Is there a test that can detect cancer early? Clarifications about the CTC test.

One of the most frequent questions I receive is: “Is there a blood test that can tell me for sure if I have cancer?”

Recently, a lot of information has emerged about a modern test—not an advertisement—that detects circulating tumor cells (CTC) in the blood. What is this test really about?

Let’s clarify together.

What are circulating tumor cells (CTC)?

When a tumor develops in the body, some cells can break away and enter the bloodstream. These are called circulating tumor cells. Their presence can indicate a malignant process, even in early stages, before the tumor is visible on imaging tests (CT, MRI, ultrasound).

What are the benefits of the CTC test?

✔ Early detection: It can identify traces of cancer in its early stages.

✔ Personalized screening: It is especially useful for people at high risk (family history, exposure to risk factors).

✔ Monitoring: Oncologists can track treatment response or detect recurrence.

✔ Medical guidance: A positive result does not indicate the tumor’s location, but it warns that further investigation is needed.

When is it recommended?

The test is recommended especially for people aged 40–70, when cancer risk significantly increases. However, there is no strict age limit—it can also be performed at younger ages, especially if there are risk factors or family history.

How does it work and how sensitive is it?

A blood sample is analyzed using special technologies that identify abnormal cells with tumor characteristics. The test is highly sensitive, but not 100%. In most cases, if there is active cancer, CTCs can be detected. However, some small tumors or those with specific biological features may go undetected.

What are the limitations and disadvantages of the test?

✔ It does not indicate the tumor’s location. The test only shows oncological risk; additional tests are needed to identify the type and location.

✔ Possible false negatives or false positives. It does not replace classic diagnosis based on imaging, biopsy, and histopathology.

✔ It does not replace an oncological consultation. It is just one piece of the puzzle, not the final diagnosis.

Is it the same as tumor markers?

No. Tumor markers (CA-125, PSA, CEA, etc.) are proteins found in the blood that can change in cancer, but also in many benign diseases. The CTC test detects circulating malignant cells, giving it higher specificity.

Is it confused with genetic tests?

No, it should not be confused with genetic panels (BRCA1, BRCA2, TP53, etc.), which analyze DNA to assess genetic predisposition to cancer.

  • Genetic test: Shows the risk of developing the disease in the future.
  • CTC test: Shows if there are already tumor cells in the body now.

Conclusion

The CTC test is a modern, promising method that complements the diagnostic tools in oncology. It is not infallible and does not replace classic investigations, but it can be a valuable warning sign for both doctor and patient.

My recommendation: Always discuss with an oncologist or specialist before deciding to take the test. Each result needs correct interpretation and a tailored medical plan.

Promising Advances in Cancer Treatment: The KRAS-Targeted Vaccine

In recent years, significant breakthroughs in oncology have illuminated a novel approach to treating cancers associated with KRAS mutations, such as pancreatic and colorectal cancers. A new therapeutic vaccine called ELI-002 2P, developed by Elicio Therapeutics, has shown remarkable potential in activating the immune system to combat these challenging cancers.

Understanding KRAS Mutations

KRAS mutations are present in approximately 25% of all solid tumors, making them one of the most common drivers of cancer growth. They are particularly prevalent in pancreatic cancer, with about 90% of cases affected, and in roughly 50% of colorectal cancers. Historically, these mutations have posed a significant challenge for conventional therapies, highlighting the importance of developing targeted vaccines.

How ELI-002 2P Works ?

The ELI-002 2P vaccine employs a unique strategy by utilizing synthetic peptide antigens that mimic the KRAS mutations frequently found in these cancers. Here’s a breakdown of how it operates:

1. Targeting the Immune System: The vaccine is designed to stimulate the immune system to recognize and attack cancer cells that carry KRAS mutations.

2. Delivery Mechanism: It is chemically engineered to bind to albumin in the bloodstream, allowing it to travel directly to lymph nodes, where immune responses are activated.

