Patients are at the centre of cancer research

To mark Irish Cancer Week, Trinity College Dublin and the Irish Cancer Society are collaborating on their key annual conferences. This means the conferences can share speakers and, most importantly, share the theme: Living well with cancer.

Cancer survival rates are continuing to increase and the clinical and scientific experts, who are at the cutting edge of research driving advances in medical treatment will, as a result, get to address the two very different but equally important audiences.

Prof John Reynolds, consultant surgeon and head of department at TCD and St James's Hospital, says this planning enables the national and international speakers to "communicate to researchers, scientists, and clinical cancer professionals but also to patients and their families so they can give the clinical talk and the scientific talk but also the layperson's talk or the talk for the patient."

“To have excellent people here and for them to impact on both the patient [Irish Cancer Society] conference and our own, is of great value.”

Collaboration is also seen at every level in the work of the experts in the field. They are involved in translational cancer research which involves the science and medicine coming together with researchers and patients.

According to Reynolds, “a lot of it is the day-to-day activity in major cancer hospitals and academic universities and it is linked in a well-structured way.”

He works closely with scientists such as Orla Sheils, professor of histopathology in TCD and Dr Jacintha O’Sullivan, senior lecturer in the department of surgerye.

“We work in an integrated way and a lot of what we want to discover is done through the translational research and clinical trials,” he says.

In all of this, “the patient is at the centre of this algorithm,” says Sheils.

The benefit is seen in better outcomes for patients. Reynolds says there has been “approximately a 15 per cent increase in the past 10 years,” in the five-year survival rate for oesophageal and stomach cancer, an area he specialises in.

“For the most complex cancer cases we are seeing very significant improvements not only in the safety of operations but the cure rate of complex operations.”

He says interdisciplinary teams in cancer hospitals that provide specialised care including nursing, surgery and critical care units are “a big advance.”

Other advances mean surgery in breast and bowel cancer is minimally invasive while the quality of imaging technology used in MRIs and other scans allows doctors to more accurately assess the stage a cancer is at and, “therefore their treatment is much better defined and appropriate than it might have been years ago”.

Surgery for secondary cancers is no longer “absurd”, says Reynolds. Instead for a particular subset of patients with secondary cancers, particularly of the liver and lung, surgery is now an option and that “is a massive advance”, he says.

Surgeon’s role The role of the surgeon is such that they are now, “at the interface with the patient and the scientists,” and can link the patient with the team that is involved in cancer research, involved in translational research and involved in clinical trials.

He says simply: “If you are [working] in cancer and not working towards achieving absolute best outcomes for your patients and stage per stage cures commensurate with best reported literature, you are not doing your job.”

Some of the work involving TCD researchers is on cancer and the environment, specifically the danger of exposure to ultraviolet light.

The conference will hear about research that has “highlighted some of the specific mutations that happen and that we see in the Irish patients that get malignant melanoma,” says Sheils.

They have examined the signalling processes in cells and how that process is altered by cancer.

“In skin cells which have been damaged by ultraviolet light where melanoma is forming, there is a very simple mutation that occurs. It is literally like a typographical error, where an A is replaced by a T.”

“At a genetic code level it causes a small building block of a protein to be changed, to be substituted; and that in turn means that particular molecule inside the cell is left permanently in the ‘on’ position and the cell is being told keep growing, keep dividing, get more blood vessels in, do not die whatever you do, and that is passed on.”

She says a new drug, still going through the trial process, “targets that tiny molecule that is permanently switched on”.

Dr O’Sullivan has been involved in work on circulating tumour cells that use the bloodstream to set up “a new colony of tumour cells in a distant organ.” Circulating tumour cells offer scientists, “a window into how the tumour is growing or upstaging and spreading,” and work is continuing on monitoring the cells with blood tests.

These cells allow themselves to be cloaked or covered by platelets, normal cells in the blood, “and that trick allows the tumour cell to transit through the blood system and not be taken out by the person’s own immune system.”

The work on this, which also involves Prof John O'Leary, has been funded almost exclusively from Science Foundation Ireland and "is in collaboration with colleagues in DCU. We are trying to unpick the biology and DCU are trying to develop a new device which could be used in the clinic to count the cells."

Other work on the tumour microenvironment is examining how a cancer cell alters the way it produces its energy. In a normal cell energy is produced a certain way but as cells start to transform into a cancer they use energy in a different way. “They produce energy in a way that allows them to remain immortal. They can switch energy pathways that allows them not to die,” says O’Sullivan.

There are, the doctors agree, aspects of cancer research and developments in clinical practice in which Trinity “would be acknowledged as in the premier division and up close to the Champions League”.

Funding is vital for the research work to continue and O’Sullivan anticipates, “the focus for funding in the last couple of years and definitely in the next five to 10 years is that they are pushing academics to work very closely with industry partners because it is believes that will accelerate the discovery phase in bringing something from the bench back to the clinic.”

Sheils concurs. “I am working in this area for 15 years and in all of those years I have had some form of active collaboration with some form of bio-tech company or another,” she says

“So Trinity is very keen that we straddle that phase between the clinician, the patient, the basic researcher and industry. We need all of those parties at the table to make any kind of success or to accelerate any discovery.”

According to Reynolds, the National Cancer Strategy, which centralised services into eight cancer centres, has “been very successful in delivering good strong clinical structures for cancer but there is still work to be done”.

Crumlin Children’s Hospital, the only children’s cancer centre in the country, “functions to a very high standard and is very well connected with clinical trials as well,” says Prof Reynolds.

The National Cancer Control Programme, which is delivering the National Cancer Strategy, acknowledges more than 60 per cent of cancers are cured and in the next decade cancer prevention and screening will be a long-term priority and surviving cancer will emerge as a dominant theme.