- Early stage lung cancers are very small lesions and generally treated by surgical removal of the tumor
- These patients may however be shedding tumor cells into the bloodstream resulting in distant spread and relapse of cancer sooner than later
- Detection of such tumor cells in the blood may indicate an unfavorable outcome in persons with early stage lung cancer
Presence of tumor cell groups in the blood may be associated with a bad prognosis in early lung cancer according to a study conducted at the University of Michigan. This finding could be used to initiate additional treatments such as chemotherapy to control the spread of disease.
The study team was led by Sunitha Nagrath, University of Michigan (U-M) professor of chemical engineering (who designs devices capable of capturing tumor cells within the blood) and included cancer specialists and surgeons. The study titled "Poor prognosis indicated by venous circulating tumor cell (CTC) clusters in early stage lung cancers" will be published in Cancer Research in August 2017.
Looking For CTC Clusters In The Blood - The Findings Of The Study
The team collected blood samples before, during and following surgery to remove the tumor. At every stage, the surgeons sampled blood from a vein in the patient's arm, far from the tumor. During surgery, before disturbing the tumor, the surgeons withdrew blood from the lung vein that emerged from the tumor, where tumor cells would be expected to be highly concentrated.
The samples were analyzed by Vasudha Murlidhar, then a doctoral student in the Nagrath lab, using a microfluidic chip that she designed herself.
- Tumor cells from the arm vein showed a median count of around 1.3 per 3 ml, while the vein closer to the lung tumor showed 7.5 per 3 ml of blood.
- Clumps of two or more tumor cells indicated shorter duration of survival. Six of the nine patients who suffered a relapse of their cancer during the two to 26 months of follow-up showed tumor cell groups in their blood.
Circulating Tumor Cells (CTCs) In Blood - Key In Cancer Treatment And Prognosis
Although a person may be clinically diagnosed to have early stage lung cancer, there may be cancer cells in his bloodstream which might lead to tumor dissemination within the body and relapse of cancer in spite of removing the primary lung lesion.
"Even though you removed the tumor, you left behind these hundreds and hundreds of cells," Nagrath said. "If you know this patient walking out of the clinic is going to relapse after less than a year because of these cells, why don't we treat them now?"
Unique Features Of Circulating Tumor Cell Clusters
Tumor cell clusters have been found on genetic analysis to show an increased expression of genes encoding aggressive characteristics. They were able to travel better, dodge the immune system, and recruit immune cells to help them develop resistance to therapy. In short, tumor cell clusters were better adapted for cancer spread to distant sites.
"These are drivers of tumor progression and resistance, and they are more important to target with therapy," Nagrath said.
Scope Of Current Study
- Finding tumor clumps in the blood helps to identify patients who may benefit from additional treatments as well as targeted therapy utilizing the unique features of these cells.
"With a simple blood draw, we can tell the dynamic state of the disease during the treatment and after the treatment, monitoring it closely. If something has to show up on a CT scan, it may already be too late," Nagrath said.
In conclusion, the study shows that a simple blood test may be able to predict outcome in patients with early stage lung cancer, much before radiological findings become evident.
- Vasudha Murlidhar, Rishindra M Reddy, Shamileh Fouladdel, Lili Zhao, Martin K. Ishikawa, Svetlana Grabauskiene, Zhuo Zhang, Jules Lin, Andrew C. Chang, Philip W Carrott, William R Lynch, Mark B. Orringer, Chandan Kumar-Sinha, Nallasivam Palanisamy, David G. Beer, Max S. Wicha, Nithya Ramnath, Ebrahim Azizi, Sunitha Nagrath. Poor Prognosis Indicated by Venous Circulating Tumor Cell Clusters in Early Stage Lung Cancers. Cancer Research, 2017; canres.2072.2016 DOI: 10.1158/0008-5472.CAN-16-2072
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Dr. Lakshmi Venkataraman. (2017, September 01). Detection of Tumor Cells In Blood May Indicate Prognosis In Early Lung Cancer. Medindia. Retrieved on Aug 18, 2022 from https://www.medindia.net/news/healthinfocus/detection-of-tumor-cells-in-blood-may-indicate-prognosis-in-early-lung-cancer-172721-1.htm.
Dr. Lakshmi Venkataraman. "Detection of Tumor Cells In Blood May Indicate Prognosis In Early Lung Cancer". Medindia. Aug 18, 2022. <https://www.medindia.net/news/healthinfocus/detection-of-tumor-cells-in-blood-may-indicate-prognosis-in-early-lung-cancer-172721-1.htm>.
Dr. Lakshmi Venkataraman. "Detection of Tumor Cells In Blood May Indicate Prognosis In Early Lung Cancer". Medindia. https://www.medindia.net/news/healthinfocus/detection-of-tumor-cells-in-blood-may-indicate-prognosis-in-early-lung-cancer-172721-1.htm. (accessed Aug 18, 2022).
Dr. Lakshmi Venkataraman. 2021. Detection of Tumor Cells In Blood May Indicate Prognosis In Early Lung Cancer. Medindia, viewed Aug 18, 2022, https://www.medindia.net/news/healthinfocus/detection-of-tumor-cells-in-blood-may-indicate-prognosis-in-early-lung-cancer-172721-1.htm.