3. Activating T Cells: The vaccine primes both CD4+ helper T cells and CD8+ killer T cells, equipping the immune system to effectively target and destroy cancer cells.

Clinical Trial Results

The results from the AMPLIFY-201 Phase 1 trial are particularly encouraging. This trial involved 25 patients—20 with pancreatic cancer and 5 with colorectal cancer—who had undergone surgery and standard treatment but still showed minimal residual disease. The trial reported the following outcomes:

– Relapse-Free Survival: An average of 16.3 months, significantly improving outcomes for this high-risk group.

– Overall Survival: An average of 28.9 months, exceeding historical data.

– T Cell Responses: 84% of patients developed KRAS-specific T cell responses, while 71% exhibited both helper and killer T cell responses.

– Complete Clearance: Six patients achieved complete clearance of circulating tumor DNA, indicating a significant reduction in residual cancer.

Additionally, the vaccine demonstrated an intriguing phenomenon known as “antigen spreading,” where the immune system began to recognize and attack tumor mutations not included in the vaccine formulation itself. This was observed in two-thirds of the patients, suggesting a broader immune recognition beyond just KRAS.

Looking Ahead

The AMPLIFY-201 trial results represent a significant advancement in cancer vaccine research, and a randomized Phase 2 trial is already underway to test an expanded formulation that includes additional KRAS and NRAS peptides. If successful, this vaccine could provide a standardized treatment option that is readily accessible to patients, especially in urgent care situations.

In conclusion, the development of the ELI-002 2P vaccine marks an exciting milestone in the fight against KRAS-driven cancers. This innovative approach could usher in a new era in cancer treatment, where vaccines play a crucial role in harnessing the body’s immune system to combat cancer effectively. As we continue to observe these developments, we move closer to the hope of more effective and lasting treatments for patients facing challenging cancer diagnoses.

Hepatocellular Carcinoma Treatment: Insights from Oncology Congresses

Introduction

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, often arising in the context of chronic liver disease and cirrhosis. This article summarizes the key points discussed by leading experts in the field, focusing on innovative treatment strategies and the evolving landscape of HCC management.

Understanding Hepatocellular Carcinoma

What is Hepatocellular Carcinoma?

Hepatocellular carcinoma (HCC) is a primary malignancy of the liver, originating from hepatocytes, the main type of liver cell. It is closely linked to chronic liver diseases such as hepatitis B and C infections, alcohol-related liver disease, and non-alcoholic fatty liver disease (NAFLD).

Causes of HCC

The development of HCC is often associated with several risk factors, including:

  • Chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV)
  • Excessive alcohol consumption leading to liver cirrhosis
  • Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH)
  • Exposure to aflatoxins, which are toxins produced by certain molds found in food
  • Genetic metabolic diseases and other conditions that cause liver damage

Treatment Innovations in HCC

New Targets and Mechanisms

Recent research has identified novel therapeutic targets and mechanisms for treating HCC. These include:

  • Immune Checkpoint Inhibitors: Drugs that target immune checkpoints such as PD-1/PD-L1, CTLA-4 (Cytotoxic T-Lymphocyte-Associated Protein 4), LAG-3 (Lymphocyte-Activation Gene 3), TIGIT (T Cell Immunoreceptor with Ig and ITIM Domains), and TIM-3 (T Cell Immunoglobulin and Mucin-Domain Containing-3) have shown promise in enhancing the body’s immune response against cancer cells.
  • Cytokine Targeting: Therapies aimed at cytokines like IL-27 and GDF15 (Growth Differentiation Factor 15) are being explored for their potential to modulate the immune environment and improve treatment outcomes.
  • Bispecific Antibodies: These antibodies can simultaneously bind to two different antigens, offering a targeted approach to attack cancer cells more effectively.

