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How a space-age smoking scalpel could transform cancer treatment

Cancer Revolution: Science, Innovation and Hope is exhibiting at the Science Museum - Eleanor Bentall
Cancer Revolution: Science, Innovation and Hope is exhibiting at the Science Museum - Eleanor Bentall

The future of cancer treatment doesn’t always look like you think it will. Amid futuristic displays of virtual reality tumour modelling and nano-engineered prostate cancer tests at the Science Museum’s show, Cancer Revolution, one cabinet contains a distinctly low-tech looking sponge on a string.

This, the cytosponge, is swallowed in pill form, then expands before being pulled out, grabbing cells from the oesophagus as it goes. Remarkably a patient, Liz, describes the process as “not unpleasant”, which hardly sounds possible. She then says it is “quicker and easier than an endoscopy”.

The hi-tech process begins with the cells that are recovered by the sponge pill, which are dyed to flag up a protein that is only found in abnormal cells, with images scanned by artificial intelligence (AI) to pinpoint their presence.

As Liz points out, “the survival rate for oesophagal cancer isn’t good. The fact that it got picked up earlier when I could have simple surgery has meant that I am now clear of cancer, which is fantastic.”

Future cancer surgery itself could benefit from more obviously space-age advances, such as the iKnife, developed by scientists at Imperial College, London, which aims to help doctors excise the maximum possible cancer, and so prevent repeated surgeries. This it does by burning rather than cutting tissue, with the smoke instantly analysed to detect if it is from cancerous or healthy tissue.

And while the iKnife is still in the research phase, oncologists are already using 3D-printing to create precise replicas of complex tumours inside patients, allowing them to plot and plan ways of removing them well ahead of surgery. One patient to have benefitted from such a model is Leah Bennett, who was six when she was diagnosed with a tumour wrapped around her spine and entangled with major blood vessels. Several teams told her family it was too risky to operate. But armed with a 3D model, on display in the exhibition, a team at Alder Hey in Liverpool were able to excise 90 per cent of the tumour, and Leah was eventually able to return to school.

The 3D model that helped save Leah - Kasim Asim
The 3D model that helped save Leah - Kasim Asim

In future, however, the very presence of such giant tumours requiring near-miraculous surgery might come to be regarded as a failure. For the future frontline of our battle with this disease will increasingly be drawn not around those long familiar pillars of treatment – surgery, radiotherapy, chemotherapy (the exhibition even offers a reminder that chemo has its roots in mustard gas and the Great War) – but around prevention and, failing that, early diagnosis.

“Early diagnosis is key to improving outcomes,” says Prof Charles Swanton, the chief clinician at Cancer Research UK, which advised the curator of Cancer Revolution. “Shifting [detection] from Stage 4 cancer to Stage 1 or 2 is the most important step in offering patients a realistic chance of cure.”

Hence the trial currently under way within the NHS of the Galleri blood test, developed by American manufacturers Grail. It can detect 50 types of cancer from a single blood test and even helps to locate the cancer within the body. Some 140,000 people are being signed up for the trial and, if it proves as game-changing as it seems, it could be adopted by the NHS in two to three years. At a stroke, dozens of cancers could be added to the roster of those for which we already routinely screen. In just a few years, all of us over 50, say, may get used to such screening blood tests, with those shown to have cancer hopefully benefitting from the early detection they bring – and hence that “realistic chance of cure”.

Such screening can be even more effective if twinned with genome sequencing – scanning our DNA to see if we carry genes associated with a high risk of developing cancer. Mutations of the most infamous gene – known as the BRCA gene – are strongly linked with breast and ovarian cancer, for example, and the NHS is involved in a trial to see if newborn babies should routinely have their DNA sequenced to flag up future health risks. The idea, inevitably, comes not just with huge medical, but also huge ethical consequences.

“Targeted prevention is top of my list [of future cancer treatments],” says Swanton. “In other words, identifying high-risk individuals who don’t have cancer [through] sequencing markers in the genome, and then offering them strategies that might include a pill that might eradicate early pre-malignant cells in the body.”

While gene sequencing exists, such pills do not and are not for the near future – though Swanton says they could well be in a decade or two.

If such prevention does not work, he says, the best thing in future will be maximising chances of early detection with multiple cancer tests like Galleri, or similar urine-based diagnoses.

When it comes to battling tumours that are detected, the magic word is “immunotherapy”. These treatments are, in some ways, the opposite of chemotherapy, with its “poison the cancer before you poison the patient” approach. Instead immunotherapy uses the body’s own systems to tackle cancer.

It is a cutting-edge approach that, through a technique known as Car-T, has made its debut in the NHS, helping to cure otherwise untreatable leukaemia patients by taking their own T-cells, which play a key part in the body’s immune response, and genetically modifying them so that they hunt it down and kill it.

“It’s as if the T-cells have been anaesthetised by the tumour, and then they are woken up,” says Swanton.

The exhibition reveals the past, present and future of how cancer is prevented, detected and treated. - Eleanor Bentall
The exhibition reveals the past, present and future of how cancer is prevented, detected and treated. - Eleanor Bentall

Yet immunotherapy can go further. Car-T remains fantastically expensive, and is used only in blood cancers. However, it is being trialled on solid tumours, and Prof Swanton has done work with it in melanoma. “It’s exciting technology, personalised medicine taken to the limit,” he says. “I think of it as though each patient has their own mini pharma company inside their bodies [with T-cells] but they need help, need to be expanded against the patient’s specific cancer.”

The concept is almost dizzying. But back at the Science Museum, exhibits tell not just of future potential. There the technologies of tomorrow are surrounded by photos and stories which emphasise too the reality of today. Cancer is fundamentally a disease of ageing, of cellular processes that increasingly go wrong as we get older. And as society ages, cancer is increasingly a fate that we must all face.

Today, one in two of us will receive a cancer diagnosis at some point in our lives. Only half will live for 10 years afterwards. Such grim statistics are a constant reminder to temper the thrill of innovation with humility about its limitations.

“We’re trying to inspire and excite people,” says curator Katie Dabin, looking around the exhibits. “But we’re not trying to oversell the science. Cancer still kills a lot of people.”

Cancer Revolution: Science, Innovation and Hope is exhibiting at the Science Museum