Spot Stomach Cancer Early With This Device

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Researchers here have pioneered a special endoscope that they hope will help reduce the high mortality rate for stomach cancer.

The endoscope - a flexible, thin tube used to look inside the body - allows doctors to examine the stomach lining in microscopic detail for abnormal cells that sound the alarm on cancer.

'It allows us a clear view of every part of the stomach and increases the odds of finding something, rather than blindly taking a few random samples for biopsy that may miss the affected areas,' said Associate Professor Ho Khek Yu of the National University of Singapore's department of medicine, who led the work.

'We hope that, in a few years, this would become a common screening tool for patients.'

There are about 450 new cases of stomach cancer diagnosed here every year. Early diagnosis is critical because by the time most sufferers show symptoms such as pain, weight loss and vomiting, it is too late.

If the cancer is detected early, a simple minimally invasive operation called endoscopic mucosal resection, which uses another endoscope to cut out the fledgling tumours, can help 90 per cent of patients live a relatively healthy and long life.

But while new treatments and early diagnosis have improved the odds for sufferers of, say, breast and colorectal cancers, stomach cancer treatment has been lagging behind because of a lack of warning signs.

As a result, six out of 10 sufferers die of the disease, a statistic that has not changed for decades.

'That's why our strategy has to change. We should be screening potential patients rather than relying on symptoms.' said Prof Ho, who is also clinical director of the National University Hospital's endoscopy centre and a senior consultant at its department of medicine.

His group of four gastroenterologists, a surgeon, two pathologists and two research nurses has been testing the equipment on patients for the past year and found it to be very accurate. It is now planning to do a long-term study on the device's effectiveness.

To get a good look at the insides of the stomach, the device - called a confocal laser endoscope - has a microscope at its tip.

It magnifies cells 1,000 times so that any telltale changes in healthy stomach cells can be seen clearly. A tiny camera attached to it can take thousands of pictures as well.

While a handful of centres around the world have used the device to detect other cancers, its use in stomach cancer is rare. Stomach cancer is prevalent in Asia but little studied in medical strongholds like the United States. Singapore is helping to fill that research gap.

Prof Ho's team presented its endoscope at the world's top meeting for gastroenterologists - the Digestive Diseases Week in the US - earlier this month.

'Of course, the examination of biopsy tissue in the lab is still the gold standard and will be used in cases where the endoscopy detects something abnormal,' he said. 'Using this device for early screening is like using a scanner at airports. All are checked but only the suspicious ones get a thorough body search.'

Ten Local Patients to Try ut Target-specific Cancer Drug

Ten cancer patients here are the first in Asia to try out an experimental cancer drug that uses a genetic process and is more refined than conventional chemotherapy.

The drug, code-named CYC202, is an example of a new generation of drugs that targets specific diseased cells, and leaves healthy cells alone.

CYC202 was developed by British-based company Cyclacel, which was founded by noted British scientist David Lane, who currently heads the Institute of Molecular and Cell Biology (IMCB) here.

On the sidelines of a cancer symposium at the Biopolis yesterday. Sir David revealed this as an example of how anti-cancer drugs are becoming more refined.

'It is increasingly important that we minimise the damage from the treatment - which can be highly toxic and damaging. Some patients used to say they had two illnesses: cancer, and the treatment for cancer.' Conventional chemotherapy - essentially controlled amounts of highly toxic substances - works rather indiscriminately, attacking all cells, whether healthy or diseased.

The drugs start the killing process by damaging the DNA of cells, which tells the cells something is wrong. This starts the cascade of chemical signals that gets the cells to kill themselves.

Unfortunately, only about half the patients will respond to such treatment.

One reason is that the other half do not have what scientists call a 'normal' p53 gene and mechanism. Without a functioning p53 gene and the protein it manufactures, there cannot be this chemical cascade and the cells don't get the signal to die.

'It's akin to dropping a Hiroshima bomb, which would damage lots of cells' DNA, but there is no signal for the cells to die - which is supposed to be the point of the whole exercise,' explained Sir David.

CYC202 works differently. It interferes with another, very basic process: the rate at which DNA is copied into RNA.

RNA, the messenger, takes instructions from the DNA in the nucleus to the rest of the cell. CYC202 is not generally available to patients yet as it is still in the second phase of clinical tests, which tells researchers how safe and effective it is.

The Singapore trial is on nasal pharyngeal cancer patients at the National University Hospital. It is expected to give Cyclacel information about how the drug works on this cancer and how it reacts in an Asian population. It has been tested on lung and breast cancers in other countries.

Another breakthrough by the scientists: the possibility of buoying the p53 response. The logic is that if triggering p53 can suppress and kill cancer, then a way has to be found to keep the level of p53 proteins up.

But the body breaks down p53 proteins naturally, explained Sir David, who discovered p53 in 1979 and is the seventh most commonly cited scientist in the world.

'If we can block this, then we have hope of drugs that are more effective but less toxic.' The genetic revolution, he said, would be instrumental in the rational treatment of patients.

'When you have a complete understanding of the biology of the disease, even at the smallest molecular level, you can then match the drug to the patient, and make it work well.'

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