Highly Exploratory Treatments

Emerging treatments under investigation include:

  • CAR-T and TCR Cell Therapies: These involve genetically modifying a patient’s T-cells to better recognize and attack cancer cells.
  • Oncolytic Viruses and Vaccines: These therapies aim to stimulate the immune system to recognize and destroy cancer cells.
  • Targeting β-catenin and HDAC Inhibitors: New agents that inhibit specific pathways involved in cancer cell growth and survival are being tested for their efficacy in HCC.

Clinical Insights and Treatment Strategies

First-Line Treatments

The current first-line treatments for advanced HCC include combinations of immune checkpoint inhibitors and VEGF inhibitors, such as:

  • Atezolizumab plus Bevacizumab: This combination has shown significant improvements in overall survival and progression-free survival in patients with advanced HCC.
  • Tremelimumab plus Durvalumab: Another promising combination that has demonstrated efficacy in clinical trials.

Subsequent Lines of Therapy

For patients who do not respond to first-line treatments, subsequent therapies are crucial. Options include:

  • Tyrosine Kinase Inhibitors (TKIs): Drugs like Sorafenib, Lenvatinib, and Cabozantinib are used in various lines of treatment to inhibit cancer cell growth and proliferation.
  • Combination Therapies: Ongoing trials are investigating the efficacy of combining different therapeutic agents to overcome resistance and improve patient outcomes.

Conclusion

The landscape of hepatocellular carcinoma treatment is rapidly evolving, with numerous innovative therapies on the horizon. The presentations at the recent congress highlighted the importance of targeting new pathways and utilizing combination therapies to improve patient outcomes. As research continues, the hope is that these advancements will translate into more effective and personalized treatment options for patients with HCC.

Insights from the Congress: The Future of Colorectal Cancer Screening

Introduction

As a medical oncologist, I recently attended a major congress where groundbreaking advancements in colorectal cancer (CRC) screening were presented. The insights shared at the event highlighted both current methodologies and emerging technologies that promise to revolutionize how we approach CRC detection and prevention. Here, I summarize these findings and their implications for clinical practice.

Current Screening Landscape

Colorectal cancer remains a significant global health challenge, making effective screening strategies more crucial than ever. The congress underscored several established screening methods:

  1. Colonoscopy: Widely regarded as the gold standard, colonoscopy allows for the visualization and removal of polyps throughout the colon. Its role in reducing CRC incidence and mortality is well-documented.
  2. Stool-Based Tests:
    • Fecal Immunochemical Test (FIT): This test detects occult blood in stool samples and is praised for its non-invasive nature and cost-effectiveness.
    • Fecal Occult Blood Test (FOBT): Utilizes a chemical process to identify blood in the stool, serving as an alternative to FIT.
  3. Stool DNA Testing: By analyzing genetic mutations in stool samples, this method offers a promising avenue for early detection.
  4. Flexible Sigmoidoscopy: Focuses on the lower part of the colon and is less invasive than a full colonoscopy.
  5. CT Colonography: Also known as virtual colonoscopy, this imaging technique provides a comprehensive view of the colon without the need for traditional endoscopy.

Emerging Technologies in CRC Screening

The congress also showcased innovative screening technologies that are poised to enhance our diagnostic capabilities:

  • Blood-Based Biomarkers:
    • cfDNA Tests: The FDA-approved Guardant Shield™ test detects circulating tumor DNA in the bloodstream, offering a convenient and non-invasive screening option.
    • cfDNA + Protein Tests: Freenome’s approach combines cfDNA with protein biomarkers to improve detection rates, particularly for early-stage CRC.
  • Advanced Stool Tests:
    • MT-sRNA Test: Developed by Geneoscopy, Colosense™ utilizes stool-derived RNA markers to identify CRC with high sensitivity.
    • MT-sDNA Test: Exact Sciences’ Cologuard Plus™ integrates multiple DNA markers to enhance detection accuracy, representing a significant advancement over traditional stool tests.

