When can we sound the all-clear?
However, new avenues of research are opening up which may, one day, solve these difficult conundrums. This issue of Advances in Breast Cancer examines some of the new technologies which may, in the very near future, be used to detect microscopic disease and enable us to move into a new era of prognosis, therapy and follow-up.
Goyal et al. examine a new method for detection of tumour DNA within sentinel nodes removed at surgery which does not involve the pathologist! Using polymerase chain reaction technology they discuss a quick and apparently reliable method of real-time assay to detect sentinel axillary lymph node metastases intraoperatively by assessing the homogenate of the nodal tissue. The threshold value for the polymerase chain reaction assay can be set to detect micrometastases or macrometastases and it is commercially available and approved by the FDA and by the European Union. By enabling detection of metastases in lymph nodes in real time during the operation, patients can be spared a second operation, and the method may be applicable to other tumour types such as prostate cancer, melanoma and colorectal cancer.
Another area of great advance is in the detection of micrometastases in the bone marrow of breast cancer patients. Such research has, in fact, been going on for more than 50 years, but it was not until the more recent introduction of antibodies raised against proteins of epithelial origin, confirming the presence of cancer cells within the bone, that the technology has become practical. Rudman et al. discuss the evolution of this technique and the use of the more current methods for detecting circulating tumour cells in the blood of cancer patients. There is even the possibility of detecting the so-called 'cancer stem cell' in bone marrow aspirates or peripheral blood. This will be an active area of research over the next few years in large randomised trials as discussed by Jiao et al. in their article on circulating tumour cells as tumour markers.
In this fast-moving field and with improving technology, it is highly likely that in the future we will have accurate methods of measuring minimal residual disease in our patients, and this could be one of the greatest advances for 20 years, allowing us to reassure patients who have no disease, and treat better those who are not disease free.
Breast Unit, Velindre NHS Trust, Cardiff, UK
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|Publication:||Advances in Breast Cancer|
|Date:||Sep 1, 2008|
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