or conversely well-advanced malignancy to be more treatable than its apparent staging would suggest.

Lead author Reza Mirnezami of the Department of Surgery and Cancer at Imperial College London, explains further: "Working out the stage of a tumour is critical for planning a patient's treatment. Increasingly, before we surgically remove a tumour, we will give therapies to try and shrink it down, but the kinds of therapies we offer depend on our assessment of how advanced that tumour is. The more accurate we can be, the better the patient's chances of survival." He adds that, "Our research suggests that using metabolic fingerprinting techniques in addition to scanning could give us the clearest possible picture of how the cancer is progressing."

Finding metabolic targets

The team analysed the metabolic fingerprint of 44 bowel tumour tissue samples, provided by patients at Imperial College Healthcare NHS Trust, using high-resolution magic angle spinning nuclear magnetic resonance spectroscopy (HR-MAS NMR). The results showed NMR profiling to be as accurate at determining the stage that the cancer had reached as existing radiological methods. Team leader Ara Darzi adds that, "We know that even with the impressive scanning technology we have available at the moment, it's not always possible to correctly ascertain the local stage of a cancer. Our study suggests that used alongside medical imaging, metabolic fingerprinting could enable us to gain more accurate information. This would give us greater certainty about the right course of treatment to give to patients, sparing some patients from invasive treatment where they don't need it."

The findings also have implications for research into tumours that focuses on specific metabolic targets. It might be possible for instance to block or promote a particular metabolic route pharmacologically at different stages of the disease's development and so block further growth or slow the rate of growth with highly drugs of a highly targeted mode of action unique to the given metabolic pathway exploited by the growing tumour. According to Jeremy Nicholson, this work is just one part of a much larger program aimed at advancing technology for improving patient safety and outcomes in the surgical environment.

The team also points out that the metabolic profile reveals major differences between cancers in the colon and in the rectum, which challenges the received wisdom regarding the biochemistry and physiology of different regions of the bowel.

Related Links

Ann Surg 2013, online: "Rapid Diagnosis and Staging of Colorectal Cancer via High-Resolution Magic Angle Spinning Nuclear Magnetic Resonance (HR-MAS NMR) Spectroscopy of Intact Tissue Biopsies"

Article by David Bradley

The views represented in this article are solely those of the author and do not necessarily represent those of John Wiley and Sons, Ltd.

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