Comparative Analysis of Screening Methods

A comparative analysis presented at the congress highlighted the strengths and limitations of various screening methods:

MethodSensitivity for CRCSpecificityKey Features
FIT67%-91%95%Non-invasive, cost-effective
Cologuard Plus95%91%-94%Multi-target stool DNA test
Colosense94%88%RNA markers + FIT
Shield™ or Freenome80.5%-83%90%Blood-based cfDNA test

Challenges and Limitations

While the potential of blood-based cfDNA tests is immense, several challenges were discussed:

  • Detection of Advanced Adenomas: These precancerous lesions may not release sufficient ctDNA for reliable detection, limiting the effectiveness of blood-based tests.
  • Tumor Size and Stage: The amount of ctDNA in the bloodstream is generally proportional to tumor size and stage, affecting the sensitivity of these tests.
  • Stool-Based Tests: Continue to show superior sensitivity for detecting advanced adenomas compared to blood-based methods.

The Role of Artificial Intelligence

Artificial Intelligence (AI) is making significant inroads into CRC screening, particularly in enhancing the accuracy of colonoscopies. AI-assisted colonoscopy can improve adenoma detection rates by identifying additional neoplastic lesions that might be missed by the human eye.

Future Directions: Fecal MicroRNAs and Multi-Cancer Early Detection

Emerging research into fecal microRNAs presents a promising frontier for CRC detection. These small, non-coding RNA molecules are stable in stool samples and can accurately classify CRC patients from controls. Additionally, Multi-Cancer Early Detection (MCED) tests using cfDNA are being developed to screen for multiple cancer types simultaneously, although their sensitivity for early-stage CRC currently stands at around 53%.

Conclusion

The congress provided valuable insights into the evolving landscape of CRC screening. While traditional methods like colonoscopy and stool-based tests remain highly effective, emerging technologies such as blood-based biomarkers and AI-assisted colonoscopy offer exciting possibilities for the future. As medical professionals, our goal is to leverage these advancements to improve patient outcomes and adherence to screening recommendations. Ultimately, the best screening test is the one that gets done, ensuring that more individuals can benefit from early detection and intervention.

References

  • Sinicrope, F. A. (2024). Next Generation Screening for Colorectal Cancer.
  • Imperiale TF, et al. NEJM 2024.
  • Chung, D et al. NEJM 2024.
  • Hassan et al, Gastroenterology 2021.
  • Pardini, B et al. Gastroenterology 2022.

Bone Metastases in Oncology

Bone Metastases in Oncological Pathologies: Understanding, Diagnosis, and Management.

What are Bone Metastases?

Bone metastases occur when cancer cells spread from their original site to the bones. This process is a common complication in various cancers, including breast, prostate, and lung cancer. Once these cancer cells establish themselves in the bone, they can disrupt normal bone function, leading to pain, fractures, and other serious complications.

How Can Bone Metastases Be Diagnosed?

Diagnosing bone metastases typically involves a combination of imaging studies and laboratory tests. Common diagnostic methods include:

– X-rays: These can reveal abnormalities in bone structure, such as fractures or lesions.
– CT scans: These provide detailed cross-sectional images of bones and surrounding tissues.
– MRI scans: Useful for assessing the extent of bone involvement and soft tissue.
– Bone scans: These can detect areas of increased activity in the bones, indicating potential metastases.
– Biopsy: In some cases, a sample of bone tissue may be taken for histological examination to confirm the presence of cancer cells.

Risks and Complications Associated with Bone Metastases

Bone metastases can lead to several complications, including:

– Pain: Often severe and can significantly impact the patient’s quality of life.
– Pathological fractures: Weakened bones are more prone to fractures, which can lead to immobilization and further complications.
– Hypercalcemia: Increased calcium levels in the blood can occur due to bone breakdown, leading to symptoms such as nausea, confusion, and kidney issues.
– Spinal cord compression: If metastases occur in the spine, they can compress the spinal cord, leading to neurological deficits.

How Can Bone Metastases Be Prevented?

While not all cases of bone metastases can be prevented, certain strategies may reduce the risk, such as:

– Early detection and treatment of primary cancers.
– Regular monitoring for patients with known cancer risk factors.
– Lifestyle modifications, including maintaining a healthy weight and engaging in regular physical activity.

Medications Useful in Treating Bone Metastases

Various medications can help manage bone metastases, including:

– Bisphosphonates: These drugs help strengthen bones and reduce the risk of fractures.
– Denosumab (Jubereq): A monoclonal antibody that inhibits RANKL, reducing osteoclast activity and bone resorption. Approved in the EU, Jubereq is indicated for the prevention of skeletal-related events in patients with advanced malignancies involving bone and for treating giant cell tumors of the bone.

Is Radiation Therapy Useful for Bone Metastases?

Yes, radiation therapy can be an effective treatment for bone metastases. It can help alleviate pain, reduce tumor size, and prevent complications such as fractures. Palliative radiation therapy is often used to improve the quality of life for patients experiencing significant discomfort due to bone metastases.

Dietary Considerations for Patients with Bone Metastases

Patients with bone metastases should focus on a balanced diet rich in essential nutrients to support bone health. Key dietary components include:

– Calcium and Vitamin D: Important for bone strength. Sources include dairy products, leafy greens, and fortified foods.
– Protein: Essential for overall health and recovery. Include lean meats, fish, legumes, and nuts.
– Hydration:Staying well-hydrated is crucial, especially if hypercalcemia is a concern.

Restrictions: Patients may need to limit high-sodium foods, as excessive sodium can lead to calcium loss from bones.

In summary, bone metastases pose significant challenges for patients with cancer, but with early diagnosis, appropriate treatment, and lifestyle modifications, many complications can be managed effectively. Always consult healthcare professionals to tailor a treatment plan that suits individual needs.

Physical Activity in Oncology

 Physical Activity in Oncology: Breaking Myths, Embracing Truth!

Dear colleagues and patients, today I want to discuss an essential topic that can transform how we approach cancer treatment: physical exercise! Although there are still many misconceptions, science increasingly shows us that physical activity is a safe, effective, and essential intervention in cancer care.

Recently, a landmark clinical trial followed 889 individuals with colon cancer over eight years, and the results were remarkable:

 A 28% reduction in cancer recurrence

 A 37% reduction in overall mortality

Even more striking, the benefits of structured exercise surpassed those of many drugs currently prescribed in cancer follow-up care!

Despite this evidence, myths persist. Here are some of the most widespread misconceptions and the truths behind them:

❌

 **Myth 1:** Exercise during radiotherapy can worsen skin burns.

✅

 Fact: Exercise does not aggravate skin reactions caused by radiotherapy; in fact, it can help reduce inflammation and support healing.

❌

 Myth 2: People with bone metastases should avoid all physical activity.

✅

 Fact: Supervised, low-impact exercise can be beneficial, strengthening muscles and lowering fall risk, even in individuals with bone metastases.

❌

 Myth 3: Strength training is contraindicated during chemotherapy.

✅

 Fact: Chemotherapy often leads to muscle loss, and strength training is one of the most effective ways to maintain functionality and quality of life.

Exercise is a form of medicine! Like any therapy, it should be personalized, risk-assessed, and guided by trained professionals. Let’s embrace this approach and encourage movement as an integral part of cancer treatment! 

 #Oncology #PhysicalActivity #Health

Cancer in Pregnancy: Understanding Risks, Diagnosis, and Treatment

Cancer during pregnancy is a complex and sensitive issue that affects a small percentage of expectant mothers. While the overall incidence is low, understanding the factors that contribute to cancer development, diagnosis, and treatment options is crucial for the health of both mother and child.

Continue reading →

The Importance of Lung Cancer Screening in Never Smokers

Lung cancer remains one of the leading causes of cancer-related mortality worldwide, affecting not only smokers but also never smokers. Lung cancer screening (LCS) is a vital tool in early detection and prevention, particularly for those who may be at risk but have never smoked.

Continue reading →

Frequently Asked Questions for Oncologists: Clear Answers for Patients

 **Frequently Asked Questions for Oncologists: Clear Answers for Patients** 

1. **What is cancer?**
Cancer is a disease characterized by the uncontrolled growth of abnormal cells in the body. These cells can form tumors, invade healthy tissues, and affect the normal functioning of organs.

2. **Is cancer easily transmitted? Do family members living with me have a risk of developing cancer?**
Cancer is not transmitted like an infectious disease, but certain genetic factors can increase the risk of cancer. First-degree relatives (parents, siblings) with a history of cancer may have a genetic predisposition. It is important to discuss family history and the possibility of genetic testing with your doctor.

3. **What are the symptoms of cancer?**
Symptoms vary depending on the type of cancer but may include unexplained weight loss, persistent fatigue, pain, changes in the skin, or unusual bleeding. It is important to consult a doctor if you notice these signs.

4. **Can fever be an indication of metastasis?**
Fever can occur in various situations, including infections or reactions to treatment. While it is not a direct indicator of metastasis, it is important to discuss persistent fever with your doctor, as it may be a sign of disease progression.

5. **If I have metastasis in another organ, do I have treatment options?**
Yes, there are treatments available for patients with metastasis. Treatment options depend on the type of cancer, the affected organs, and the patient’s overall health. It is important to discuss a personalized treatment plan that addresses your specific needs.

6. **What tests can I undergo to know if I have cancer or not?**
To determine if you have cancer, it is important to consult an oncologist who will recommend a series of tests, including blood tests, imaging (such as ultrasounds, CT scans, or MRIs), and, in some cases, biopsies. There is no single test that can confirm the presence of cancer; the evaluation is complex and depends on your symptoms and medical history.

7. **What types of treatments are available for cancer?**
Treatment may include surgery, chemotherapy, radiation therapy, immunotherapy, and targeted therapies. The treatment plan is personalized based on the type of cancer, its stage, and the patient’s overall health.

8. **Is it true that I can treat cancer with natural methods, or is baking soda effective?**
Unfortunately, there is no scientific evidence to support that natural methods or baking soda can cure cancer. Cancer treatment should be evidence-based and conducted under the supervision of an oncologist. Standard treatment options, such as chemotherapy, radiation therapy, and surgical interventions, are the most effective methods to combat cancer.

9. **What dietary restrictions exist for cancer patients?**
Nutrition plays a crucial role in supporting the health of cancer patients. It is recommended to avoid processed foods high in sugars and saturated fats. Consume plenty of fruits, vegetables, whole grains, and lean proteins. Hydration is also crucial. Discussing a personalized dietary plan with a nutritionist specialized in oncology can provide significant benefits.

10. **What are the side effects of treatment?**
Side effects depend on the type of treatment. They may include fatigue, nausea, weight loss, hair loss, and infections. It is essential to discuss what to expect and how to manage these effects with your doctor.

11. **I’ve heard that B vitamins, milk, and meat are contraindicated for cancer patients; is this correct?**
It is incorrect to state that B vitamins, milk, or meat are generally contraindicated for cancer patients. Nutrition should be personalized and tailored to each patient, considering overall health, type of cancer, and treatments being followed. It is essential to discuss this with a nutritionist specialized in oncology.

12. **What can I do to prevent cancer?**
Adopting a healthy lifestyle is crucial. This includes a balanced diet, regular physical exercise, avoiding smoking, and excessive alcohol consumption, as well as having regular medical check-ups.

If you have any additional questions, feel free to ask your oncologist. Your health is our priority!